August 15, 2025 • 24 mins
In this episode, Dr. Tracy Beth Hoeg discusses the implications of SSRIs during pregnancy, the role of serotonin in fetal development, and the importance of transparency in FDA communications. The conversation also touches on the hormone therapy debate, the issue of over-medication in society, and the need for a focus on root causes in treatment approaches. The Tudor Dixon Podcast is part of the Clay Travis & Buck Sexton Podcast Network. For more visit TudorDixonPodcast.com
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Tutor Dixon Podcast.
Speaker 2 (00:03):
I'm excited today we have a senior advisor for clinical
Sciences at the US Food and Drug Administration. We have
doctor Tracy Beth Hogue with us today. Doctor Hoague, thank
you so much for joining me.
Speaker 3 (00:16):
So great to be here, Tutor, thanks for having me
on the show.
Speaker 2 (00:19):
I feel like I cannot possibly have enough time with you,
because there's so much I want to talk about. But
I was looking at your Twitter feed and I was
watching some I guess it was a panel on SSRIs
and so for people who don't know what those are,
that's an antidepressant, Is that correct?
Speaker 3 (00:35):
That's correct.
Speaker 4 (00:36):
Yes, selective serotonin reuptake inhibitors and they're mainly uses antidepressants,
that's correct.
Speaker 2 (00:42):
So that conversation was about using them during pregnancy. And
I found it fascinating because I think we as the
public are constantly searching for why are we having some
of these changes in our kids?
Speaker 1 (00:55):
Why are we seeing higher rates of autism?
Speaker 2 (00:57):
Why are we seeing different rates of brain development and
development in children? And one of the doctors who was
on there was saying, like, if you think that this
isn't affecting the baby's brain, but it is affecting the
mom's brain, then you're not really.
Speaker 1 (01:11):
Looking at the research. And that was shocking to me.
Speaker 4 (01:14):
Yeah, exactly, And that was doctor Adam Murato who said that.
And he is one of the world's leading experts in
this topic, and he's also an obstetrician and sees patients
daily who are on SSRIs and is very familiar with
this topic.
Speaker 3 (01:28):
And it is.
Speaker 4 (01:30):
Really important for women to understand that that if these
medications are affecting the way we think and the way
our brain works, then they would also because they crossed
the placenta to the baby, they are also affecting the baby.
And we know that serotonin plays a critical role in
fetal development, and so if we're altering the serotonin system,
(01:54):
then we would expect to find alterations in the development
of the baby. And in fact, we do see this
because we know one of the SSRIs has a well
known safety signal, this is paxel SSRI, that it's listed
on the FDA label that it causes heart malformations. Beyond that,
(02:18):
we know that it can cause persistent pulmonary hypertension, which
is another condition in the newborn. It increases risk of
postpartum hemorrhage in the mother, and so we know that
these SSRIs have impacts on both the mom and the baby.
And just to get back to your question about autism
and neurodevelopmental disorders, I agree this is a huge and important.
Speaker 3 (02:43):
Topic right now.
Speaker 4 (02:44):
Why are rates of autism increasing? Is it just a
different threshold for diagnosis alone, or is something else going on?
And you know, I think it's important to systematically look
at this, and I certainly the point of the panel
was not to say, look, SSRIs are causing autism, but
to say, let's take a step back. So we know
(03:05):
the SSRI that serotonin plays this crucial role in the
development of the brain, and we know that over five
percent of women in the United States when they're pregnant
are on these medications, and what impact is it having.
And we have some observational studies that show adverse effects
on neurocognitive development and intellectual development. And so it's concerning
(03:30):
enough to take a step back and say, you know,
wait a minute, should we look more closely at this,
And also to inform women of child bearing age because
it may be you know, the development of the fetus
happens so early in pregnancy and SSRIs are medications that
are very hard to come off of, and so.
Speaker 1 (03:51):
This is real.
Speaker 2 (03:52):
He said you should think about it before because he
did say that in that panel, he said, if you're
thinking of getting pregnant, you need to think about take
getting off of SSRI before you get pregnant.
Speaker 1 (04:02):
That's why.
Speaker 4 (04:03):
Well, that's correct, and this is I mean, it's a
complex topic and discussion because obviously depression is an important problem,
but this is a conversation that should be had where
women are being fully informed about what we know about
the potential benefits but also the potential risks to their
developing baby. And so one of the reasons we wanted
(04:24):
to have this panel, and I was so excited that
doctor McCarey, you know, wanted to have this panel, is
to bring attention to this issue, which I don't think
has received enough attention. And so also that you know,
women who are of childbearing age, they don't wait until
they're pregnant to look into this. So it's something that
(04:44):
you know, our society really has a good understanding of.
So that women of childbearing ages just know to ask
their doctor and to have this conversation before they become pregnant.
Speaker 1 (04:55):
Well, let me tell you why.
Speaker 2 (04:55):
I felt like as I was watching that it was
so important right now because I think that that as
a community, as a country, we have come out of
this pandemic and we've started to go, gosh, do we
trust the CDC, do we trust the FDA?
Speaker 1 (05:09):
Do we believe what they're saying?
Speaker 2 (05:11):
And we've never had it seems like in my lifetime,
we've never had an FDA that's come out and said, hey,
even though these things are approved, maybe we need to
look deeper, maybe we need to talk to.
Speaker 1 (05:21):
The public about it.
Speaker 2 (05:22):
It was always like behind closed doors, like you know,
the Wizard of Oz.
Speaker 1 (05:25):
It was something we weren't allowed to know about.
Speaker 2 (05:28):
And to see doctor Jurato sit and talk about this
and to say.
Speaker 1 (05:32):
You know what, I'm gonna be honest with you.
Speaker 2 (05:34):
In rats, we've seen different behaviors and that, and even
on ultrasounds and human ultrasounds, we've seen different movements of
the baby and twelve studies.
