Marlee Madora

Marlee Madora, MD, a reproductive psychiatry fellow at the Brigham, wants to improve mental well-being for expecting and new parents, a longstanding interest sparked by her early work at a methadone clinic for perinatal patients. She reflects on how a diverse team of non-medical and medical specialists must work together to care for new mothers, both during and after their pregnancies. This year, she published a narrative review tracing the complex medical, psychological and social treatments required for one mother with postpartum psychosis, a diagnosis that often goes undetected and unaddressed. In this Q&A, she discusses her career trajectory, her reproductive psychiatry research, and the future of treating women’s mental health through preventative and holistic wellness-focused approaches.

Q: What drew you to study women’s mental health, especially for postpartum patients?

During my medical school in Philadelphia at Thomas Jefferson University, I had the opportunity to work at a methadone clinic for pregnant and postpartum people. Many of my patients had a history of childhood trauma and used opioids to cope with symptoms of post-traumatic stress disorder, such as nightmares and flashbacks.

I saw the transformative impact of reproductive psychiatry, where evidence-based interventions and psychopharmacology can help patients heal and manage their distress rather than relying on substances of abuse. I was inspired by witnessing how motherhood served as a powerful motivator for recovery. After that experience, I knew I wanted to pursue this type of work, helping mothers become the best versions of themselves.

Q: What motivated you to apply to the Women’s Health Fellowship at Brigham?

I pursued a fellowship in reproductive psychiatry to gain a deeper understanding of how hormones influence mental health throughout a woman’s lifespan, not just during pregnancy and postpartum. The diversity of patients and clinical experiences offered by the Brigham Fellowship appealed to me. I love collaborating with my team of incredible psychiatrists within the Division of Women’s Mental Health, as well as the social workers, psychologists, case managers, obstetricians, pediatricians and other esteemed support staff at the Brigham. The people, including the extraordinary patients, are always what makes the experience special.

Q: Can you tell us more about your recent narrative review? Who is the patient Ms. A, and what were the steps taken to treat her for a mood/psychotic disorder as opposed to just her immunologic abnormalities? What are the roles of different medical specialists making these diagnoses?

The narrative review focuses on a patient I encountered during my residency who was diagnosed with postpartum psychosis but had a complex presentation and course of treatment.  She developed delusions, hallucinations and insomnia, along with neurological symptoms such as alterations in consciousness and confusion soon after delivery. Various specialists needed to work together to appropriately diagnose and treat her. Our team of psychiatrists was concerned that her symptoms were due to postpartum psychosis and recommended a mood stabilizing antipsychotic. The neurology team was concerned about autoimmune encephalitis, and recommended steroids to reduce the inflammation. This combined treatment approach led to rapid improvement; however, it also complicated the identification of the precise underlying cause of her condition.

Q: What were you taught during medical school and residency about typical management of postpartum psychosis since there is no formal diagnostic criteria or standardized guidelines?

During my general medical training, I never learned the unfortunate truth that psychiatric disorders are a leading cause of maternal morbidity and mortality. After following my interest in the field of reproductive psychiatry in residency, I learned about postpartum depression and psychosis. The current understanding is that postpartum psychosis often manifests in individuals at risk of bipolar disorder, which can be unmasked during the postpartum period due to hormonal fluctuations and sleep deprivation. Treatment involves employing similar psychopharmacotherapy used for bipolar disorder, such as mood stabilizers like lithium and antipsychotics. Prioritizing sleep and utilizing sedating medications like benzodiazepines to aid recovery is also crucial. Close monitoring and hospitalization in a psychiatric facility are often required since unsafe behaviors can abruptly arise.

Q: What other research questions are you working on? How do you see the diagnoses and treatment of women’s mental health disorders evolving in the coming years, and how will your career fit into this?

I am currently involved in projects to expand mental health care for new mothers at Brigham and Women’s Hospital. One such initiative is The Lullaby Project, originally created at Carnegie Hall, where we pair new and expectant caregivers with songwriters to create personalized lullabies that improve mental well-being, childhood neurodevelopment and family bonding.

Recognition of the importance of treating mental health conditions in the perinatal period is growing, and I am excited to witness the research and care programs that will emerge in response. I strive to enhance access to reproductive psychiatry services across diverse clinical settings and advocate on a larger scale for the improvement of family well-being through the implementation of preventative and integrative approaches.

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