Sarah B Mathews, MD

Women’s Behavioral Health

Pregnancy

Women often require specialized psychiatric care when preparing for pregnancy and during the perinatal period. Maintaining emotional health during pregnancy is imperative for a healthy pregnancy, though women commonly have concerns about starting or continuing psychiatric medication during their pregnancy. When medications are not continued, some women are at risk for recurrent illness, and the negative effects of the illness on the pregnancy can be higher than the risk of taking medication.

Women with a history of psychiatric illness, including mood and anxiety disorders may develop recurrent symptoms during pregnancy requiring treatment. Psychotherapy can be effective, however some women may also need to consider the addition of medication. Many women will consider consultation regarding their treatment plans prior to pregnancy, while others will require management when symptoms occur during pregnancy. The majority of psychiatric medications are considered very safe to start or continue throughout pregnancy. Consultation with a women’s health psychiatrist when planning for your pregnancy or if you are experiencing mood or anxiety symptoms during your pregnancy can provide support and education for this challenging process.

Postpartum

The postpartum period is a time of higher risk for the development of depression, anxiety and mood changes for many women.  Those women with a history of psychiatric illness are at highest risk of recurrence. The hormonal fluctuations occurring after delivery as well as the typical lack of sleep and increase in stress level when adjusting to care of a newborn contribute to this risk. Just as we see during pregnancy, the risk of untreated maternal illness in the postpartum typically is higher than any risk of taking a medication. A combination of psychotherapy and medication can be highly effective for management of post-postpartum mood and anxiety disorders.  Women may have concern about taking medications while breastfeeding, however many medications are considered very safe to take. A women’s health psychiatrist can help to create a treatment plan with you to address your symptoms while giving consideration to the special concerns present in the postpartum period. 

Infertility

PreMenstrual Dysphoric Disorder

Many women experience emotional changes in the premenstrual phase, but some have more pronounced changes due to premenstrual dysphoric disorder (PMDD), a condition that is more severe than premenstrual syndrome (PMS). Women who experience PMDD often experience sadness, irritability, and anxiety, and uncomfortable physical symptoms that take place each month prior to the onset of menstruation. These symptoms may last from several days to weeks, and interfere with daily activities. After several days of menstrual flow, women with PMDD feel as if they are back to their normal selves.

Although exercise and proper nutrition may help alleviate some of the milder symptoms of PMS that occur, research studies have shown that these strategies do not consistently alleviate the types of symptoms that occur with PMDD. Several antidepressant medications have demonstrated success in treating PMDD, providing relief for many women. Oral contraceptive pills, on the other hand, have less predictable effects on a women’s premenstrual symptoms. A women’s health psychiatrist can work closely with your gynecologist to choose the best treatment plan to manage symptoms of PMDD.

Peri-menopause

Women undergoing a natural menopause at mid-life will often develop depressive symptoms, anxiety, or cognitive symptoms, even with no history of psychiatric illness. Those with a history of a mood or anxiety disorder are at even more risk for recurrence of their illness.  The variability in hormones during this time period, which can often last years, is likely a strong contributing factor, and the many changes occurring during mid-life can certainly create stress. Other women may experience an earlier or more abrupt menopause transition due to surgery (oophorectomy), medication (anti-estrogen chemotherapy agents), or premature ovarian failure. 

Fortunately, effective treatments are available to address these symptoms. For some, hormone replacement therapy may be an option. For others, this might not be safe or preferable. Psychiatric medications have been proving beneficial to address these symptoms as well.  Antidepressants can effectively treat depression and anxiety in adult women. Additionally, stimulant medications which are typically used to treat attention deficit disorder, have been helpful for women with cognitive complaints that interfere with their daily functioning.  A women’s health psychiatrist can provide guidance in making decisions regarding which type of treatment might be most effective.