Speaker 1 (05:43):
I mean, I thought it was amazing.
Speaker 2 (05:44):
He said, twelve studies show us that these SSRIs alter
the fetal brain. And he but here he was clear,
like we don't know that this is causing there's a cause,
and effect, but we do know that the that the
effect is autism, but we do know that there is
some effect, and that we've seen babies that have been
born jittery and babies that have been struggling to with
(06:06):
their pulmonary abilities and whatnot.
Speaker 1 (06:09):
But he said, I think that we need to.
Speaker 2 (06:12):
Be more upfront with informing the public, and to me,
just the panel was a huge step that we have
not seen.
Speaker 4 (06:21):
Yes, well, thank you so much for saying that. And
I have to say that's one of the reasons I
absolutely love working at the FDA right now because I
feel like things are changing because doctor McCarey has really
made it one of his top priorities to be transparent
and also, you know, to challenge the current dogma and
to ask questions that maybe have not been asked in
(06:42):
the past, and to hear from different voices and so
you know, we don't always want to just take for
granted something that we've been told for many years in
a row. We want to hear from, you know, researchers
on the cutting edge and people who really know the
most current data like doctor Erroto and like many of
the other are experts in the panel and say you
know what, what have we been what have we learned
(07:04):
recently in the best studies that we have now And
and you're right, I'm glad that you brought up the
jitteriness too, because that is also in the newborn because
that is also a well established side effect of these
medications that I've heard and read around even up to
eighty percent of babies that are born with moms that
are on SSRIs have this basically have a withdrawal.
Speaker 3 (07:27):
Syndrome when they're when they're born.
Speaker 4 (07:29):
So we absolutely know these medications are affecting the babies.
And you know, grateful that this information is now getting
out to the public.
Speaker 3 (07:38):
And I will tell you I have had.
Speaker 4 (07:40):
So much positive feedback from friends and colleagues and family
members just calling me to say thank you. I had
no idea that and and this is actually, like I said,
well established on the label of one of the ssri
I products. So you know, we're we're constantly discussing, so
how do we change things. What can we do better
(08:02):
at the FDA to inform the public about what we
do and don't know about, you know, the risks of
these products during pregnancy.
Speaker 2 (08:10):
Well, and it's a time when I mean my kids
are older now, my youngest two or twelve, but that
I mean, I clearly remember the time of being pregnant,
and it is a time where you are just consuming
as much information as you can because first of all,
you have no idea what you're about to embark on,
and you're like, what is this? You know, so you're
learning what your body is doing, and then you're learning
(08:31):
what the baby is going to be doing when.
Speaker 1 (08:33):
You have the baby.
Speaker 2 (08:34):
And I had never seen anything about outside of advil.
It was like, don't take advil while you're pregnant, take
tail and all. Now I think they're saying don't take
til at all. So I at the time that was
the only thing I had ever seen. And so I
was listening to this and I'm like, wow, that is
extremely powerful and such a great opportunity for because there
(08:56):
is such a massive consumption of consumption of information at
that time with parent.
Speaker 1 (09:01):
Magazines and parent websites, and.
Speaker 2 (09:03):
You have the you know, every week you get an
email this is what's happening in your body, and this
is what's happening in the baby's body. Wow, that's there
are so many resources to get this information to moms.
So I'm excited to see that it's starting to happen.
Speaker 3 (09:16):
Yeah. Absolutely, And I agree with you.
Speaker 4 (09:19):
And I mean, I think women are very much when
when they become pregnant, they really want to do everything
they can to have a healthy baby. And I remember
too when when I think we both have four children,
and I if I.
Speaker 3 (09:32):
Read correctly, yes, yes I do.
Speaker 4 (09:34):
We can relate all the two of minor step children.
But but I will say I could definitely relate to that.
You know that all women really want to do the
best with their pregnancy so that they have healthy children.
And you know, I remember reading all sorts of things
like you don't want to be exposed to too much heat,
you know, you want to watch your mercury intake, you
don't want to clean the litter box. And now it's
(09:55):
like we have all of these medications, our society is
so highly metic CAD and vaccine recommendations, the different medications
that women may be on for different purposes when they
become pregnant, and it's like we have a different standard.
We're not asking those same questions as we were about
like changing the litter box, and like, you know, should
(10:17):
I be out in the heat for a prolonged period
of time, and you know, how much.
Speaker 3 (10:21):
Coffee should I drink?
Speaker 4 (10:22):
And it's like, why do we have a different standard
for pharmaceutical products, Like we really should be looking into
the safety.
Speaker 3 (10:29):
Of these, you know, medications.
Speaker 4 (10:32):
And vaccines that women take during pregnancy, and so I
hope that we can move the needle on that issue
so women are better informed.
Speaker 2 (10:39):
So I think historically it has been that we have
anything medical, we have believed, Okay, this isn't a bubble,
that is not our expertise, and someone's telling us it's okay,
and therefore I won't research it anymore.
Speaker 1 (10:50):
And generally that's not the stuff out there.
Speaker 2 (10:52):
But you're right, it's like don't eat sushi and don't
eat this and take this supplement, and for some reason
we believe all of that. But now even more so,
you have a lot of influence on social media, and
some of that is good, in some of that is bad.
I mean, I remember being young and it was like,
do not ever eat an egg.
Speaker 1 (11:10):
An egg is going to.
Speaker 2 (11:10):
Give you high cholesterol to disaster, and then suddenly that
all change. And that's kind of so with that being said,
I feel like that's sort of been hormone therapy for
women too, if we go to menopausal women, so we
go from childbirth to menopausea and it's like my life
journey here if we do that. But you talk about
hormone therapy, and I think hormone therapy got a really
(11:32):
bad rap. But then I saw doctor McCarey saying, actually,
we're finding out that if you don't have it, you're
at a higher risk.
Speaker 1 (11:38):
Of heart disease.
Speaker 3 (11:40):
Right.
