Q/A with a Reproductive Psychiatrist

For this month’s blog update, PHA asked local reproductive psychiatrist, Dr. Sarah Kauffman, a few questions related to the treatment of PMADs.

Dr. Kauffman is a psychiatrist who specializes in reproductive and forensic psychiatry.  Her private practice (sarahkauffmanmd.com) is focused on women’s mental health, including psychotherapy, medication management, and consultation.  She also works in the community as a correctional psychiatrist and is passionate about the intersection of mental health and the law.

 Unfortunately, most of the medications we have available to treat PMADs can take up to two months to provide significant symptom relief.  This is why it is important for a parent to keep taking prescribed medication during initial treatment, even if they don’t feel immediate relief, as it can take a few months to determine if they will respond to the medication.  That said, some symptoms, like difficulty sleeping, can (and should) respond more quickly to treatment with medications—often with the first dose of the medication.  It is important to ask your doctor when starting a medication when you should expect to notice a change with that particular medication so you can alert them appropriately.  Additionally, you should always feel comfortable reaching out to your doctor if you experience a worsening of mood symptoms or other side effects after starting a new medication.

2. What should therapists tell their clients about what to expect from their psychiatrist? (What does a common initial appointment look like) 

A typical initial appointment with a psychiatrist can take anywhere from 45 minutes to 2 hours (and can include one or more sessions) depending on your history and reason for the evaluation.  The psychiatrist will usually ask you about what brought you to the appointment, your current daily functioning, your current symptoms, medical history, reproductive history, psychiatric history, family history, and developmental/social history.  The initial appointment may include some questions that can be difficult to answer, such as those concerning sexual history or history of traumatic experiences and you should always feel comfortable letting the psychiatrist know if you don’t want to answer certain questions.  The psychiatrist may also want to reach out to a family member, or prior treaters (therapist, ob/gyn, psychiatrist, etc.), to help them complete a comprehensive evaluation.

3. Is gene testing for psychotropic medications a possibly valuable tool when prescribing medication?

Genetic testing can provide guidance towards tailoring psychiatric medications in certain limited situations; however, it can be very expensive and is typically not covered by insurance.  For this reason, I rarely use genetic testing when treating patients.  As genetic testing is becoming more affordable, and as the evidence potentially grows in our ability to apply the knowledge we gain from testing, I imagine it will become a more important tool in treatment.  If your provider recommends genetic testing, you should be empowered to ask what specific question(s) the testing if going to answer and how this will potentially be used to tailor your treatment.

4. It is common for parents to take supplements and alternative medications to support their mental health. For a clinically depressed or anxious parent, how do you manage these types of patients?

I am supportive of many alternative treatments, including vitamins, supplements, dietary changes, and complementary medicine, to prevent, or cope with, psychiatric symptoms.  What is most important is having an open discussion with parents about what alternative treatments they are pursuing.  This is essential both to discuss the risks and benefits of each treatment as well as their potential interactions with any medications I am thinking of prescribing.  Many alternative treatments can act on the brain in similar ways to psychiatric medications so it is important for me to both support a parent in their treatment choices and also to ensure that any medications I am prescribing are safe in combination with their alternative treatments.

5. What do you recommend for parents to look for in a psychiatrist, in order to be wise consumers?

I would look for a psychiatrist that you feel you can talk to openly, demonstrates they are listening to you and cares about your personal goals, and focuses on working collaboratively with you and your support system (this could include therapists, family members, etc.).  Fortunately, there has been a shift in recent years to a focus on “patient-centered” care so many psychiatrists are practicing in this collaborative manner.  If you feel that you cannot share certain information, or engage in a productive dialogue (it should be a TWO-way conversation), with a potential psychiatrist, I recommend seeking out another provider.  If possible, I would look for a psychiatrist with special training or experience in treating parents.  This is particularly important for pregnant and lactating women as many psychiatrists are not well versed in the current evidence and recommendations for prescribing medications in this group.  Finally, I would seek out a psychiatrist who is forthright about their fees and policies.  While it can be awkward to discuss money with a potential doctor (or anyone for that matter), this is an important step to ensure you can afford to see a potential provider and that there will not be additional fees you do not anticipate.  Keep in mind that while many psychiatrists do not accept insurance, they can provide you with a “superbill” that you can submit to insurance that will often reimburse for a significant portion of your treatment.  You should feel empowered to ask about the specifics of this process, and any other policies, with a potential provider.