Reproductive Psychiatry
Reproductive psychiatry aims to diagnosis and treat psychiatric disorders that may be related to a woman's reproductive cycle, including the menstrual cycle, pregnancy (both pre- and post-), and menopause.
For most women, physical and emotional symptoms of PMS such as abdominal bloating, breast tenderness, irritability, depressed mood, and difficulty concentrating, are manageable aspects of the menstrual cycle. But in 3-8% of women, these symptoms are so severe that they impair ability to function. This syndrome is called Premenstrual Dysphoric Disorder (PMDD). Many women with PMDD respond successfully to medications that have traditionally been used for depression.
Pregnancy can be a period of emotional well-being, but for some women it can be just the opposite: studies show that depression is one of the most common complications of pregnancy. Women with pre-existing psychiatric disorders are at particular risk of relapsing during pregnancy. Family history of depression, poor social support, and unplanned or unwanted pregnancy are also risk factors for depression during pregnancy.
If you have already been treated for a psychiatric disorder or feel that you are at risk for developing one, a consultation with a psychiatrist who specializes in reproductive women's mental health can advise you about diagnosis and treatment both during and after your pregnancy. A psychiatrist can help you weigh the risk associated with treatment against the risk of untreated maternal psychiatric illness. For example, some medications are safer to use in pregnancy than others and a specialized psychiatrist can help review the data that are available. Psychotherapy may also be recommended.
The post-partum period (after pregnancy) is another time when women are vulnerable to depression and/or relapse of previous psychiatric illness. Although many women experience passing feelings of "baby blues" in the 3-14 days after giving birth, about 10 to 20 percent of women become clinically depressed during this period. A common symptom of post-partum depression is anxiety. Women may worry that they are not doing a good enough job in caring for the baby. These symptoms can worsen to the point of impairing a woman's ability to care for herself or the baby. A specially trained psychiatrist can help a woman manage these symptoms. In extreme cases, a woman may lose touch with reality, for example hearing voices or believing the baby would be better off dead. This is a psychiatric emergency and requires immediate treatment.
Breastfeeding while taking psychiatric medications is another area of specialty within reproductive psychiatry. A psychiatrist can review the data that are available regarding breastfeeding and psychotropic medication and help a woman make informed decisions regarding what is safest for her and her baby.
Finally, menopause marks another transition period within a woman's life. It is characterized by physical symptoms such as hot flashes, sleep disturbance, and vaginal changes. Some women also experience emotional symptoms. If these symptoms begin to impair a woman's life, a mental health specialist can provide diagnostic and treatment advice.