Speaker 4 (11:41):
So this is such an interesting contrast because it's like,
on the one hand, you want people to be informed
about the harms and potential harms of you know, medications
and in this case, you know, hormone replacement, but you
also don't want to inappropriately scare people. And so that's
where the hormone replacement therapy conversation UH fell into that category.
(12:03):
And and so actually doctor McCarey's book Blind Spots, which
if anyone hasn't read it is wonderful really I think
opened a lot of people's eyes to sort of the
dogma around hormone replacement therapy and how women have really
been misled about the risks about UH for for cancer,
(12:27):
for cardiovascular disease.
Speaker 3 (12:28):
And he goes through the evidence there.
Speaker 4 (12:30):
And then we also had this expert roundtable recently about
hormone replacement therapy where the experts really went through the
data and discussed that if you start hormone replacement therapy
within the first ten years of menopause, that really, you know,
what we're seeing in the studies is we're seeing benefits,
(12:50):
especially related to taking estrogen in terms of cardiovascular disease,
all cause mortality and and and and that the increase
in breast cancer that we saw it, you know, that
doesn't that doesn't pan out. If it didn't, it never
translated to increase in cancer mortality risk, and it we
(13:10):
don't see that when when women take estrogen alone or
if they started early in the first ten years after menopause.
And so I think you know, women had a lot
of questions answered about that. They were more reassured that
if you know you're experiencing symptoms of menopause, that you
know it may be a net benefit for youse an
(13:31):
individual to take the hormone replacement therapy. Some of the
data is showing benefits in terms of cardiovascular disease and
all and reducing all cause mortality and also bone health
and I was glad that we got into testosterone as well,
and I know it came up that we really need
some sort of a testosterone preparation for for for women too,
(13:54):
that that kind of was brought into the conversation with
hormone replacement therapy.
Speaker 1 (13:59):
What do you mean back because women are are low and.
Speaker 4 (14:02):
So yeah, so for women at the testosterone level also
decreases with age, and so that that wasn't covered in
depth during the panel, but I think that's something that
we there should be ongoing discussions about as well, and
also in terms of bone health and osteoporosis in women.
Speaker 2 (14:23):
Let's take a quick commercial break. We'll continue next on
a Tutor Dixon podcast. So I will say, I don't
know if I have different types of doctor's appointments because
I am a breast cancer survivor, and so every time
I go to my appointment, they're like, oh, there's nothing
we can do for you. You have I have hormone
(14:45):
receptive cancer, so or we can't do anything for you.
But I wonder like, is it going to be common
for women to have their hormones tested? I mean, is
that something Maybe it's already been done and they just
don't do that for for me, I don't know.
Speaker 1 (15:00):
I'm just curious about that.
Speaker 3 (15:03):
I mean, that's that's a good question.
Speaker 4 (15:05):
And you know, there are a lot of providers who
are now getting certified in hormone replacement therapy, and I
think that women should really, you know, try to seek
out physicians who have a specific certification in this specialty
so that they get the best advice and not always
settle for you know, there's nothing we can do because
(15:27):
I don't you know, I'm a practicing physician myself, and
I know I always try to avoid saying that. It's like,
you know, either I'm gonna try I would try to
find the information or I'm going to send you to
someone who I know can get you the information.
Speaker 3 (15:40):
So there is at least so we at least have.
Speaker 4 (15:41):
Things we can try and look into to help you,
you know, to help people with their symptoms.
Speaker 2 (15:47):
I mean that is interesting because I feel like maybe
I have fallen back into I told myself I would
never fall into the trap of taking the first bit
of information from a doctor if.
Speaker 1 (15:59):
It didn't sound like it was the best possible.
Speaker 2 (16:01):
Because when I did have cancer, I went to multiple
different places ultimately ended up at Johns Hopkins with actually
a friend of doctor McCarey, so it was and I had.
Speaker 1 (16:11):
A great experience there.
Speaker 2 (16:13):
I mean as great as you can have when you
have cancer, but you know, you want to have good healthcare, and.
Speaker 1 (16:18):
I had great doctors.
Speaker 2 (16:19):
But now you make such a great point because I'm thinking, gosh,
you know, I did go into just my general practitioner
and they were literally like, hey, there's nothing you can do.
Speaker 1 (16:30):
You can go on.
Speaker 2 (16:30):
An SRSRI, and I was like, that's that's not for me.
I'm not going to do that. So there's nothing I
could do. But I didn't look any further, and now
I'm like shaming myself.
Speaker 4 (16:41):
Well, you shouldn't shame yourself or feel guilty. But that's
so interesting because obviously that didn't get to the root
cause of the problem, which is also one of the
things we're really interested at the FDA is root causes
of health problems, and prescribing an SSRI for a problem
that's related to you know, hormones and that could be
addressed with hormone replacement therapy. It's really a shame that
(17:04):
we default to something that sort of masks the symptoms
rather than trying to solve the problem.
Speaker 1 (17:08):
Do you think that that happens too often? And how
can that be changed?
Speaker 2 (17:13):
Because I'm looking at again on your twitter feed, I
think I saw that one in five people is on
an SSRI in the country, and it seems like, gosh,
it's like such a massive push to get you on something,
and this is like, oh, this has nothing to do
with this is.
Speaker 1 (17:30):
The effects of like hot flashes.
Speaker 2 (17:32):
This will change that put that will put you on
an SSRI, And I'm like, I don't want to be
on a massive antidepressant for something that I'm like, I'll
just take a layer of clothing off, you know, Like
this is it seems crazy to think that it's immediately
pushed and in the past I would have just been like, oh, great,
a medication that will fix this, Yes, I want that.
And I think too often we think that there is
(17:54):
a quick fix and people are just going on a
massive amount of medication.
Speaker 1 (17:59):
Are we over dedicated as a country?
