In this episode of Mental Health Pathfinders, host Erin Connors speaks with Dr. Nancy Byatt about women’s mental health and the growing importance of reproductive psychiatry. Their conversation explores how mental health needs can arise across the lifespan, from menstruation and pregnancy to postpartum and menopause, and why prioritizing emotional well-being is essential for both women and their families. Dr. Byatt also addresses common concerns about antidepressant use and pain treatment during pregnancy, while highlighting the importance of trusted medical guidance, early support, and greater awareness of maternal mental health.

Transcript

Erin Connors (00:05) Hello and welcome to this episode of Mental Health Pathfinders. I'm your host, Erin Connors. March is Women's History Month, a time to celebrate women's contributions to history, culture, and society. This is also an important time to focus on women's mental health, including the field of reproductive psychiatry. Joining us today is Dr. Nancy Byatt, Professor of Psychiatry and Obstetrics and Gynecology at UMass Chan Medical School. Dr. Byatt also developed the Massachusetts Child Psychiatry access program for moms, a statewide program that has increased access to mental health care for thousands of women and become a national model for perinatal mental health care. She's also a member of the APA's Council on Women's Mental Health. Dr. Byatt, thank you so much for joining us today.

Nancy Byatt (00:52) Thank you. It's a pleasure to be here.

Erin Connors (00:54) You know, this is such an important topic because women, you know, we are often the caregivers of families and we kind of overlook ourselves sometimes. What can we do to help women learn to prioritize their own well-being, especially when most women are juggling so much?

Nancy Byatt (01:11) Yeah, so I would say that the most important thing when we think about parents and women in general taking care of themselves, particularly when we're parenting, as you mentioned, juggling so much, is that for us to be able to take care of other people, we have to be taking care of ourselves. Right. There's often this fallacy that I feel like, you know, many of the patients that I serve and also in my personal life have that, oh, I'm going to ignore my needs to take care of my baby or to take care of my children and thinking that that's gonna be best for like their loved ones. And in fact, it's not, we have very clear data on this and it's very clear that the best thing that a parent or a mother can do for themselves and their baby or their child growing up is to take care of their own mental health. And I think that's one of the things that we often have misconceptions about. And I'd say the other things is there's lots of things we can do. So for example, you know, if when we're, when we think about pregnancy and postpartum, one of the really important things is that if that we're focusing on our mental health and that we're taking care of ourselves, that could be therapy. It could be, if we do have a mental health need, getting the mental health help that we need, which could be pharmacotherapy when that's indicated. And there's lots of other things like exercise, peer support. There's many, many treatments and supports that can be available, whether someone has an illness or not. There's so many things that we can do to take care of ourselves.

Erin Connors (02:37) So it's not one size fits all for anybody.

Nancy Byatt (02:40) Exactly. Like whether someone has, you know, anxiety or depression symptoms or whether they're, you know, parenting is hard for all of us and so is pregnancy and postpartum. And there's always things we can do to be maintaining our own mental wellness. It's like we talk about, you everyone knows it's good to go to the dentist to take care of your dental hygiene, right? Like we also need to do that for our mental health. Like it takes work. And the more we do that, the healthier we're going to be and the better parent we're going to be as well.

Erin Connors (03:10) Let's talk about the field of reproductive psychiatry and the importance of this subspecialty. So this ranges from the reproductive years into menopause.

Nancy Byatt (03:20) Yeah, so reproductive psychiatry sort of really refers to sort of reproductive mental health across the lifespan. So it starts with really menarche when women, you know, start girls, teenage girls first start, you know, having their menstrual cycles. And there is a fair amount and just around the menstrual cycle in general, there's something called premenstrual dysphoric disorder that is when people could have symptoms, irritability, there could be physical symptoms a few days before the menstrual cycle. So that's a part of it. And that really crosses all of when a woman is menstruating. And then there's the perinatal time period, which is a time that we know of increased risk for mood and anxiety disorders. And then also around menopause, there's a lot of hormonal changes that happen around menopause and physiological changes that can increase women's risk of mood and anxiety disorders as well. So it really refers to all of the physiological changes that women experience that can often increase the risk of mood and anxiety disorders and other mental health disorders.

Erin Connors (04:23) I think a lot of women during the menopause years too often think of all the physical symptoms that they'll be feeling. They don't actually try to look at the and tackle maybe the mental health symptoms they might be dealing with as well. Is there a good time to consider going to a reproductive psychiatrist?

