3.12 Perinatal Psychiatry

12 snips

Jul 21, 2025

Dr. Christina Wichman, a Professor of Psychiatry and Obstetrics & Gynecology, shares her expertise in reproductive psychiatry. She discusses the unique challenges of treating mental health during pregnancy and postpartum, emphasizing the need for compassion and validated screening tools. The conversation explores various perinatal mood disorders, medication management, and the innovative Periscope Project aimed at improving access to care. Dr. Wichman also highlights the importance of preconception planning and navigating the balance between maternal and child health.

Ask episode

AI Snips

Chapters

Transcript

Episode notes

ANECDOTE

Formative Case Sparks Interest

Dr. Wichman shares a formative case of a pregnant woman with schizophrenia whose antipsychotic was nearly stopped.
She advocated continuing treatment, leading to a healthy pregnancy and successful parenting.

INSIGHT

Treat Mother First, Then Baby

Dr. Wichman advises treating the pregnant patient as you would if she were not pregnant.
This approach helps avoid unnecessary medication changes that risk decompensation.

ADVICE

Distinguish Baby Blues From Disorder

The "baby blues" affect 70-85% of new moms and usually resolve within 2 weeks.
Intervene with treatment only if symptoms persist beyond 2-3 weeks or impair functioning.

Get the Snipd Podcast app to discover more snips from this episode

Get the app

Dr. Christina Wichman, Professor of Psychiatry and Obstetrics & Gynecology, Medical Director of The Periscope Project and Director of Women’s Mental Health at the Medical College of Wisconsin, joins us for an in-depth introduction to reproductive psychiatry. This episode is co-hosted by Erica Browne, an M4 at Saint Louis University School of Medicine.

We explore the unique clinical and ethical challenges of treating psychiatric illness during pregnancy and the postpartum period, including how to navigate the needs of both mother and child. Dr. Wichman walks us through distinctions between common perinatal mental health presentations—such as baby blues, perinatal depression, and major depressive disorder—and discusses how to differentiate normal postpartum stress from psychiatric conditions that require treatment.

The episode covers validated screening tools, pharmacologic treatment during pregnancy and lactation, and non-pharmacologic options for patients with limited access to care. Dr. Wichman shares her clinical approach to balancing risk and benefit when initiating or continuing psychotropic medications, and offers guidance on red flags for perinatal psychosis.

We also highlight The Periscope Project, a model for expanding access to reproductive psychiatry expertise, and discuss training pathways and future directions in women’s mental health.

Key References & Clinical Resources

1. The Periscope Project – A perinatal psychiatry consultation and resource program based in Wisconsin.
2. National Access Programs – Lifeline for Moms – A directory of statewide perinatal mental health access programs.
3. National Curriculum in Reproductive Psychiatry (NCRP) – Free, evidence-based training for clinicians in reproductive psychiatry.
4. MGH Center for Women’s Mental Health – Clinical and research resource for perinatal and reproductive psychiatry.
5. MotherToBaby – Trusted information on medication and other exposures during pregnancy and breastfeeding.
6. Pharmacologic Treatments for Mania (Kishi 2021) – Meta-analysis regarding antimanic effects of selective estrogen receptor modulators.