Speaker 4 (18:02):
Yeah, I mean absolutely. I mean I do think that
there are so many examples of medications, SSRIs being one
of them where it really.
Speaker 3 (18:09):
Isn't the fix to the problem.
Speaker 4 (18:12):
And I think, you know it, it may help with
symptoms but the issue is that, you know, we have
been told the medical profession and the public alike that
there's some sort of a serotonin deficiency or some sort.
Speaker 3 (18:26):
Of imbalance in the brain.
Speaker 4 (18:28):
That means the SSRIs are what's going to solve the problem.
But one of the expert panelists and now it's actually
she knows very much about this, has published a lot
about this, doctor Moncrief, But and it's really been exposed
over time that that's not the case, that there's not
actually a serotonin chemical and balance in the brain. And
really what the medications SSRIs are doing is sort of
(18:51):
you know, dulling you know, the way you feel and
masking the symptoms but not getting to the root caused
the problem, which as you pointed out, it may be
the you're going through menopause and hormones are changing and
maybe you know any number of things, like there are
many different causes of depression and really getting you know,
going back full circle, it's it's really important to have
(19:13):
that conversation and and and get to the cause, the
cause of the depression and try and treat that rather
than rather than masking it with the medication. But but yes,
I absolutely think that we as a society are over medicated.
And as someone I used to practice medicine in Denmark
and I'm a dual citizen Danish American, and it's it's
(19:34):
a very different approach to medicine there, which has given
me an interesting perspective because they do not default to
medications to solve problems like we do in the United States.
Speaker 3 (19:44):
And I don't know if that's you know.
Speaker 4 (19:47):
The result of sort of the pressure of the pharmaceutical
industry direct you direct to consumer advertising. But there's something
very different in our society that we we tend to
look to medical solution in surgeries, drugs, you know, first,
rather than you know, finding out how can I solve
this through what I do, the way I live and
(20:08):
alternative sorts of treatments.
Speaker 2 (20:10):
You know, I've I have had many people in my
life and I don't know if this is something that
is like Michigan based or what, but in the medical
system here, for you to go to a therapist, the
therapist almost so a psychologist they almost always say well
you need to be prescribed something, and then you have
(20:31):
to go to the psychiatrists. And so you have it's
like a schedule. You go to the psychiatrist once a
month you have, but then you have to have the
two appointments with the psychologist for the psychiatrists to prescribe.
It's like this, that's how the system works. So you
have to pay for three appointments every month because you
have to see both of these people.
Speaker 1 (20:52):
And then you have the prescription.
Speaker 2 (20:54):
And it almost seems like there's it's like when you heard, oh,
dentists have a a number a quota they have to
get for cavities, Like do you have a quota of
patients you have to have that are on a medication.
Speaker 1 (21:08):
But I really do think.
Speaker 2 (21:09):
There's such a push for medication, And I think what
you said is interesting because I think probably most of
the people that are listening who have had a loved
one who has gone on one of these medications, has
seen that where they may see that there is less depression,
there is less feeling overall, and that can be really
hard for the person around that, the people around them.
Speaker 3 (21:30):
Yeah.
Speaker 4 (21:31):
Absolutely, and so I do think that it's also just
you know, in the United States, it's there's a very
limited amount of time that doctors have with patients, Like
the visits are also very quick, and prescribing a medication
is really sometimes the easiest thing to do rather than saying, okay,
(21:53):
so let's go through this, what's going on, Let's go
through all the medications you're taking. Let's go through like
your overall health and how things are going at home,
what do you enjoy doing? You know, these sort of
background questions that can give insight into you know, what,
what might be the cause of the depression, Like you know,
it may even be another medication that they're on, and
(22:13):
so you know, it's I think, you know, if there's
one I would I would really love to see a
shift in our society to focusing you know, you know,
more on the root causes of the problems and less
on seeing medications as a quick fix.
Speaker 3 (22:30):
And and and.
Speaker 4 (22:32):
I think that this current FDA, you know that that's
something that we're prioritizing, which I which is really cool
because it's different than in the past, but also really
focusing on, you know, how to get effective cures quickly
to patients with serious diseases, especially where there's unmet needs.
So it's like, you know, there has to be a
(22:54):
balance of the two things. But over medicating and not
getting to the root cause of problems of common problems
is certainly not the answer that we're looking for.
Speaker 2 (23:04):
This has been honestly, I've so enjoyed talking to you,
and I think this is the beauty of what we
see with the Maha movement and with this administration in general,
I think there's a lot more freedom to have these discussions.
I know a lot of people we've had some experts
on who have even said they want to do some
studies on how these medications are affecting teens and if
(23:26):
they have been involved in any of these mass shootings
where teens suddenly, for some reason, something trips in their
brain and they decide that they're going to go in
and shoot up a school, And is there a way
to research that? And I think that so many of
us feel like we've been screaming into a vacuum for
so long that there's nobody just a black hole, and
(23:48):
it is a breath of fresh air to have you
all in there and focused on this. Thank you for
coming on and talking to us, Thank you for being
willing to share this with the public here. And I
think these are the omens where we continue to engage
with the public and educate and say I like you
reminded me you don't always have to take that first
(24:08):
bit of advice from a medical professional. You can you
are in the United States of America. You can go
ask someone else, that's right.
Speaker 3 (24:17):
Thank you so much for having me on.
Speaker 4 (24:19):
I really enjoyed this discussion as well, so thank you
for asking these very excellent questions.
Speaker 2 (24:26):
Well, you know, it's interesting when you're going through some
of these things on your own, you know, and you're like,
if I'm doing it, most people other people are dealing
with this and they need to hear so Doctor Tracy
Beth Hogue, thank you so much for being here.
Speaker 1 (24:40):
Thank you Tutor absolutely, and.
Speaker 2 (24:42):
Thank you all for joining us on the Tutor Dixon podcast.
Speaker 1 (24:45):
For this episode and others.
