What Is Comprehensive Reproductive Psychiatry and Mental Healthcare?

What Is Reproductive Psychiatry?

Historically, women’s mental health issues were brushed aside and referred to as hysteria until 1980, when the term was removed from the Diagnostic and Statistical Manual. According to an article by the American Psychiatric Association (APA), the Edinburgh Postnatal Depression Scale (EPDS) — a widely accepted tool to screen for postpartum depression — was not developed until nearly a decade later, in 1987.

The historical context and lack of focus on maternal or women’s mental health prompted the National Institutes of Health (NIH) to mandate increased research on postpartum depression.

Although the mandate came into effect in the 1980s, it wasn’t until 2002 that the first psychiatry subspecialty fellowship in women’s mental health was launched at the University of Illinois at Chicago. Over half a decade later, in 2008, Brigham and Women’s Hospital and Columbia University launched the second and third programs.

Reproductive psychiatry — sometimes called perinatal psychiatry — is a relatively new psychiatric subspeciality that focuses on reproductive health throughout various reproductive stages.

“This is a 30–35-year-old specialty; it isn't very old. It’s in just a few academic centers. I had the privilege of training at Columbia University, where they had this specialty,” Oreck told LifeSciencesIntelligence.

Since its inception, reproductive psychiatry has grown dramatically, with approximately 16 programs across the United States today. Even so, the field remains small, with very few individuals aware of this subspecialty.

“Mavida’s co-founder, who herself struggled with mental health issues after a second-trimester loss, never even knew about this field until she met me. This is a real problem because often people with these specialized needs bounce in and out of the mental health care system, and they're not addressed,” she added.

Although psychiatrists are trained to handle mental health issues, Oreck describes her experiences as a resident working alongside general psychiatry residents, noting that many of her peers sought her help while treating pregnant patients with mental health issues.

“The general psychiatrists graduating from some of the best programs don't feel well equipped when they see pregnant patients. Some of the most well-read, esteemed professors put up their hands when they saw a pregnant patient. It’s not part of the general curriculum enough,” she explained.

Today, multiple programs and resources can facilitate better reproductive psychiatry education. For example, the National Curriculum in Reproductive Psychiatry was launched in 2018. The program touches on the relationship between reproductive cycles and psychopathology, the epidemiology of postpartum mental illnesses, perinatal disorders, psychiatric complications related to infertility, pregnancy loss, and birth trauma, premenstrual mood disorders, and psychiatric symptoms of perimenopause.

Beyond that, the National Trainee Interest Group in Reproductive Psychiatry was launched in 2021 to connect and educate medical professionals and students interested in women’s mental health. Finally, in 2022, the APA published the Textbook of Women’s Reproductive Mental Health.

“It is important to invest more time and energy in education because mental health issues are the number one complication of childbirth. Medicine is training OB/GYNs so well in treating gestational hypertension or diabetes during pregnancy, and yet mental health is a blind spot,” said Oreck.

What Are the Key Focus Areas of Reproductive Psychiatry?

Reproductive psychiatry covers various conditions and experiences throughout the reproductive health cycle. Its focus areas include the following:

• Perinatal mood and anxiety disorders
• Infertility and reproductive loss
• Parenthood adjustments
• Menopausal mental health

“From trying to conceive pregnancy and lactation in the postpartum, reproduction is a huge inflection point in many women and birthing people's lives where they are the most impacted by mental health issues or impacted for the first time with a mental health issue,” noted Oreck.

Perinatal mood and anxiety disorders (PMADs) may be some of reproductive psychiatry's most well-known focus areas. This area includes postpartum depression and a broad range of other conditions, such as postpartum obsessive–compulsive disorder (OCD), postpartum psychosis, and postpartum anxiety.

Reproductive psychiatrists may also treat patients experiencing infertility or pregnancy loss. These healthcare professionals may guide and manage the emotional impacts and psychological stress associated with infertility and pregnancy loss. Additionally, providers may assist in managing grief, loss, trauma, PTSD, and other psychological symptoms associated with this phase of reproductive health.

After pregnancy, comprehensive reproductive mental health may involve helping a parent or family adjust to a newborn and parenting. Clinicians may provide strategies for adapting to the new routines of parenthood, managing stress or anxiety, or developing parent–child bonds.

Although female mental health during menopause is poorly understood, reproductive psychiatry can help patients manage psychiatric symptoms rooted in hormonal changes. Additionally, these specialists can care for menopausal patients with mood disorders, cognitive changes, identity and self-esteem issues, or sexual health changes.

“The next inflection point in many women's lives is perimenopause. Many startups and venture capitalists have invested money in treatments for perimenopause. Still, they've focused on the physical aspects and not as much on the mental health aspects,” Oreck explained. “After pregnancy and postpartum, perimenopause is where people experience the most depression and anxiety.”

Tools for Addressing Issues in Reproductive Psychiatry

Throughout the discussion with LifeSciencesIntelligence, Oreck discussed multiple tools or systems that could improve maternal mental health outcomes. Her company, Mavida Health, champions the idea that “it takes a village.” Beyond that statement's social and community implications, Oreck emphasized that there needs to be a healthcare village.

“Therapists and prescribers — a whole team to wrap around the pregnant person — should communicate with their OB/GYN. This forms that village, creating a mental health village,” she said.

Childcare

In addition to group therapy and psychosocial support systems that foster community and understanding, Oreck explains the importance of accessible and affordable childcare for reducing stress on new parents.

Multiple factors, including extended parental leave and affordable childcare characterize communities with improved maternal health outcomes.

“So many childcare services are closing in the US. And that's challenging. The pandemic has made it clear that infrastructure for supporting parents is simply unavailable,” she emphasized.

Medication

Beyond childcare, reproductive psychiatrists can use medications to manage maternal mental health conditions. The FDA recently approved a new treatment for severe postpartum depression called Zuranalone.

“Within three days of taking this medication, an oral pill, patients have some benefits or decrease in depression. They only have to take it for 14 days, and the efficacy lasts about 45 days, maybe even more.”

The gold standard for managing postpartum mood and anxiety disorders is selective serotonin reuptake inhibitors (SSRI). “SSRIs take about four to six weeks to work and have many side effects. Patients have to continue taking them to have lasting effects,” explained Oreck. Zuranolone may replace this gold standard by providing a short-term therapy with long-term effects.

As the field of reproductive psychiatry continues to grow and evolve, future research may focus on PMADs, hormonal influences, genetics, new treatments, psychopharmacology through pregnancy and lactation, psychosocial interventions, parent–infant bonding, and long-term outcomes.