Dr. Burt specializes in reproductive psychiatry and women’s mental health, addressing the areas of:
- Pre-pregnancy consultation for women with mood and anxiety disorders
- Mood and anxiety disorders in pregnancy
- Postpartum depression and anxiety
- Psychiatric treatment of infertility for women and couples undergoing assisted reproduction
- Psychiatric treatment for women and couples experiencing pregnancy loss
- Psychiatric treatment for women and couples grieving the loss or illness of a child
Pre-pregnancy consultation for women with mood and anxiety disorders
Women with significant psychiatric histories should plan in advance for, even if they are not currently symptomatic or taking medications. The goal is for women to become pregnant when they are feeling well and able to handle the physiological and psychological demands of pregnancy and motherhood. With this in mind, women with histories of psychiatric disorders who wish to become pregnant are carefully evaluated and treatment recommendations are made so that they can move forward to become mothers in the safest way possible for themselves and their babies. Patients receive written copies of their consultation, with carefully thought-out, evidence-based justification for treatment recommendations.
Mood and anxiety disorders in pregnancy
It is important to remember that the overall mental health of an expectant mother is an important determinant of the health of the fetus and newborn. The goal of treatment is to maintain psychiatric stability while minimizing risks to the developing fetus. Depression and anxiety are sometimes overlooked during pregnancy, because changes in sleep, appetite and energy coincide with normal physical complaints of pregnancy. However for women with histories of depression, bipolar disorder, anxiety, panic, and OCD, particularly if they have discontinued the psychiatric medications that have kept them stable before or as they became pregnant, the risk of relapse and recurrence is significant. Symptomatic relapse makes pregnancy a challenge and seriously increases the risk for postpartum psychiatric disorders. Thus, patients with active psychiatric disorders during pregnancy require careful assessment and care. A treatment program is developed after careful consideration of the risks and benefits for both mother and fetus of the various treatment modalities (e.g., psychotherapy, medications, and other treatments). The written consultation is carefully reviewed with the patient and (with the patient’s permission) her other care providers.
Postpartum depression and anxiety
Postpartum psychiatric illness has been associated with ongoing risks for recurrent illness in the future and has serious negative effects on the infant and the family. Conditions of disordered mood occurring following childbirth include postpartum blues, depression, bipolar disorder, psychosis, and anxiety (including generalized anxiety, panic disorder and OCD). About one-half of new mothers wish to breast-feed. Women at risk for postpartum psychiatric disorders or who suffer from active postpartum disorder symptoms are comprehensively assessed and evaluated. Attention is paid to the physical as well as the psychiatric factors associated with postpartum psychiatric difficulties. A carefully thought-out treatment plan is organized and justified by evidence-based medicine that takes into account the risks and benefits for the new mother and her baby. For breast-feeding mothers, if psychiatric medications are suggested, the choice of medication carefully takes into consideration the safest options for their breastfed babies.
Psychiatric treatment of infertility for women and couples undergoing assisted reproduction
Up to 15% of all couples are unable to conceive after one year of unprotected intercourse. Infertility is probably caused by male factors in about 50% of cases. In addition to the usual known female causes of infertility, eating disorders, depression and anxiety may be associated with a decline in ovarian function and may therefore also contribute to difficulties with conception. The difficult and demanding aspects of infertility involve the daily monitoring of reproductive-related bodily functions and can have a negative impact on spontaneity and intimacy. For women with preexisting psychiatric disorders, infertility often produces negative mood changes and may precipitate relapses and recurrences. A psychiatric evaluation may be helpful to address the mental health needs of women dealing with the challenges of infertility and also enhance her ability to move forward with fertility treatments. Psychiatric treatment options include psychotherapy (both individual and couples therapy), and sometime judiciously chosen psychiatric medications.
Psychiatric treatment for women and couples experiencing pregnancy loss
Miscarriage and late term pregnancy loss is a serious traumatic event. Often, parents who have experienced miscarriage or later fetal losses, feel isolated, confused, and fearful. Research has shown that in the six months following a pregnancy loss, women frequently experience anxiety and depression. The psychiatrist’s role for women and their partners experiencing a pregnancy loss is to provide support, an opportunity to sort through the various (often overwhelming) feelings and disturbing thoughts, and to distinguish carefully between normal bereavement and psychiatric illness. In cases where bereavement evolves into a more serious psychiatric condition (which frequently occurs when there is a prior history of depression or anxiety), a combination of psychotherapy and psychopharmacology can effectively provide full relief and allow for movement forward with a sense of peace of mind despite the very understandable sadness associated with loss.
Psychiatric treatment for women and couples grieving the loss or illness of a child
The loss of a child or the realization that a child has a serious illness presents loving parents with an enormous burden of grief and sorrow. While a normal response to the loss or illness of a child is one of depressed mood and often anxiety as well, it is important to ensure that grieving parents are given the opportunity to vent their feelings in a safe and empathic setting. Frequently parents are not synchronized with one another with regard to their feelings and therefore cannot use one another as a source of comfort and release. Thus a psychiatrist is able to offer to parents suffering these sorts of losses a forum to talk, to review, to mourn, to rebuild, to regain hope and perspective. In some cases, if the intensity of symptoms is so great that function is impacted, more aggressive treatment is indicated and will enhance a return to normal functioning. This is particularly important when other children are present in the family, and are themselves facing the grieving process while trying to move on in their own lives.