Research has shown that a portion of women has a higher risk to develop onset or worsening of psychiatric disorders at times of reproductive events linked to physiological gonadal hormonal fluctuation and unique psychosocial adjustments.
The team offers consultations or longitudinal care to women struggling with the following conditions:
Psychiatric disorders during pregnancy and postpartum (one year after birth)
Depressive disorder in the postpartum is considered the most frequent complication of childbirth affecting about 1 in 7 women and in at least 50% of the cases starts during pregnancy. More than 10% of women experience symptoms of anxiety during pregnancy. Maternal psychiatric disorders – as of today often untreated - may be associated with heightened rates of poor obstetrical, neonatal, and child development outcomes.
Postpartum women are welcomed to attend the visits with their children (birth -1 year of age). Having infants accompanying their mothers not only eliminates a significant barrier to treatment engagement but also helps to support maternal-child functioning, a key goal of treating perinatal mental illness. Transition to their established outpatient providers will occur at patient discretion either upon clinical stabilization or at the conclusion of the postpartum period.
Pre-conception consultation for women with a history of psychiatric illness
Our team also provides pre-conception consultation for women with a history of mental illness and/or considering the use of psychiatric medications during pregnancy. This consultation allows women or couples an opportunity to discuss concerns or questions about mental health treatment during pregnancy. Included in this consultation is an option to meet one on one with our clinical psychiatric pharmacist to discuss the possible risks and benefits of psychiatric medications during pregnancy.
Mood and anxiety problems during the menopausal transition: Natural or as a consequence of medical or surgical treatment
Although self-limiting depressive symptoms can be part of the physiological transition to midlife, findings from prospective cohort studies indicate that the menopause transition is a period of increased vulnerability for clinically relevant depressive symptoms or major depressive episodes in a subset of women. When treating women with depression during the menopausal transition, specific aspects become part of treatment plan consideration, including common psychosocial factors such as themes of grief/loss, body image concerns, role transition, as well as vasomotor symptoms and sleep disruption. Differences in assessment and management apply if premature ovarian insufficiency or menopause were caused by medical or surgical treatment.
Premenstrual Dysphoric Disorder
Premenstrual psychological and somatic symptoms lie on a continuum of severity. While about 85% of women experience at least one mild premenstrual symptom; 20% to 25% experience moderate to severe premenstrual symptoms (premenstrual syndrome or PMS), and about 5% meet diagnostic criteria for a premenstrual dysphoric disorder (PMDD), the most acute form of PMS. The impact on quality of life and functional impairment of PMDD is similar to depressive disorders and when in comorbidity with bipolar disorder may be associated with worse clinical outcome. Criteria for the diagnosis of PMDD have been established. It is essential to differentiate between premenstrual syndrome, PMDD and depressive, bipolar and/or anxiety disorder with premenstrual worsening, as management is different.
Care Team Approach
Our team utilize a bio-psycho-social model of assessment and care and includes expertise in psychiatry, psychiatric pharmacist, and social work. We work with each patient and referring provider to develop an individualized treatment plan to help meet the patient’s goals.