By: Dr. Naomi Vilko
It all starts with puberty.
Until then, boys need psychiatric intervention at two times the rate of girls. At puberty, this reverses.
From then on, women have rates of depression and anxiety disorders two times that of men. Mood disorders peak in women at times of hormonal flux: in adolescence, the premenstrual period and perimenopause.
Depression is not just a problem for the identifiably mentally ill; it is very common and very treatable. Incredibly, though, 60 percent of those affected by depression are not getting any help. Just as everyone is entitled to good physical examinations, everyone deserves a good psychiatric evaluation.
Many women are troubled with premenstrual syndrome for the week or two before their menstrual period. These symptoms include irritability, sudden mood changes, tension, sadness, decreased interest in usual activities, difficulty concentrating, abdominal bloating and breast tenderness, food cravings, lack of energy, change in sleep, and relationship problems.
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‘Mood changes in menopause are related to the profound effects that hormones have in the brain. Don’t be afraid to ask friends, relatives or co-workers if they are depressed.’ Dr. Naomi Vilko
Psychiatrist The Medical Center at Princeton |
Most women have at least some of these symptoms. Some women have severe symptoms which lead to functional impairment at home, school or work. Premenstrual exacerbation of other medical conditions is very common. Migraine headaches, irritable bowel syndrome, seizure disorders and psychiatric disorders usually get worse during the premenstrual period. These common medical disorders can become unbearable during these years, leading to more depressive symptoms.
Premenstrual syndrome peaks in severity in the perimenopausal period. To make things even more complicated, symptoms of PMS are unrelated to actual hormone levels. Instead, they are probably the result of a woman’s reaction to cyclical variations in hormone levels, which become more pronounced during perimenopause.
Women always have fluctuations in hormone levels. During the 10 years or so before the cessation of menses, hormone fluctuations become more dramatic. The brain has a hard time coping with these wildly fluctuating levels of estrogen and progesterone. Women are more vulnerable to mood disorders in their 40s, because estrogen and progesterone have profound effects on the brain chemicals, which regulate mood, sex, sleep and memory.
Because women’s bodies produce wildly varying amounts of hormones during perimenopause, it is often not easy to take estrogen supplementation. Typical symptoms of mood disorders in women include a combination of an unhappy mood and anxiety.
The common symptoms of hormonal mood changes in the brain are irritability, mood swings, fatigue, hot flashes, changes in sleep and not getting pleasure out of one’s favorite activities. Often women complain of poor coordination and they do get into more accidents during the premenstrual period of the month.
During perimenopause, irregular and heavy bleeding can add additional stress. Loss of interest in sexual activity can become more common. Women may find themselves less focused and have trouble concentrating and/or remembering things. Some women who have mild symptoms can benefit from some amounts of estrogen during the perimenopause and then go on to receive hormone replacement therapy.
Whether or not HRT is taken is an individual decision which involves risk factors, symptoms and individual preferences. If hormone therapy is chosen, there needs to be flexibility in the type and amount prescribed as well as good communication between the patient, the gynecologist and the psychotherapist.
Estrogen can be used for short-term symptomatic relief of symptoms. After a woman reaches menopause, the issues of prevention of cardiovascular disease, osteoporosis and memory loss need to be considered.
For sexual dysfunction, estrogen delivery by vaginal route is often most effective. Understanding the effects of sex steroids on the brain is the new frontier in research in menopause.
Estrogen has a positive effect on memory, mood and quality of life scales. There are reports that women with histories of depressive episodes may respond better to natural hormones, so this is another option. Women who are clinically depressed need antidepressants as well as HRT. It is comforting to know that antidepressants are not addictive.
Those women who have a history of PMS and postpartum depression are more sensitive to the effects of hormonal fluctuations and are particularly at risk of developing perimenopausal depression. Women with a family history of bipolar illness are also at risk for both manic and depressive episodes during perimenopause.
Seeing an experienced psychiatrist and taking prophylactic therapy as indicated can offer much relief. Other risk factors that can contribute to an overall feeling of malaise include being overweight, drinking too much alcohol and suffering from sleep disorders. It is important that all of these conditions be diagnosed and treated.
When it comes to sleep, sometimes hormone therapy helps and sometimes sleep medication is needed. Without treatment, sleep deprivation can become part of a vicious cycle of insomnia leading to low energy and low mood, leading to more insomnia. Hot flashes during the night also disrupt sleep. Good sleep hygiene includes exercising, making dietary changes, practicing relaxation techniques, limiting alcohol and adjusting medications as needed.
Depression is one of the most common medical problems that women have, and it is very costly to our society. Depression is a medical illness that is twice as common in women as in men and affects both body and mind. Depression is the result of a combination of genetic vulnerability, environmental factors and psychological stresses.
Mood changes in menopause are related to the profound effects that hormones have in the brain. Don’t be afraid to ask friends, relatives or co-workers if they are depressed. Ask people if they are finding life less enjoyable, have trouble sleeping, are drinking more alcohol or having relationship problems.
The earlier a person gets treatment, the better the outcome. This holds true for mood disorders, alcoholism and menopausal symptoms, as well as heart disease and cancer. The best way to fight the stigmatization of psychiatric illness is with education.
Women need to take control of their healthcare and insist on getting the best information to guide them in keeping their bodies and minds healthy. Remember that there are very effective treatments available and feeling good about yourself can make all the difference in the world.
Dr. Naomi Vilko is a psychiatrist on staff at The Medical Center at Princeton. Dr. Vilko has a private psychiatric practice in Princeton, specializing in the treatment of women. Health Matters appears Fridays in the Lifestyle section of The Packet and is contributed by The Medical Center at Princeton.