Speaker 2 (24:46):
You can go to the iHeartRadio app, Apple Podcasts, or
wherever you get your podcasts, or watch it on Rumble
or YouTube at Tutor Dixon.
Speaker 1 (24:54):
Thank you so much and have a blessed day.
Welcome to the Tutor Dixon Podcast.
Speaker 2 (00:03):
I'm excited today we have a senior advisor for clinical
Sciences at the US Food and Drug Administration. We have
doctor Tracy Beth Hogue with us today. Doctor Hoague, thank
you so much for joining me.
Speaker 3 (00:16):
So great to be here, Tutor, thanks for having me
on the show.
Speaker 2 (00:19):
I feel like I cannot possibly have enough time with you,
because there's so much I want to talk about. But
I was looking at your Twitter feed and I was
watching some I guess it was a panel on SSRIs
and so for people who don't know what those are,
that's an antidepressant, Is that correct?
Speaker 3 (00:35):
That's correct.
Speaker 4 (00:36):
Yes, selective serotonin reuptake inhibitors and they're mainly uses antidepressants,
that's correct.
Speaker 2 (00:42):
So that conversation was about using them during pregnancy. And
I found it fascinating because I think we as the
public are constantly searching for why are we having some
of these changes in our kids?
Speaker 1 (00:55):
Why are we seeing higher rates of autism?
Speaker 2 (00:57):
Why are we seeing different rates of brain development and
development in children? And one of the doctors who was
on there was saying, like, if you think that this
isn't affecting the baby's brain, but it is affecting the
mom's brain, then you're not really.
Speaker 1 (01:11):
Looking at the research. And that was shocking to me.
Speaker 4 (01:14):
Yeah, exactly, And that was doctor Adam Murato who said that.
And he is one of the world's leading experts in
this topic, and he's also an obstetrician and sees patients
daily who are on SSRIs and is very familiar with
this topic.
Speaker 3 (01:28):
And it is.
Speaker 4 (01:30):
Really important for women to understand that that if these
medications are affecting the way we think and the way
our brain works, then they would also because they crossed
the placenta to the baby, they are also affecting the baby.
And we know that serotonin plays a critical role in
fetal development, and so if we're altering the serotonin system,
(01:54):
then we would expect to find alterations in the development
of the baby. And in fact, we do see this
because we know one of the SSRIs has a well
known safety signal, this is paxel SSRI, that it's listed
on the FDA label that it causes heart malformations. Beyond that,
(02:18):
we know that it can cause persistent pulmonary hypertension, which
is another condition in the newborn. It increases risk of
postpartum hemorrhage in the mother, and so we know that
these SSRIs have impacts on both the mom and the baby.
And just to get back to your question about autism
and neurodevelopmental disorders, I agree this is a huge and important.
Speaker 3 (02:43):
Topic right now.
Speaker 4 (02:44):
Why are rates of autism increasing? Is it just a
different threshold for diagnosis alone, or is something else going on?
And you know, I think it's important to systematically look
at this, and I certainly the point of the panel
was not to say, look, SSRIs are causing autism, but
to say, let's take a step back. So we know
(03:05):
the SSRI that serotonin plays this crucial role in the
development of the brain, and we know that over five
percent of women in the United States when they're pregnant
are on these medications, and what impact is it having.
And we have some observational studies that show adverse effects
on neurocognitive development and intellectual development. And so it's concerning
(03:30):
enough to take a step back and say, you know,
wait a minute, should we look more closely at this,
And also to inform women of child bearing age because
it may be you know, the development of the fetus
happens so early in pregnancy and SSRIs are medications that
are very hard to come off of, and so.
Speaker 1 (03:51):
This is real.
Speaker 2 (03:52):
He said you should think about it before because he
did say that in that panel, he said, if you're
thinking of getting pregnant, you need to think about take
getting off of SSRI before you get pregnant.
Speaker 1 (04:02):
That's why.
Speaker 4 (04:03):
Well, that's correct, and this is I mean, it's a
complex topic and discussion because obviously depression is an important problem,
but this is a conversation that should be had where
women are being fully informed about what we know about
the potential benefits but also the potential risks to their
developing baby. And so one of the reasons we wanted
(04:24):
to have this panel, and I was so excited that
doctor McCarey, you know, wanted to have this panel, is
to bring attention to this issue, which I don't think
has received enough attention. And so also that you know,
women who are of childbearing age, they don't wait until
they're pregnant to look into this. So it's something that
(04:44):
you know, our society really has a good understanding of.
So that women of childbearing ages just know to ask
their doctor and to have this conversation before they become pregnant.
Speaker 1 (04:55):
Well, let me tell you why.
Speaker 2 (04:55):
I felt like as I was watching that it was
so important right now because I think that that as
a community, as a country, we have come out of
this pandemic and we've started to go, gosh, do we
trust the CDC, do we trust the FDA?
Speaker 1 (05:09):
Do we believe what they're saying?
Speaker 2 (05:11):
And we've never had it seems like in my lifetime,
we've never had an FDA that's come out and said, hey,
even though these things are approved, maybe we need to
look deeper, maybe we need to talk to.
Speaker 1 (05:21):
The public about it.
Speaker 2 (05:22):
It was always like behind closed doors, like you know,
the Wizard of Oz.
Speaker 1 (05:25):
It was something we weren't allowed to know about.
Speaker 2 (05:28):
And to see doctor Jurato sit and talk about this
and to say.
Speaker 1 (05:32):
You know what, I'm gonna be honest with you.
Speaker 2 (05:34):
In rats, we've seen different behaviors and that, and even
on ultrasounds and human ultrasounds, we've seen different movements of
the baby and twelve studies.
Speaker 1 (05:43):
I mean, I thought it was amazing.
