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By thoughtfully using a lifespan approach to receiving consultations, Penn Center on Women’s Behavioral Wellness offers solutions within a private practice model for women who are struggling with the decision about a pregnancy that might be impacted by taking psychiatric medications.
Wide Awake

It is vaguely amusing that a few years back what the Penn Center for Women’s Behavioral Wellness (PCWBW) does might have been considered “niche medicine,” a very specific specialty. It is disconcerting that they are one of only a few clinics doing it—they are truly pioneers and that doesn’t seem right. What PCWBW does is provide consultations and solutions for women who experience behavioral changes due to reproductive issues or who need help managing their psychiatric problems during pregnancy. They consult with patients about the risks and possible interactions of psychiatric medications and pregnancy. They also develop therapies for women who suffer from cognitive difficulty associated with perimenopause and post menopause, which occurs naturally in most women during their late 40’s to early 50’s but can occur acutely after an oophorectomy (i.e., when ovaries are removed to reduce cancer risk) or simply due to hormonal sensitivity. [http://www.med.upenn.edu/womenswellness/]

“We provide a thoughtful, detailed evaluation regarding a whole woman using a lifespan approach—we need the lifespan approach to understand hormonal sensitivity that occurs in some women,” said C. Neill Epperson, M.D., Director of the PCWBW. “Stress and reproductive hormone fluctuation impact normal behavior, but some women experience psychiatric problems during periods of hormonal fluctuation such as during the perimenstrual period, during pregnancy or postpartum periods, and during the menopause transition. Hormones have a major impact upon the brain—estradiol is hugely important, for one.”

PCWBW uses a private practice model for evaluating and treating patients. There is a brief screen and discussion with the patient about the nature of the problem, as well as a briefing on the services the Center offers. PCWBW has a psychiatrist on staff who can treat pregnant patients, as well as a geriatric psychiatrist who can prescribe hormonal therapies. The Center can treat pretty much every problem that might be revealed by evaluation. Treating physicians also review possible therapies with the patient, such as treatment that involves psychotherapy, drug therapy, or a combined approach.

PCWBW has found that the patients who benefit most from their approach are those who are struggling with the decision about a pregnancy that might be impacted by taking psychiatric medications. “They may really need a specialist to discuss the risks and benefits of using psychotropic meds while pregnant. They want to know, ‘What are the risks?’ Their mental health concerns may be stable, but they have questions about taking medication during pregnancy, and as much as 50 percent of our patients’ pregnancies are unplanned,” said Dr. Epperson. “Sometimes they go off the meds and find they are not stable, and we need to pull them back—stability of the mother is the most important goal. And many psychiatrists do not understand hormonal and pregnancy issues and their impact on mental states of at-risk women. Patients benefit from more fully informed psychiatrists and psychotherapists.” This is precisely what PCWBW provides—onsite mental health care.

Some perimenopausal and postmenopausal women may experience anxiety, depression, and even new-onset psychosis as a result of hormonal changes that occur during the transition to menopause. PCWBW treats women of all socioeconomic groups, accepting Medicaid and Medicare patients, as well as the underinsured.

“In rare cases, we have had patients who have a recurrence of psychotic symptoms when we try to wean them from estrogen treatment, despite continuing to prescribe traditional antipsychotic medications. The most common reasons that we evaluate and treat menopausal women is noted decline in mood, ability to sleep, sexual interest, and cognition. Animal studies provide some evidence that the best approach to maintain cognitive performance during the early postmenopausal years is for women to use cyclical hormone therapy,” Dr. Epperson stated. “It is important to understand the peaks and valleys of estradiol levels that occur naturally in premenopausal women when considering how to provide ongoing hormone therapy for peri- and early postmenopausal women.” Dr. Epperson pointed out that the menopause transition is not a medical problem, and most women do not experience serious mood or cognitive disturbances, but there is help for those who do. “Women should discuss their concerns with their primary care doctors who can then refer them for specialty mental health consultation and treatment if appropriate.”

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