Perinatal Psychiatry: Risk, Ethics, and Clinical Decision-Making with Dr. Christina Wichman

Pregnancy and postpartum are times of profound change and nowhere is that complexity more visible than in psychiatry. In this episode, 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 a deep dive into reproductive psychiatry. Co-hosted by Erica Browne, an M4 at Saint Louis University School of Medicine, this conversation explores how to care for both mother and baby with empathy, evidence, and balance. We walk through distinctions between baby blues, perinatal depression, and major depressive disorder, discuss how to identify red flags for perinatal psychosis, and explore the ethical and clinical nuances of treating psychiatric illness during pregnancy and lactation. Dr. Wichman explains how to approach risk–benefit decisions around psychotropic medications, highlights validated screening tools, and offers real-world strategies for supporting patients who face barriers to care. We also spotlight The Periscope Project, a pioneering model for connecting clinicians with reproductive psychiatry expertise—and discuss how the field is expanding training, access, and awareness for the next generation of women’s mental health specialists.

Takeaways:
Pregnancy changes everything, but not always for the worse. Psychiatric treatment during pregnancy can and should be individualized, balancing the safety of both mother and baby.

Know the distinctions. Baby blues typically resolve within two weeks; perinatal depression lasts longer, while postpartum psychosis requires urgent evaluation.

Medication decisions are about risk versus risk. Untreated psychiatric illness carries real dangers, sometimes greater than the medications themselves.

Access matters. Programs like The Periscope Project expand reproductive psychiatry consultation to clinicians everywhere, improving outcomes system-wide.

The future is integrated care. Psychiatrists, OB-GYNs, and primary care providers working together can transform perinatal mental health into standard, not specialized, care.


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

SUPPORT OUR PARTNERS:
⁠⁠⁠⁠⁠SimplePractice.com/bootcamp⁠⁠⁠⁠⁠ (Now with AI documentation! Exclusive 7 day free trial and 50% off four months)
⁠⁠⁠⁠⁠Beat the Boards⁠⁠⁠⁠⁠ Boot camp listeners now get FREE access to over 4400 exam-style questions)


Learn more and get transcripts for EVERY episode at https://www.psychiatrybootcamp.com/
For Sales Inquiries & Ad Rates, Please Contact:⁠⁠⁠⁠[email protected]⁠⁠⁠⁠
Connect with HumanContent on Socials: @humancontentpods
Produced by: ⁠⁠⁠⁠Human Content⁠⁠

Chapters:
00:00 Introduction and Personal Relevance
00:50 Episode Overview and Guest Introductions
02:03 Dr. Wichman's Journey into Reproductive Psychiatry
05:29 Balancing Treatment for Mother and Child
09:19 Understanding Postpartum Mental Health
21:10 Navigating Medication Decisions
24:28 Resources and Future Directions in Perinatal Psychiatry
27:25 Case Study and Practical Applications
29:08 Sponsorship and Final Thoughts
31:53 Ensuring Diagnostic Accuracy in Complex Patients
34:00 The Importance of Sleep for New Mothers
34:48 Non-Pharmacologic Options for Perinatal Mood Management
41:10 Distinguishing Intrusive Thoughts from Psychotic Symptoms
43:39 The Periscope Project: Supporting Perinatal Mental Health
52:33 Training Opportunities in Women's Mental Health
57:05 Final Thoughts and Encouragement