Essential Reads: Looking Back at 2020

Well, it’s been a year like no other. And we are all hoping for better times in the new year. Nonetheless, as I scroll over the posts from the last year, it is clear that, despite the pandemic, the field of reproductive psychiatry has continued to expand rapidly, with an unprecedented number of papers published in 2020. At the MGH Center for Women’s Mental Health, we have devised new strategies for reaching and supporting patients and their providers, including new virtual course offerings and a weekly remote version of our reproductive psychiatry clinical rounds.

Our website continues to grow. We added about 200 new blog posts in 2020 and attracted 1.9 million visits and a total of 3.6 million page views this year.

As always, we are grateful to our readers and those who support our work and research. We wish all of you health and happiness in the new year.

Ruta Nonacs, MD PhD

Weekly Virtual Rounds

In mid-March, the MGH Center for Women’s Mental Health went remote, and it’s hard to believe that, for the most part, we have not yet returned to the hospital. As a group we continue to meet virtually each week to discuss clinical cases and new research, and we have extended this format to include other clinicians around the country who are interested in reproductive psychiatry: Virtual Rounds at the Center for Women’s Mental Health.

Every Wednesday we look forward to a lively discussion, and, at a time when we are all feeling disconnected, this meeting has strengthened our connections within this community. In addition to having input from all of our faculty members, we have also had the pleasure of having a star-studded list of special guests who have lent their expertise and wisdom to our discussions:

Veerle Bergink, MD PhD – Director of the Mount Sinai Women’s Mental Health Program,

Catherine Birndorf, MD – CEO and Medical Director of the Motherhood Center of NYC

Wendy Davis, PhD PMH-C – Postpartum Support International

Paige Bellenbaum, LMSW – Founding Director of the Motherhood Center of NYC

Dvora Entin, LCSW – Private Practice, Philadelphia

Alison Hermann, MD – Director of the Payne Whitney Women’s Program, Weill Cornell Medicine

Helen Kim, MD – Co-founder and Director of the Hennepin Healthcare Mother-Baby Program

Birdie Gunyon Meyer, RN, MA, CLC – Certification Director, Past President, Postpartum Support International

Alison Reminick, MD – Medical Director of Women’s Mental Health, UC San Diego

Carly Snyder, MD – Private Practice, New York

Adele Viguera, MD MPH – Director of Research for Women’s Mental Health at the Cleveland Clinic

Lisa Weinstock, MD – New York Medical College, in Valhalla, New York

Virtual Rounds will continue into 2021. You can register HERE.

Introducing Essential Reads

In December, we announced a new feature on our website: ESSENTIAL READS. This is a kind of shortcut which allows you to find the most relevant reviews and articles in reproductive psychiatry. Each Wednesday, we add a new article to the collection. In this section of our website, we will highlight the most up-to-date articles to help guide diagnosis, clinical decision-making, and treatment options. For example, if you want to learn more about PMDD, you can simply go to ESSENTIAL READS and look at the PMDD section. As we continue to update this section in real-time, we will be able to provide a curated collection of clinically oriented, practical articles for those interested in reproductive psychiatry.

COVID-19 and Pregnant and Postpartum Women

This year has been a particularly difficult year for women who are pregnant or planning a pregnancy. Especially in the early part of the year when we knew so little about the impact of the novel coronavirus.

•Mitigating psychiatric disorder relapse in pregnancy during pandemic

•Increased Prevalence of Depression, Anxiety in Pregnant Women During the COVID Pandemic

•Resource: A Woman’s Guide to Pregnancy and the Postpartum Period During the COVID-19 Pandemic

•What About Pregnant Women and the COVID-19 Vaccine?

•COVID-19 Positive Mothers and Newborns: What Should we Recommend?

We have created a new page on our website listing various COVID-related resources for our patients and providers:

•COVID-19 Pandemic: Resources for Pregnant and Postpartum Women

Course of ADHD During Pregnancy

While we see a significant number of women with attention-deficit/hyperactivity disorder (ADHD) who are either pregnant or planning to conceive, we have had very limited information on the course of ADHD during pregnancy. A new study from the MGH Center for Women’s Mental Health is the first to prospectively follow women with ADHD during pregnancy.

•New Research from the CWMH: The Course of ADHD During Pregnancy

Zuranolone for Postpartum Depression

While there has been much excitement about the new medication for postpartum depression — brexanolone, marketed by Sage Therapeutics as Zulresso — it has not been widely available because it requires medical supervision during its intravenous infusion. However, an oral version of this novel antidepressant – SAGE 217 or zuranolone – has been finishing up its Phase 3 trials and hopefully will be available in the near future. Like brexanolone, SAGE-217 is a neurosteroid, an analogue of allopregnanolone which is a positive allosteric modulator of the GABA-A receptor. What distinguishes SAGE-217 from brexanolone is that it has much better oral bioavailability and thus does not have to be administered intravenously. It can be taken as an oral medication, just like conventional antidepressants.

•More Data on the Neuroactive Steroid Zuranolone for Postpartum Depression

•Development of Zuranolone (SAGE 217) for PPD Will Move Forward

Other Neuroactive Steroids in the Pipeline

Neurosteroids, also known as neuroactive steroids, constitute a class of steroid hormones produced in the brain and endocrine tissues which can modulate neurotransmission. Animal studies have demonstrated that neurosteroids have a broad range of activities, including antidepressant, anxiolytic, sedative, analgesic, anticonvulsant, neuroprotective, and neuroproliferative effects. Brexanolone and zuranolone are neuroactive steroids derived from allopregananolone for and are effective for the treatment of postpartum depression.

Similar neurosteroids may be effective for the treatment of premenstrual dysphoric disorder (PMDD):

•Allopregnanolone Sparks Interest as New PMDD Treatment

Other neuroactive steroids are being investigated as a treatment for perimenopausal depression:

•Pilot Study of Neurosteroid Ganaxolone for Menopausal Depression

•New Research Study: Pregnenolone Neurosteroid for the Treatment of Menopausal Depression

More Data on the Reproductive Safety of Gabapentin

Although gabapentin (Neurontin) is now used in a wide variety of clinical settings — for epilepsy, pain management, anxiety, sleep disturbance – there has been relatively little information regarding its reproductive safety, until a recent study from Patorno and colleagues. Using data from the US Medicaid Analytic eXtract (MAX) dataset, a population-based study of 1,753,865 Medicaid-eligible pregnancies examined the risk of major congenital malformations associated with gabapentin exposure during the first trimester. Data collected from a total of 4,642 pregnancies with first trimester gabapentin exposure indicated no evidence of an association between gabapentin exposure during early pregnancy and overall risk of major malformations.

•Study Supporting the Reproductive Safety of Gabapentin During Pregnancy

Examining the Impact of Prenatal Antidepressant Exposure on Long-Term Outcomes in Children

In a recent study, Rommel and colleagues present a systematic review examining the long-term effects of prenatal exposure to antidepressants on physical, neurodevelopmental, and psychiatric outcomes in children 4 years of age or older, summarizing data from a total of 34 studies.

•Exposure to Antidepressants During Pregnancy: Less Impact on Long Term Outcomes Than Previously Reported

New Strategies for the Management of Menopausal Symptoms

About 80% of women experience vasomotor symptoms (VMS) – hot flashes and night sweats — as they transition into the menopause phase. For most, the symptoms are manageable, but for a sizable subset of midlife women, these symptoms can negatively affect sleep, mood, cognitive abilities, sexual functioning, and overall quality of life. While several recent articles suggest that the burden of menopausal symptoms is greater than generally perceived, we have a limited number of options when it comes to treating troublesome menopausal symptoms.