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Why Reproductive Psychiatry?

Trying to figure out what kind of doctor you should become? Wondering which specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Doyle chose reproductive psychiatry and why it is a great field.

Imagine you are ready for pregnancy. It is as good a time as any from the perspective of relationship, financial stability, and career. You are healthy but have been taking an antidepressant for the past five years for depression and anxiety. You had a severe depressive episode in college but have been doing well since. Anxiety has been a lifelong struggle for you, but the medication has really helped in combination with psychotherapy. When you go to your psychiatrist, they tell you to stop this medication because it is unsafe for the baby.

Of course, you want what is best for your unborn child and heed the advice. You then become pregnant and your anxiety spikes. You feel panicked all the time, but “white knuckle” your way through it. After delivery, the depression returns. Your husband becomes worried because you aren’t bonding with your baby and don’t seem like yourself. After about six months, you decide to talk to your OB who restarts your antidepressant. You start to feel better within a month. After the experience, you ask yourself: Was this really the best thing?

More awareness for postpartum depression exists now more than ever. While the awareness is positive, women are often given conflicted messages about treatment. This leaves them feeling confused, guilty, and isolated.

Reproductive psychiatry is a subspecialty of psychiatry that focuses on behavioral health during times of hormonal transition (pre-menstrual, pregnancy, postpartum, menopause).

Reproductive psychiatrists are knowledgeable about the potential risks of untreated mental illness during pregnancy, as well as potential risks of psychotropic medications.

They help women balance the risks, discuss preventive care, and collaboratively make a treatment plan with the patient.

Many reproductive psychiatrists are self-taught, as there was no formal training available until the past decade. However, this is changing and there are now over ten post-residency fellowships in reproductive psychiatry or women’s mental health. The fellowships are usually 1 year in length. Some are more clinically focused while others are more research-focused. The fellowship is currently available to those who have completed a psychiatry residency, but there is discussion about whether the fellowship should be available to other specialties, such as OB/GYN or Family Medicine.

Reproductive psychiatrists can practice in any setting, but most clinical work is outpatient due to the dearth of psychiatric inpatient units that cater specifically to perinatal women and their children.

Many consult-liaison psychiatrists practice some reproductive psychiatry if they see women on the OB floors. Many reproductive psychiatrists are passionate about education and advocacy, so there are plenty of opportunities in these areas. The group is small, tight-knit, and supportive. Many opportunities for mentorship exist which is helpful for career advancement.

After my adult psychiatry residency, I completed a fellowship in Women’s Mental Health. My clinical practice is primarily outpatient, but I have clinics in both psychiatry and OB/GYN. I love working with women during this life transition. This is vulnerable population, and I enjoy helping them work through the complexity of their own personal journey to make decisions that feel right for them. Outside of clinical practice, I am involved in our national organization. Our reproductive psychiatry group at University of Nebraska Medical Center is also very involved locally and regionally.

Consider a career in reproductive psychiatry if:

· You enjoy working with women during times of vulnerability and transition.

· You have a high tolerance for complexity and ambiguity.

· You enjoy thinking about biological and psychosocial factors in regards to overall health.

· You are impassioned by advocacy work.

· You work well in a team and are a good collaborator.

· Work-life balance is important to you. (This is true for all of psychiatry!)

Come join us!

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