Let's Talk: Reproductive Psychiatry | Podcast

Nikki Lively: Hi everyone! My name is Nikki Lively and I'm the Clinical Director of the Transitions to Parenthood program at The Family Institute. We are a team of psychotherapists specializing in reproductive mental health and provide therapy and support to women, men, infants, couples and families in this important life transition. Today I'll be talking to Dr. Kara Driscoll, a reproductive psychiatrist specializing in perinatal mental health. Dr. Driscoll collaborates with women during times of emotional and biological change, such as pregnancy, the postpartum period, perinatal loss, infertility, perimenopause and the menstrual cycle. She provides individual psychotherapy, medication management, preconception consultation or second opinion consultations. Additionally, Dr. Driscoll works with patients who experience the chronic health effects of mental illness such as epilepsy, multiple sclerosis, thyroid disease or cancer. She is the founder of the Allegro Center, LLC in Lakeview where she sees patients, and is a faculty member in the department of psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine.

Welcome Kara. 1:11

Kara Driscoll: Thank you. I'm glad to be here.

NL: So, I want to focus first on your work in reproductive psychiatry with women around the biological changes that come up with motherhood. What are some of the most common presenting problems you see with pregnant women?

KD: I see a number of presenting problems. So, I often have women who are often coming in for the first time. Maybe they've developed anxiety, depression, obsessions or compulsions during their pregnancy, and they are interested in getting an evaluation for a possible diagnosis, as well as some treatment. I also have patients who unexpectedly become pregnant while they are already in treatment, and they have concerns that maybe the medication they're taking may have adverse outcomes for their pregnancy and they would like a consultation. And I also see women who have a prior history of depression or anxiety, who perhaps have discontinued treatment in advance of a pregnancy and then suffer a recurrence of their symptoms and want to know what options they might have for getting back into treatment. 2:14

NL: One of the most common concerns that women have during pregnancy is that psychotropic medications, so medications for psychiatric treatment, are things that will harm the fetus, shouldn't be taken. I'm wondering if you could describe how you collaborate with women around this, and what your thoughts are about the increased stigma of taking these medications while pregnant? It seems like psychotropic medications have more of a stigma than other classes of medications that women take during pregnancy. 2:45

KD: The treatment of mental health diagnoses such as depression or anxiety remains a hot button issue in the general public, and honestly, I think even within the medical community. I think this does relate to lingering stigma about mental health, or maybe just a limited understanding of the practice of treating depression or anxiety with medication. The causes of depression and anxiety are still largely unknown. So, I think there's some apprehension around this issue. However, there is a large body of evidence for medication to treat moderate to severe depression and anxiety. Another thing that I hear from my patients is that treating anxiety or depression is optional. Maybe it's not so severe. I've still had patients regularly tell me that their family or friends, or even their doctors tell them that they should just sort of buck up and deal with it. I had a patient tell me that another one of her physicians told her, well, it's only nine months. So you can deal with your anxiety for nine months right?

Maybe another more charitable reason that there's some increased vigilance is that depression is common. It's common during the perinatal period. We have data to suggest that one out of eight women during pregnancy, and one out of eight women postpartum will experience noticeable symptoms of depression. And then your question about how do I, how do I approach this with women? Gently.

I, you know, I often think there's a lot of anxiety about this issue, so I use their consultation as an opportunity to gather information, both for the patient and myself, and try to do some planning, and really to collaborate. I like the idea that this is a collaboration. So, I usually spend a lot of time in the first visit collecting information. I want to know about a person's history. Kind of what are their symptoms like? When do they bother them? How severe does it feel? When was the last time they felt like their normal self? I want to know all about their fears and anxieties. Did they even want to come to this appointment? Did someone make them come to this appointment? What have they heard? Did they look on the internet? Did a friend tell them this is what they can or cannot do? Did another, you know, did a pharmacist tell them, oh my gosh you can't fill this medication? You're pregnant. And then, once I have a good idea of kind, you know, kind of those concerns, I try to provide as much scientific information as possible in order to help a woman make a decision. And it's going to depend on the individual and what she's experiencing. And I want to make sure, that if we are talking about the treatment, it is something that she feels comfortable with. And I'm always happy to collaborate with their others doctors. You know, their OB/GYN, maybe a pediatrician if the baby's already born. In the hopes of again, to make patients feel comfortable with their choices. 5:23

NL: What are some of the differences in partnering or collaborating with women for treatment who are dealing with infertility? And how might your approach change based on the process of using medical intervention to become pregnant or not, and what might change or not once she becomes pregnant?

KD: Well, infertility is a really significant stressor for women. I actually was at a conference recently where they reminded the audience, and this was an audience of mental health providers, that the stress of infertility is comparable to the stress of people undergoing treatment for cancer. And it's sort of a silent stressor because it's not visible. It's not something that women feel comfortable talking about. They are experiencing this stress but not really feeling like they have any place to get support. So, certainly when you're under that level of stress, if you have a history of having depression or anxiety, I think it can be a trigger for a recurrence for those symptoms. But we also see women who are experiencing higher levels of anxiety or stress than they ever have before. So, I would really encourage people to reach out, to get help.