Nancy Byatt (04:28) Mm-hmm. Yeah, I would say that, I mean, so I think generally if somebody is having, so reproductive psychiatrists tend to see people when it's a little more because we're so specialized. We don't, I don't think someone necessarily has to see a reproductive psychiatrist to have some, like ideally obstetricians, gynecologists, all the people who see women throughout the lifespan are also getting trained in this and there's huge focus on this. So I would say finding reproductive psychiatrists can be a little more challenging. I wish it was easy. but it's not always. And so I think people could start with talking to their GYN. They could talk to their primary care physician about these things. And then, you know, if they're not able to get the support they need there, then looking for a reproductive psychiatrist, or they may get referred to a reproductive psychiatrist. I don't know that people necessarily have to start there also, because that can be a little bit more difficult to access sometimes.

Erin Connors (05:31) Well, let's look specifically at maternal mental health. You know, there can be a high cost here if it's left untreated, specifically when it comes to the parent-child relationship and the mental health of the children as well, right?

Nancy Byatt (05:44) Yep, yeah. Yeah, so mental health and substance use disorders combined are the leading cause of maternal deaths in the United States. So 23 % of maternal deaths are due to mental health and substance use disorders combined, and many of them are due to suicide. So it's really important that we're addressing this as old as this is. And back, like why I said earlier, the best thing you do for yourself and your baby is to get the support that you need because it can be tragic. And regardless of that, those are tragic outcomes, which are fortunately not common. However, there's a lot of other things, even if it's more mild illness, that can affect the baby. So for example, in pregnancy, mood and anxiety disorders can impact the ability to go to healthcare appointments. It can impact the baby's weight when the baby's born, the time at which the baby's born. And then also in the postpartum period, it can affect bonding between the parent and the baby. and so forth. And then there's also data showing that kids of mothers who have mood and anxiety disorders during pregnancy and postpartum are an increased risk of having their own mental health illnesses later on. And so I think in general that we know that untreated mood and anxiety disorders during this time period have an impact on the parent and the baby.

Erin Connors (07:02) Yeah, you know, there've been so many stories in the news lately around the topic of taking antidepressants during pregnancy. Some of this news can be very confusing, obviously, especially for women who've been real successful in managing their depression with antidepressants before pregnancy.

Nancy Byatt (07:09) Yep. Yep. Yes, so I think the short story with antidepressants in pregnancy is that we think about the risks of no treatment. I just outlined the risk of no treatment. It includes maternal mortality. It includes all these effects on the potential effects on the baby, effects on the mother's health, right? And then we think about the risk of the illness. And when I, as a perineal psychiatrist, am working with a pregnant or postpartum individual, I am usually far more concerned about the risks of not treating treating the illness than I am about the risks of the medication. Because these illnesses themselves have risk. Overall, antidepressants in pregnancy, they are not major teratogens. They have not been known to cause major birth defects. There have been some associations. Most of the associations with those concerns have been small. And so in general, if I was pregnant or postpartum and I needed to take an antidepressant, I would take one because I would believe that the benefits outweighed the risks. And so I think in general that we really have to be thinking about that.

Erin Connors (08:22) And another story we've heard lately in the news is the link between taking Tylenol during pregnancy and the link to autism. Is this something that a woman needs to talk with her doctor about? And when is it right to take Tylenol for women? Is it important that they do when they're in pain?

Nancy Byatt (08:37) Yeah, so women's pain needs to be treated, right? Tylenol has been around for very, very long time, and we have lots of studies showing that Tylenol is a reasonable option to take during pregnancy. There has been a lot of misinformation around Tylenol in pregnancy recently. If a woman is pregnant and they need to treat their pain, Tylenol is a reasonable option. Many professional organizations reaffirm this when there was some misinformation going on around this more recently. we do not want to ignore people's pain, women's pain, when they're pregnant. And Tylenol is a very reasonable option to take. women can certainly ask their doctors about that if they'd like to, which I expect that they were going to get reassuring information from their providers around the use of Tylenol in pregnancy.

Erin Connors (09:25) And I would think with all of these issues, just having that conversation with your doctor when you have concerns or you have worries and just opening up that dialogue is just so important.

Nancy Byatt (09:30) Yep. Absolutely. I mean, if anyone has concerns about any of these things, asking your obstetricians increasingly are more more aware of mental health and are increasingly able to address it, asking them about any of these things is really important. And also there's a lot of great resources as well out there. Postpartum Support International has a wonderful warm line that has great information. There's a free maternal mental health hotline. There's a lot more resources out there than there used to be. And so I really encourage people to use those and of course talk to their provider, particularly around any questions around medication use in pregnancy.

Erin Connors (10:09) Dr. Bai, great conversation today. Thank you so much for joining us. And to our listeners, you can find more episodes like this on a range of mental health topics on APA's Medical Mind Channel, available on all major podcasting platforms.

Nancy Byatt (10:12) Thank you. It's a pleasure to be here.