Chat with a Psychiatrist

By Veronica James, LCSW

This month I have the honor of introducing you to Dr. Alison Reminick.   Dr. Reminick is a board-certified psychiatrist  who directs the UCSD Women’s Reproductive Mental Health Program, which helps women manage and recover from anxiety, depression, or other emotional issues during infertility, pregnancy, or the postpartum period.   Dr. Reminick specializes in the mental health care needs for women with premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), pregnancy and postpartum mood disorders, and emotional disturbances during menopause.  Her research interests include perinatal mood and anxiety disorders, mood changes associated with infertility treatment, and adoption.

Many of us know and respect Dr. Reminick’s work with women with PMADs.  In keeping with May being Maternal Mental Health Awareness month, PHA asked Dr. Reminick a few questions that may help guide providers in the field.

Dr. Reminick, what are some current trends you are seeing in your direct practice with the women in your program? 

There is still a very large gap in care.  Many OB/GYN providers, midwives, maternal health providers are getting better at identifying perinatal anxiety and depression but are not comfortable with providing care while many psychiatrists are not comfortable caring for pregnant/postpartum patients. The field of women’s mental health is growing but we are still not at the point where it is easy for patients to access appropriate treatment in a timely way.   We know that although more patients are being identified, many patients are not getting adequate care and are suffering unnecessarily.

On the other end, I am seeing more patients who have been proactive and seek a support network prior to becoming pregnant.  This is typically because they have seen a friend or family member suffer from a perinatal mood or anxiety disorder or there is a personal history of depression or anxiety.  At UCSD, we have a collaborative care approach where a patient who is at risk for PMAD can see one of our therapists in conjunction with the OB provider.  At each appointment we can monitor both their physical and emotional health so we can act quickly if further intervention is warranted.  This approach seems intuitive since PMAD is the most common maternal comorbidity, much more so than any other pregnancy complication including gestational diabetes, hypertension, and preeclampsia.

What is also interesting is that many patients seem to be hearing about “postpartum anxiety” and seeking treatment. We are finding out now that in our push to identify and diagnose postpartum depression, those with postpartum anxiety were not getting treatment because they did not associate with this diagnosis.  Using the terminology of postpartum depression really was a disservice to the patients who were experiencing anxiety, panic, OCD or PTSD symptoms prior to or post childbirth which is often more common than depressive symptoms.

What are some common questions you get and answers you give about PMAD related medication?

I would say 80% of my patients have never taken medication regularly and have never been on a psychotropic medication so there are many questions about how the medications work.  I often educate patients that the medication is not addictive.  It will not change their personality or numb them from their thoughts and feelings.  The medications are not “happy pills”.  I often use the analogy that the medication is a ladder from the illness which often feels like a deep dark well that feels inescapable.  Many of my patients describe feeling like they are drowning in their anxiety or depression and the medication is a buoy that helps them float above the illness and makes life feel more manageable and less overwhelming.  The majority of my patients are able to successfully taper off of medication within a year.  There are a number of medications that are very safe and very well studied during pregnancy and lactation.

What do you want people in the women’s field such as therapists, doulas and lactation consultants to know about PMADs that may help them bridge the gap from identifying a woman suffering from PMADs and successfully getting her the appropriate help they need?

There is a large network of providers committed to caring for these patients.  With just a referral to Postpartum Health Alliance or Postpartum Support International this paves the way to access to a large number of therapists who provide individual therapy and who are running very effective support groups.  With the access to both therapy and appropriate medication, when necessary, patients can recover within a month of treatment.

What do you find most exciting about what is happening in PMAD world?

We have been seeing more providers (including OB/GYN, midwives, pediatricians, family medicine doctors) screening patients during pregnancy after recommendations from ACOG, US preventative task force, AFP, AAP so more patients continue to be identified.  The word also seems to be spreading and stigma is slowly lifting as more celebrities like ChrissyTeigen, Adele, and Hayden Panettiere have come out with their stories.  There is also such wonderful online resources for patients including the MGH website (womensmentalhealth.org), mother to baby (mothertobaby.org), mother risk (motherrisk.org) postpartum health alliance along with the largest ever study of women with postpartum depression, anxiety, psychosis (PPD ACT) which is a study patients can access through an application on their phone to contribute data to study the genetic basis of PPD/PPA/PPP so we can continue to better identify and treat women who suffer from PMAD.

What is also exciting is the number of programs across the country expanding to include intensive outpatient programs and partial hospitalization programs to treat pregnant and postpartum women with PMAD.  These mother and baby programs provide more intensive treatments targeting areas specific to mothers and mothers-to- be including groups on reflective and mindful parenting, bonding and attachment with baby, infant massage and peer support.  UCLA and UCSD have both opened up programs specialized in treating patients with PMAD who require more intensive treatment.

PHA is grateful to Dr. Reminick for taking the time to answer these questions.  I can speak from personal experience in referring women to the UCSD Women’s Reproductive Mental Health Program that this specialized program is a much needed service that meets the unique needs of women dealing with PMAD.

For additional information about Dr. Reminick and the UCSD Women’s Reproductive Mental Health Program please call 858-534-7792 or visit https://health.ucsd.edu/specialties/psych/clinic-based/reproductive-mental-healt