You know, I think in terms of thinking about getting treatment, my rule of thumb is, what would I recommend for this person's situation, regardless of pregnancy, regardless of infertility? And is there something about their current situation, in this example infertility, that would make the treatment different? And I would tell you a lot of the times, it doesn't necessarily change the treatment. One of the advantages in a situation where someone's pursuing, say IVF, compared to someone who spontaneously gets pregnant, we actually have a little bit more of an understanding of what the timing is going to be. So if patients are wanting to try and time when they get back on a medication, or if they want to come off of their medication, we have a little better sense of when they are going to be coming close to conceiving. So that can be an advantage.

I would say a lot of my patients who are undergoing a workup for infertility or considering interventions are very, very fearful about just all of the hormones that go along with those treatments, and have heard horror stories of oh my gosh, these hormones make you crazy. Thankfully, that is not always the case. I think what's tricky is that some women are most sensitive to the hormones with IVF treatment. I advocate for the model of, get your team together. Get your supports. Whether they be doctors, therapists, friends, family. And that way if it turns out that you are having some sensitivity, or some trouble then you've got people who are already ready and will support you. 7:58

NL: I wanted to talk now about some treatment for women postpartum. And first of all, I'm just curious as a reflective psychiatrist, how you define postpartum, and what are some of the most common presenting problems you see in the postpartum?

KD: So I probably would mostly take the cue from the patient. If they are calling me because they think they have an issue that relates to being postpartum, then that's where we are going to start. I think in the medical community there is a rather narrow definition for postpartum. But I think most people practicing in this area kind of loosely think of the first year after the birthing as the postpartum period. Again, if a mom called me and said that she was weening her daughter who is fifteen months from breastfeeding and she was having some mood concerns, to me, that feels like a postpartum issue.

So, the most common things I see in the postpartum period are symptoms of depression, anxiety, trauma related symptoms. OCD is actually pretty common postpartum as well. And particularly postpartum depression — that's probably the thing that people hear the most about, and sort of the general public. We now have research that suggests, probably a third of postpartum depression cases start in the postpartum period. 9:12 Another third were problems that started in pregnancy and just weren't diagnosed or weren't able to be addressed. And then the other third were kind of thought to be patients who already had a history of depression of anxiety and they were suffering a relapse at that point.

Something that I don't see very frequently, thankfully, but is still very important to screen for is postpartum psychosis. This is a very rare condition, but it is an emergency. So, it's important for me to make sure that these are not the sort of symptoms that the patient is having. But, women in the particular situation might report: confusion, strange beliefs, hallucinations, very rapid mood swings, inability to sleep — and this often happens pretty early in the postpartum period. And this would be a reason for someone to call a doctor right away, or to go to the emergency room. 10:00

NL: Generally speaking, what would you say to a woman who's pregnant or postpartum who recognizes that they need to see a psychiatrist, but has never met with one before and is scared about how it will go? I think the most common fear I hear is if you see a psychiatrist you will inevitably be prescribed a medication, and not wanting to be coerced into that, or some fear along those lines.

KD: Usually by the end of a first session with somebody, it's not uncommon for me to hear like, I didn't know how this was going to go. I would say it's very normal to be unsure about what the appointment is going to feel like. I say, take a deep breath, ask around. Ask friends. Ask family. Ask, you know, a doctor that you've already had for a good referral because it probably helps to see someone who someone else is vouching for. And then you know, maybe jot down some notes before you come because that can be helpful. I really believe in being honest with that doctor that you're seeing and saying, man I was pretty nervous about coming here, because it's really, it's our job to help make you feel comfortable.

And my approach is, you know, I don't know if the person I see is going to be a good candidate for medication treatment. That's one of the many things that I might think about. I mean, I have patients that come in with symptoms of depression and as it turns out, it's their thyroid that is not functioning the way it was during pregnancy. And I end up referring them back to their doctor and they get thyroid treatment. So just because you see a psychiatrist doesn't mean that you're going to end up on medication. Hopefully, after you see a psychiatrist you'll have more information about maybe some of things that you are experiencing and what are the options available to you. 11:38

NL: Thank you so much for being with us. Any final thoughts?

KD: I feel really lucky to work in this area, and as you can tell I get pretty excited about it. So, I'm always working to kind of connect people with that help that going, again, help them achieve a pregnancy.  

NL: So I want to thank Dr. Driscoll for being with us today. For more information on Dr. Driscoll and her work, and her practice you can go to www.feinberg.northwestern.edu and search under faculty profiles under "D" for Driscoll, that's d-r-i-s-c-o-l-l.

This podcast is brought to you by The Family Institute at Northwestern University, a nationally recognized leader in the field of behavioral health. We bring together the right partners to support children, adults, couples and families across a lifespan. As researchers, educators and therapists, we work with our clients and partner to see change. If you'd like to request an appointment, please call us at 847-733-4300, ext. 263. You may also visit our website at family-institute.org. And please follow us on Facebook and Twitter for relationship tips and tools, and for updates on new podcast episodes. Thanks so much for listening. 12:58