As a reproductive psychiatrist, I am thrilled to see our community pay more attention to women’s mental health, and specifically postpartum depression. Articles like Devorah Melman’s Jewish Link spotlight on postpartum mood and anxiety disorders (“Ohav Emeth Hosts Learning Session on Infertility and Postpartum Depression,” September 19, 2024) go a long way in helping reduce the stigma of mental illness and empower women to advocate for their mental health needs.
Reproductive psychiatry, an emerging subspecialty of psychiatry, focuses on women’s mental health throughout a women’s lifespan, including monthly cycles, preconception planning, pregnancy and postpartum, and perimenopause. Changes in estrogen and progesterone levels associated with ovulation, pregnancy and postpartum, and perimenopause can induce brain chemistry changes that cause women to be more susceptible to mood and anxiety disorders.
There were two exciting research developments “hot off the press” that were published in September 2024. In an article published by Nature Neuroscience entitled “Neuroanatomical changes observed over the course of a human pregnancy,” researchers took serial MRIs of a woman’s brain pre-pregnancy, during pregnancy, and post-pregnancy. They noticed significant changes in the size of the brain over this period, which researchers believe helps the brain “specialize” for its role as a mother. Some of the changes even lasted for two years postpartum.
The drop of hormones after birth often leads to weepiness, irritability and mood swings that last for the first two weeks postpartum. Some women, however, experience more severe and longer lasting postpartum symptoms. Symptoms of low energy and motivation, decreased enjoyment, insomnia, and sometimes hopelessness and suicidality can be signs of postpartum depression. Women can also suffer from postpartum anxiety disorders, which may include symptoms such as excessive worries about the baby’s health, worries interfering with sleep and functioning, and overthinking and being unable to relax. There is a wide range of presentations, with some people continuing to complete their daily tasks but “not feeling like myself” and those who are unable to care for themselves or their babies because of the severity of their depression or anxiety. Either way, postpartum moms deserve to feel well, and if they are unsure of whether their postpartum symptoms meet criteria for a mood and anxiety disorder, they should consult with a physician.
Sometimes medications are necessary to help women through this phase. The concern for the babies’ well-being in utero can make women afraid to take medications while pregnant. Women sometimes feel like they are being forced to choose between themselves and their babies. However, we know that maternal and fetal well-being are intertwined. The risk to the baby from untreated or inadequately treated maternal psychiatric illness needs to be weighed against the data on medications’ safety.
The second “hot off the press” article from September 2024, entitled “Safety of psychotropic medications in pregnancy: an umbrella review,” provides reassuring data on the use of psychiatric medication in pregnancy. Weighing the low risk of negative outcomes from antidepressant medications against the known harms from psychiatric illness often favors use of medications in pregnancy. While this decision should be made in consultation with a psychiatrist, women need to know that psychiatric medications may be an important part of their treatment, in addition to psychotherapy, which is a must for those struggling from pregnancy-related symptoms. Mothers deserve to be well as they engage in growing and raising their families. Our community needs to support its mothers and lessen the stigma associated with pregnancy-related psychiatric care.
Sources:
Pritschet, L., Taylor, C.M., Cossio, D. et al. Neuroanatomical changes observed over the course of a human pregnancy. Nat Neurosci (2024). https://doi.org/10.1038/s41593-024-01741-0
Fabiano, N., Wong, S., Gupta, A. et al. Safety of psychotropic medications in pregnancy: an umbrella review. Mol Psychiatry (2024). https://doi.org/10.1038/s41380-024-02697-0
Dr. Esther Rollhaus is a reproductive psychiatrist in private practice in Riverdale, New York and via telepsychiatry to New York and New Jersey. Along with her associate Dr. Talia Weitz, she treats women in multiple life stages, including pregnancy and postpartum-related care.
For a consultation please contact: [email protected] or 347-380-5714 or check out the website childandfamilypsychiatry.com.
