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Medication and Mental Health During Pregnancy with Katherine Wisner, MD

Pregnant women get sick, and sick women get pregnant. Katherine Wisner, MD, has dedicated her scientific career to studying the psychiatric treatment of women of childbearing age and understanding how medications can be used to treat mental illnesses such as depression during pregnancy.

 

Katherine Wisner, MD

"If you're going to treat a pregnant woman with a medicine, you owe it to her to treat her effectively, because the justification is reducing that disease burden. We don't want to treat women partway. We want to reduce that disease burden fully."

Katherine Wisner, MD

  • Professor of Psychiatry and Behavioral Sciences and of Obstetrics and Gynecology

Episode Summary

Kathy Wisner, MD, conducted research related to the psychiatric treatment of women of childbearing age that was inspired by an experience she had in the mid-1980s as a resident trainee on a psychiatric inpatient unit. She witnessed an appalling lack of evidence-based care for pregnant women on psychiatric floors.

Katherine Wisner: “I was talking to one of my senior supervisors about a patient I was seeing who was about five months pregnant and depressed, and he listened, and then his comment was, 'Well, Kathy, you know you have the wrong diagnosis because pregnant women are fulfilled. They can’t be depressed.' So again, this is the '80s, and we've come a long way, but we haven't come far enough yet.”

But, pregnant women, even today, are notoriously understudied, especially in drug or therapeutic research. One of the reasons for this is the tragedy in the 1970s involving the drug thalidomide and pregnant women.

Katherine Wisner: “Thalidomide was a drug used in the first trimester as a sedative for pregnant women, and about 25 percent of women who took this drug gave birth to babies that had limb reduction problems, so basically stumps as arms and legs.”

The thalidomide disaster lead to the medical community telling women they couldn’t take any medications during pregnancy. Even today, there are still physicians and patients who believe that a pregnant woman shouldn’t take any medications, Wisner says. As women have started to wait longer to get pregnant and diseases occur earlier and earlier in the life cycle, there are more women with illnesses that need to be treated with medication.

Katherine Wisner: “What happens is, if your philosophy is 'no medicines in pregnancy' and 'we're not going to study pregnant women because it's unethical to use medicines,' what you then have is a public health problem the other way, that medicines that are used for the general public for a woman who has the same disease, if she's pregnant, there's no data to guide decision-making about reproductive safety. So, that has become the new public health crisis.”

There is now a new transgovernment report on the research gaps related to treating pregnant women with medication, a document decades in the making.

Katherine Wisner: “Diseases have major effects on the fetus as well, and generally have very poor outcomes if they're not treated. So the thinking now is, well, how do we get the best result? Whether it's medicine or other kinds of therapies, what is best for the mother and the fetus to improve reproductive outcomes?”

Depression is an important illness to treat in women of childbearing age, Wisner says. In a large study, she and her team screened 10,000 women between four to six weeks postpartum for depression. The rate of positive screens for depression was 14 percent or one out of seven women. For women who are on antidepressants during pregnancy, there is evidence that they seem to stop working partway through pregnancy. One of Wisner’s current studies evaluates monthly concentrations of antidepressants in the blood across pregnancy and postpartum, in order to identify the proper dose increases and medicate women correctly.

Katherine Wisner: “If you're going to treat a pregnant woman with a medicine, you owe it to her to treat her effectively, because the justification is reducing that disease burden. We don't want to treat women partway. We want to reduce that disease burden fully.”

There's also a new interest in epigenetics and pregnancy, or what some people call fetal programming.

Katherine Wisner: "Meaning that, what happens to the mom happens to the baby. And if that baby, the fetus, is grown in a milieu of depression, there are actually genetic changes, that we call epigenetic changes which occur that program that baby's health for life. So again, a new area of research that's being incorporated into this idea that women need to be healthy in pregnancy and if that means a medicine to treat seizures, asthma, depression, then that needs to be considered carefully in the equation.”

Currently, Wisner’s group is looking very closely at the health of the fetus with a new NIH-funded research project. They are interested in the follow-up with the infants after they are born. 

Katherine Wisner: “We are writing a curriculum now that will be put on a free NIH website that will be a curriculum for professionals interested in treating pregnant women with mental illness. I expect it will be out maybe in another year, but it's the first time, again, a comprehensive curriculum will have been developed, so lots of exciting things happening, much better than 30 years ago.”

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Continuing Medical Education Credit

Physicians who listen to this podcast may claim continuing medical education credit after listening to an episode of this program.

Target Audience

Academic/Research, Multiple specialties

Learning Objectives

At the conclusion of this activity, participants will be able to:

  1. Identify the research interests and initiatives of Feinberg faculty.
  2. Discuss new updates in clinical and translational research.
Accreditation Statement

The Northwestern University Feinberg School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement

The Northwestern University Feinberg School of Medicine designates this Enduring Material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure Statement

Katherine Wisner, MD, MS, has nothing to disclose. Course director, Robert Rosa, MD, has nothing to disclose. Planning committee member, Erin Spain, has nothing to disclose. Feinberg School of Medicine's CME Leadership and Staff have nothing to disclose: Clara J. Schroedl, MD, Medical Director of CME, Sheryl Corey, Manager of CME, Jennifer Banys, Senior Program Administrator, Allison McCollum, Senior Program Coordinator, and Rhea Alexis Banks, Administrative Assistant 2.

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