UNC-Chapel Hill professor and psychiatrist Samantha Meltzer-Brody is transforming the way care is delivered to women during pregnancy and postpartum.
Meltzer-Brody, who has studied women’s mood disorders and developed treatments for mothers experiencing depression during the perinatal period, was recognized by Forbes Magazine this month as one of “16 Healthcare Innovators That You Should Know.”
The honor highlights a career that has been focused on empowering women and believing that they need to have access to care that protects their mental health and that of their families.
Meltzer-Brody’s work is even more critical as North Carolina lawmakers discuss Medicaid expansion and following the U.S. Supreme Court’s decision to overturn Roe v. Wade, ending women’s constitutional right to abortion..
“We’re living in complex times in which it becomes very important that we protect women’s ability to have agency over decision-making on issues in their lives to preserve mental health,” Meltzer-Brody said.
Innovation in health care for women, mothers
A professor in the School of Medicine, Meltzer-Brody joined the UNC-CH faculty in 2002 and two years later founded the UNC perinatal psychiatry program. She’s currently the Assad Meymandi Distinguished Professor and chair of the department of psychiatry and also directs the UNC Center for Women’s Mood Disorders.
Meltzer-Brody and her UNC-CH colleagues opened the first perinatal psychiatry inpatient unit in the US in 2011. There, the team was able to do clinical trials for brexanolone or Zulresso, which became the first FDA-approved medication for postpartum depression in 2019.
That drug is one of the only fast-acting antidepressants offered to patients, Meltzer-Brody said. Brexanalone is given through an IV, but she’s helping develop a pill called Zuranolone as a fast-relief oral treatment for postpartum depression. That drug could get FDA-approval in the next year.
Meltzer-Brody and her colleagues, in collaboration with the Patient-Centered Outcomes Research Institute, are also running a federally funded study that looks at how to train obstetrician nurses to help deliver psychotherapy interventions using virtual care and in-person care.
“We’re looking at models of task-shifting, acknowledging that there will never be enough trained mental health providers to deliver psychotherapy and psychological interventions for all the perinatal women that need it,” Meltzer-Brody said.
Mental health has historically been underfunded and stigmatized, and its prevalence has doubled, tripled or more depending on the population.
“No one is going through life without being touched in some way, it’s either themselves personally or their family member or their child,” she said. “We can’t turn our heads the other way anymore.”
Improving access to mental health services
One of the only silver linings of the pandemic is that it forced insurance companies to start paying for telepsychiatry and telemedicine, she said. The technology has been there, but there was reluctance to pay for it.
Many of the 100 counties in North Carolina have few or no psychiatrists. Care is congregated in major metro areas, according to Meltzer-Brody. With limited access to in-person mental health care, the telehealth option has been critical given the increased levels of anxiety and depression during the pandemic.
And Meltzer-Brody hopes to expand on that.
“We have a national mental health crisis. We have a shortage of mental health professionals,” she said. “If we can use telepsychiatry to bridge that and take care of people then we absolutely have to continue to pay at parity.”
Meltzer-Brody also used digital health and app-based approaches to create the largest genetic study of postpartum depression, called the “Mom Genes” study. Using an iPhone app, her team collected DNA from thousands of women with postpartum depression to study their genetic samples.
Their findings will be presented at scientific conferences this fall.
“The genetic study is trying to understand what is the genetic signature of postpartum depression and how does that lead us to develop improved understanding and then develop novel therapies,” Meltzer-Brody said.
One treatment is not going to work for all women, so understanding that genetic signature allows researchers and doctors to be more targeted in their approach.
Taking care of women means taking care of children
Since the pandemic hit and Meltzer-Brody has become department chair, she’s thinking more broadly about mental and behavioral health.
North Carolina is ranked 42nd out of 50 state for resources put into addressing adolescent mental health, yet it’s the ninth most populated state in the country.
“There’s a massive need for us to intervene for mothers and their children,” Meltzer-Brody said.
Despite the growing number of women in the workforce, they still have disproportionately the overwhelming burden of caretaking demands, Meltzer-Brody said. And research shows that women and girls are twice as likely to experience depression.
She sees maternal and mental health as a way to take care of women during the vulnerable perinatal period. And that leads to taking care of the next generation.
“If we’re going to take care of women then we better be taking care of their kids,” Meltzer-Brody said.
The work is heavy, traumatic and difficult. The rapport with patients and seeing people get better on a individual basis keeps her going, she said, and developing programs to amplify that care is rewarding.
“You see a very distressed woman come in during pregnancy or postpartum and it is a crisis,” Meltzer-Brody said. “If you’re able to intervene, seeing that family come back, that mom come back and seeing the impact with the adorable baby … it feels enormously fulfilling.”