Speaker 2 (05:44):
He said, twelve studies show us that these SSRIs alter
the fetal brain. And he but here he was clear,
like we don't know that this is causing there's a cause,
and effect, but we do know that the that the
effect is autism, but we do know that there is
some effect, and that we've seen babies that have been
born jittery and babies that have been struggling to with
(06:06):
their pulmonary abilities and whatnot.
Speaker 1 (06:09):
But he said, I think that we need to.
Speaker 2 (06:12):
Be more upfront with informing the public, and to me,
just the panel was a huge step that we have
not seen.
Speaker 4 (06:21):
Yes, well, thank you so much for saying that. And
I have to say that's one of the reasons I
absolutely love working at the FDA right now because I
feel like things are changing because doctor McCarey has really
made it one of his top priorities to be transparent
and also, you know, to challenge the current dogma and
to ask questions that maybe have not been asked in
(06:42):
the past, and to hear from different voices and so
you know, we don't always want to just take for
granted something that we've been told for many years in
a row. We want to hear from, you know, researchers
on the cutting edge and people who really know the
most current data like doctor Erroto and like many of
the other are experts in the panel and say you
know what, what have we been what have we learned
(07:04):
recently in the best studies that we have now And
and you're right, I'm glad that you brought up the
jitteriness too, because that is also in the newborn because
that is also a well established side effect of these
medications that I've heard and read around even up to
eighty percent of babies that are born with moms that
are on SSRIs have this basically have a withdrawal.
Speaker 3 (07:27):
Syndrome when they're when they're born.
Speaker 4 (07:29):
So we absolutely know these medications are affecting the babies.
And you know, grateful that this information is now getting
out to the public.
Speaker 3 (07:38):
And I will tell you I have had.
Speaker 4 (07:40):
So much positive feedback from friends and colleagues and family
members just calling me to say thank you. I had
no idea that and and this is actually, like I said,
well established on the label of one of the ssri
I products. So you know, we're we're constantly discussing, so
how do we change things. What can we do better
(08:02):
at the FDA to inform the public about what we
do and don't know about, you know, the risks of
these products during pregnancy.
Speaker 2 (08:10):
Well, and it's a time when I mean my kids
are older now, my youngest two or twelve, but that
I mean, I clearly remember the time of being pregnant,
and it is a time where you are just consuming
as much information as you can because first of all,
you have no idea what you're about to embark on,
and you're like, what is this? You know, so you're
learning what your body is doing, and then you're learning
(08:31):
what the baby is going to be doing when.
Speaker 1 (08:33):
You have the baby.
Speaker 2 (08:34):
And I had never seen anything about outside of advil.
It was like, don't take advil while you're pregnant, take
tail and all. Now I think they're saying don't take
til at all. So I at the time that was
the only thing I had ever seen. And so I
was listening to this and I'm like, wow, that is
extremely powerful and such a great opportunity for because there
(08:56):
is such a massive consumption of consumption of information at
that time with parent.
Speaker 1 (09:01):
Magazines and parent websites, and.
Speaker 2 (09:03):
You have the you know, every week you get an
email this is what's happening in your body, and this
is what's happening in the baby's body. Wow, that's there
are so many resources to get this information to moms.
So I'm excited to see that it's starting to happen.
Speaker 3 (09:16):
Yeah. Absolutely, And I agree with you.
Speaker 4 (09:19):
And I mean, I think women are very much when
when they become pregnant, they really want to do everything
they can to have a healthy baby. And I remember
too when when I think we both have four children,
and I if I.
Speaker 3 (09:32):
Read correctly, yes, yes I do.
Speaker 4 (09:34):
We can relate all the two of minor step children.
But but I will say I could definitely relate to that.
You know that all women really want to do the
best with their pregnancy so that they have healthy children.
And you know, I remember reading all sorts of things
like you don't want to be exposed to too much heat,
you know, you want to watch your mercury intake, you
don't want to clean the litter box. And now it's
(09:55):
like we have all of these medications, our society is
so highly metic CAD and vaccine recommendations, the different medications
that women may be on for different purposes when they
become pregnant, and it's like we have a different standard.
We're not asking those same questions as we were about
like changing the litter box, and like, you know, should
(10:17):
I be out in the heat for a prolonged period
of time, and you know, how much.
Speaker 3 (10:21):
Coffee should I drink?
Speaker 4 (10:22):
And it's like, why do we have a different standard
for pharmaceutical products, Like we really should be looking into
the safety.
Speaker 3 (10:29):
Of these, you know, medications.
Speaker 4 (10:32):
And vaccines that women take during pregnancy, and so I
hope that we can move the needle on that issue
so women are better informed.
Speaker 2 (10:39):
So I think historically it has been that we have
anything medical, we have believed, Okay, this isn't a bubble,
that is not our expertise, and someone's telling us it's okay,
and therefore I won't research it anymore.
Speaker 1 (10:50):
And generally that's not the stuff out there.
Speaker 2 (10:52):
But you're right, it's like don't eat sushi and don't
eat this and take this supplement, and for some reason
we believe all of that. But now even more so,
you have a lot of influence on social media, and
some of that is good, in some of that is bad.
I mean, I remember being young and it was like,
do not ever eat an egg.
Speaker 1 (11:10):
An egg is going to.
Speaker 2 (11:10):
Give you high cholesterol to disaster, and then suddenly that
all change. And that's kind of so with that being said,
I feel like that's sort of been hormone therapy for
women too, if we go to menopausal women, so we
go from childbirth to menopausea and it's like my life
journey here if we do that. But you talk about
hormone therapy, and I think hormone therapy got a really
(11:32):
bad rap. But then I saw doctor McCarey saying, actually,
we're finding out that if you don't have it, you're
at a higher risk.
Speaker 1 (11:38):
Of heart disease.
Speaker 3 (11:40):
Right.
Speaker 4 (11:41):
So this is such an interesting contrast because it's like,
on the one hand, you want people to be informed
about the harms and potential harms of you know, medications
and in this case, you know, hormone replacement, but you
also don't want to inappropriately scare people. And so that's
where the hormone replacement therapy conversation UH fell into that category.
