Reproductive Psychiatry in 21st Century

Women are at increased risk for mood disorders from the time of puberty onward. While there are many factors that explain this increased risk, it is becoming increasingly clear that for some women, reproductive transitions represent times of particular risk for new onset and recurrent depression. For example, puberty marks the beginning of increased risk for depression in women. Most women report physical or emotional symptoms premenstrually with some severe enough to be diagnosed as premenstrual dysphoric disorder. Increasing data suggests that antenatal depression is not rare, particularly in women with past histories of depression or other mood disorders. Women who discontinue treatment with medications that keep them emotionally well upon learning that they are pregnant are particularly vulnerable to relapse or recurrence during pregnancy and the postpartum. Hormonal changes during the postpartum increase the incidence of depression and other mood disorders, and this is particularly troubling as the postpartum is a time when women are responsible not just for their own health and well-being but also the well-being of their babies and other children. Similarly, women transitioning through the years leading to menopause are at increased risk for depression, both recurrent and new-onset. Other times of hormonal challenge which are now believed to be associated with mood instability in women are post-miscarriage and during treatment for infertility. Using reproductive transitional events as markers, the latest data on prophylaxis and treatment of reproductive related mood disorders will be discussed.