I'm a reproductive psychiatrist. What this means is that I'm a board-certified psychiatrist who has chosen to specialize in diagnosing and treating the psychiatric conditions that occur around the reproductive cycle in a woman's life.
Treating women during this timeline is complex, nuanced, and requires specialized knowledge. Take pregnancy and psychiatric medications. A physician's ideal evidence for a medication would be a prospective, randomized placebo-controlled trial. However for a number of reasons, researchers generally do not design studies like this on pregnant women. Instead, reproductive psychiatrists must often work with retrospective data or uncontrolled prospective data, all of which are garnered from "real-life" and scientifically "imperfect" conditions. This means our field is incredibly dynamic, always changing, and continually acquiring and interpreting new information. Certain medications that may have had unknown safety profiles a decade ago may now have enough data for reproductive psychiatrists to make reassuring recommendations. As we acquire another 2 decades of collected data, we have an even better understanding for which medications we can recommend as having reassuring long-term neurodevelopmental effects on children. In general, the collection of data and time has been favorable in reproductive psychiatry-- we know there are many risks to babies of untreated depression and anxiety during pregnancy, and the data has allowed us to grow more confident about the safety of psychotropic medications to relieve those symptoms during pregnancy.
The same goes with psychiatric medications and breastfeeding. While scientific experiments can be done to understand what percentage of a medication gets into a breastfed baby's bloodstream, it is not a quantitative amount, but an understanding of qualitative effects that is most important in determining safety. Again, only time and the compilation of many many women's experiences give us enough information to say that a medication seems to be safe and without ill-effect when used during lactation.
Being a reproductive psychiatrist, I take my time working with patients to help them understand what the data is behind the medications I prescribe to the level of detail that my patient prefers. I always weigh the risks and benefits of medications with the risks of untreated depression and anxiety during pregnancy or breastfeeding, which can also have detrimental effects on babies. I will only ever prescribe a medication that both you and I are comfortable with during your pregnancy. The practice of medication management during pregnancy and breastfeeding is nuanced and complex, and I am privileged to have the knowledge and experience to guide my patients safely through their journeys.
As you can see, research and data collection is integral to the field of Reproductive Psychiatry. If you are pregnant and taking psychotropic medications, consider contributing to the field by participating in one of MGH Center for Women's Mental Health's National Pregnancy Registries.
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