(12:03):
And and so actually doctor McCarey's book Blind Spots, which
if anyone hasn't read it is wonderful really I think
opened a lot of people's eyes to sort of the
dogma around hormone replacement therapy and how women have really
been misled about the risks about UH for for cancer,
(12:27):
for cardiovascular disease.
Speaker 3 (12:28):
And he goes through the evidence there.
Speaker 4 (12:30):
And then we also had this expert roundtable recently about
hormone replacement therapy where the experts really went through the
data and discussed that if you start hormone replacement therapy
within the first ten years of menopause, that really, you know,
what we're seeing in the studies is we're seeing benefits,
(12:50):
especially related to taking estrogen in terms of cardiovascular disease,
all cause mortality and and and and that the increase
in breast cancer that we saw it, you know, that
doesn't that doesn't pan out. If it didn't, it never
translated to increase in cancer mortality risk, and it we
(13:10):
don't see that when when women take estrogen alone or
if they started early in the first ten years after menopause.
And so I think you know, women had a lot
of questions answered about that. They were more reassured that
if you know you're experiencing symptoms of menopause, that you
know it may be a net benefit for youse an
(13:31):
individual to take the hormone replacement therapy. Some of the
data is showing benefits in terms of cardiovascular disease and
all and reducing all cause mortality and also bone health
and I was glad that we got into testosterone as well,
and I know it came up that we really need
some sort of a testosterone preparation for for for women too,
(13:54):
that that kind of was brought into the conversation with
hormone replacement therapy.
Speaker 1 (13:59):
What do you mean back because women are are low and.
Speaker 4 (14:02):
So yeah, so for women at the testosterone level also
decreases with age, and so that that wasn't covered in
depth during the panel, but I think that's something that
we there should be ongoing discussions about as well, and
also in terms of bone health and osteoporosis in women.
Speaker 2 (14:23):
Let's take a quick commercial break. We'll continue next on
a Tutor Dixon podcast. So I will say, I don't
know if I have different types of doctor's appointments because
I am a breast cancer survivor, and so every time
I go to my appointment, they're like, oh, there's nothing
we can do for you. You have I have hormone
(14:45):
receptive cancer, so or we can't do anything for you.
But I wonder like, is it going to be common
for women to have their hormones tested? I mean, is
that something Maybe it's already been done and they just
don't do that for for me, I don't know.
Speaker 1 (15:00):
I'm just curious about that.
Speaker 3 (15:03):
I mean, that's that's a good question.
Speaker 4 (15:05):
And you know, there are a lot of providers who
are now getting certified in hormone replacement therapy, and I
think that women should really, you know, try to seek
out physicians who have a specific certification in this specialty
so that they get the best advice and not always
settle for you know, there's nothing we can do because
(15:27):
I don't you know, I'm a practicing physician myself, and
I know I always try to avoid saying that. It's like,
you know, either I'm gonna try I would try to
find the information or I'm going to send you to
someone who I know can get you the information.
Speaker 3 (15:40):
So there is at least so we at least have.
Speaker 4 (15:41):
Things we can try and look into to help you,
you know, to help people with their symptoms.
Speaker 2 (15:47):
I mean that is interesting because I feel like maybe
I have fallen back into I told myself I would
never fall into the trap of taking the first bit
of information from a doctor if.
Speaker 1 (15:59):
It didn't sound like it was the best possible.
Speaker 2 (16:01):
Because when I did have cancer, I went to multiple
different places ultimately ended up at Johns Hopkins with actually
a friend of doctor McCarey, so it was and I had.
Speaker 1 (16:11):
A great experience there.
Speaker 2 (16:13):
I mean as great as you can have when you
have cancer, but you know, you want to have good healthcare, and.
Speaker 1 (16:18):
I had great doctors.
Speaker 2 (16:19):
But now you make such a great point because I'm thinking, gosh,
you know, I did go into just my general practitioner
and they were literally like, hey, there's nothing you can do.
Speaker 1 (16:30):
You can go on.
Speaker 2 (16:30):
An SRSRI, and I was like, that's that's not for me.
I'm not going to do that. So there's nothing I
could do. But I didn't look any further, and now
I'm like shaming myself.
Speaker 4 (16:41):
Well, you shouldn't shame yourself or feel guilty. But that's
so interesting because obviously that didn't get to the root
cause of the problem, which is also one of the
things we're really interested at the FDA is root causes
of health problems, and prescribing an SSRI for a problem
that's related to you know, hormones and that could be
addressed with hormone replacement therapy. It's really a shame that
(17:04):
we default to something that sort of masks the symptoms
rather than trying to solve the problem.
Speaker 1 (17:08):
Do you think that that happens too often? And how
can that be changed?
Speaker 2 (17:13):
Because I'm looking at again on your twitter feed, I
think I saw that one in five people is on
an SSRI in the country, and it seems like, gosh,
it's like such a massive push to get you on something,
and this is like, oh, this has nothing to do
with this is.
Speaker 1 (17:30):
The effects of like hot flashes.
Speaker 2 (17:32):
This will change that put that will put you on
an SSRI, And I'm like, I don't want to be
on a massive antidepressant for something that I'm like, I'll
just take a layer of clothing off, you know, Like
this is it seems crazy to think that it's immediately
pushed and in the past I would have just been like, oh, great,
a medication that will fix this, Yes, I want that.
And I think too often we think that there is
(17:54):
a quick fix and people are just going on a
massive amount of medication.
Speaker 1 (17:59):
Are we over dedicated as a country?
Speaker 4 (18:02):
Yeah, I mean absolutely. I mean I do think that
there are so many examples of medications, SSRIs being one
of them where it really.
Speaker 3 (18:09):
Isn't the fix to the problem.
Speaker 4 (18:12):
And I think, you know it, it may help with
symptoms but the issue is that, you know, we have
been told the medical profession and the public alike that
there's some sort of a serotonin deficiency or some sort.
Speaker 3 (18:26):
Of imbalance in the brain.
Speaker 4 (18:28):
That means the SSRIs are what's going to solve the problem.
But one of the expert panelists and now it's actually
she knows very much about this, has published a lot
about this, doctor Moncrief, But and it's really been exposed
over time that that's not the case, that there's not
actually a serotonin chemical and balance in the brain. And
really what the medications SSRIs are doing is sort of
(18:51):
you know, dulling you know, the way you feel and
masking the symptoms but not getting to the root caused
the problem, which as you pointed out, it may be
the you're going through menopause and hormones are changing and
maybe you know any number of things, like there are
many different causes of depression and really getting you know,
going back full circle, it's it's really important to have
(19:13):
that conversation and and and get to the cause, the
cause of the depression and try and treat that rather
than rather than masking it with the medication. But but yes,
I absolutely think that we as a society are over medicated.
And as someone I used to practice medicine in Denmark
and I'm a dual citizen Danish American, and it's it's
(19:34):
a very different approach to medicine there, which has given
me an interesting perspective because they do not default to
medications to solve problems like we do in the United States.
Speaker 3 (19:44):
And I don't know if that's you know.
Speaker 4 (19:47):
The result of sort of the pressure of the pharmaceutical
industry direct you direct to consumer advertising. But there's something
very different in our society that we we tend to
look to medical solution in surgeries, drugs, you know, first,
rather than you know, finding out how can I solve
this through what I do, the way I live and
(20:08):
alternative sorts of treatments.
Speaker 2 (20:10):
You know, I've I have had many people in my
life and I don't know if this is something that
is like Michigan based or what, but in the medical
system here, for you to go to a therapist, the
therapist almost so a psychologist they almost always say well
you need to be prescribed something, and then you have
(20:31):
to go to the psychiatrists. And so you have it's
like a schedule. You go to the psychiatrist once a
month you have, but then you have to have the
two appointments with the psychologist for the psychiatrists to prescribe.
It's like this, that's how the system works. So you
have to pay for three appointments every month because you
have to see both of these people.
Speaker 1 (20:52):
And then you have the prescription.
Speaker 2 (20:54):
And it almost seems like there's it's like when you heard, oh,
dentists have a a number a quota they have to
get for cavities, Like do you have a quota of
patients you have to have that are on a medication.
Speaker 1 (21:08):
But I really do think.
Speaker 2 (21:09):
There's such a push for medication, And I think what
you said is interesting because I think probably most of
the people that are listening who have had a loved
one who has gone on one of these medications, has
seen that where they may see that there is less depression,
there is less feeling overall, and that can be really
hard for the person around that, the people around them.
Speaker 3 (21:30):
Yeah.
Speaker 4 (21:31):
Absolutely, and so I do think that it's also just
you know, in the United States, it's there's a very
limited amount of time that doctors have with patients, Like
the visits are also very quick, and prescribing a medication
is really sometimes the easiest thing to do rather than saying, okay,
(21:53):
so let's go through this, what's going on, Let's go
through all the medications you're taking. Let's go through like
your overall health and how things are going at home,
what do you enjoy doing? You know, these sort of
background questions that can give insight into you know, what,
what might be the cause of the depression, Like you know,
it may even be another medication that they're on, and
(22:13):
so you know, it's I think, you know, if there's
one I would I would really love to see a
shift in our society to focusing you know, you know,
more on the root causes of the problems and less
on seeing medications as a quick fix.
Speaker 3 (22:30):
And and and.
Speaker 4 (22:32):
I think that this current FDA, you know that that's
something that we're prioritizing, which I which is really cool
because it's different than in the past, but also really
focusing on, you know, how to get effective cures quickly
to patients with serious diseases, especially where there's unmet needs.
So it's like, you know, there has to be a
(22:54):
balance of the two things. But over medicating and not
getting to the root cause of problems of common problems
is certainly not the answer that we're looking for.
Speaker 2 (23:04):
This has been honestly, I've so enjoyed talking to you,
and I think this is the beauty of what we
see with the Maha movement and with this administration in general,
I think there's a lot more freedom to have these discussions.
I know a lot of people we've had some experts
on who have even said they want to do some
studies on how these medications are affecting teens and if
(23:26):
they have been involved in any of these mass shootings
where teens suddenly, for some reason, something trips in their
brain and they decide that they're going to go in
and shoot up a school, And is there a way
to research that? And I think that so many of
us feel like we've been screaming into a vacuum for
so long that there's nobody just a black hole, and
(23:48):
it is a breath of fresh air to have you
all in there and focused on this. Thank you for
coming on and talking to us, Thank you for being
willing to share this with the public here. And I
think these are the omens where we continue to engage
with the public and educate and say I like you
reminded me you don't always have to take that first
(24:08):
bit of advice from a medical professional. You can you
are in the United States of America. You can go
ask someone else, that's right.
Speaker 3 (24:17):
Thank you so much for having me on.
Speaker 4 (24:19):
I really enjoyed this discussion as well, so thank you
for asking these very excellent questions.
Speaker 2 (24:26):
Well, you know, it's interesting when you're going through some
of these things on your own, you know, and you're like,
if I'm doing it, most people other people are dealing
with this and they need to hear so Doctor Tracy
Beth Hogue, thank you so much for being here.
Speaker 1 (24:40):
Thank you Tutor absolutely, and.
Speaker 2 (24:42):
Thank you all for joining us on the Tutor Dixon podcast.
Speaker 1 (24:45):
For this episode and others.
Speaker 2 (24:46):
You can go to the iHeartRadio app, Apple Podcasts, or
wherever you get your podcasts, or watch it on Rumble
or YouTube at Tutor Dixon.
Speaker 1 (24:54):
Thank you so much and have a blessed day.
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