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Women and Mood

Women and Mood

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Women and Mood

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  1. Women and Mood Di Thompson, MD Medical Director, Behavioral Health and Integrative Services Penrose-St Francis

  2. Everything was fine until she turned twelve! Adolescence/first period PMS Pregnancy Post-partum Peri-menopause Women and Modd– January, 2014

  3. Let’s start with Teen-age GirlsMatejSternen (September 20, 1870 – June 28, 1949) January, 2014

  4. National Survey on Drug Use and Health show that among 13 to 17 year olds the prevalence of depression among girls is nearly 3 times as high as that for boys…what’s going on here? Presentation Title – Women and Mood– January 2014

  5. The hormonal changes eventually culminate in the first menstrual cycle • Depending on how this has been described to the young women, the event can have a positive or negative effect: • Option 1: Shameful, unsanitary and threats about pregnancy • Anorexia, Depression • Option 2: Celebration of womanhood, appreciating the body as mysterious and wonderful • Self Respect Women and Mood– January 2014

  6. Symptoms of PMS • Physical and Emotional • Symptoms of PMDD-must total 5 or more • 1 or More: • Marked Lability • Marked Irritability • Marked Depressed Mood • Marked Anxiety • 1 or More: • Decreased Interest in Activities • Difficulties with Concentration • Lethargy, Fatigability • Change in Appetite • Overwhelmed or Out of Control • Physical: breast tenderness, muscle pain, bloating PMS versus PMDD (American Psychiatric Association [DSM-5]. 2013) Women and Mood– January 2014

  7. Hormones and Behavior…any theories? Women and Mood– January 2014

  8. Treatment for PMS and PMDD • PMS • Bloating: decrease intake of salts, over-eating • Breast tenderness and headaches: Tylenol, Motrin • Mood: assess for underlying depressive disorder Women and Mood– January 2014

  9. Premenstrual Dysphoric Disorder SSRI’s: 60-70% vs. Placebo 30%; intermittent vs. continuous (Dimmock, 1998) Oral Contraceptives: frequently used but little data; 35% better and 21% worse (Sanders, 2001) Calcium: 48% efficacy for physical and emotional symptoms-except fatigue vs. 30% placebo. 600mg (Thys-Jacobs, 1998) Women and Mood– January 2014

  10. Cravings and Serotonin • Slight drop in serotonin = increase in carb cravings; the body uses carbs to make serotonin. Simple sugars (ie Snickers Bar)are metabolized more quickly than complex carbs, so they offer a quick serotonin fix and another drop. • Vicious Cycle: PMS means higher stress level… cortisol. If cortisol is high and serotonin is low, cravings may include both carbs and fats. Is there a pill to stop the food cravings?! Women and Mood– January 2014

  11. Eat complex carbs: whole-grain breads, pasta, and cereals. • Avoid processed sugar: Simple sugars increase insulin secretion, insulin levels shoot up enough, your appetite for carbs and fats increases. • Try foods high in essential fatty acids: Salmon, Sardines, salmon, flax seeds and walnuts allow for slower but steady absorption of carbs, this stabilizes the blood sugar, and can stop cravings • Drink plenty of water: 8 glasses of water a day can reduce bloating. • Shun salt to reduce bloating and fluid retention Advice for your patients Women and Mood– January 2014

  12. Avoid processed fat; it decreases the absorption of carbohydrates that are needed to make more serotonin. • Limit coffee and cola because caffeine intake may cause irritability and to ease breast soreness, advises the American Association of Family Physicians (AAFP). • Drinking just prior to menses may increase symptoms of depression, according to the AAFP and it can disrupt the metabolism of carbohydrates. How about those food cravings? Women and Mood– January 2014

  13. Let’s explore the differences between men and women a bit more • Estrogen • Serotonin • What about gender and pharmacologic treatment response? Metabolism on Mars and Venus Women and Mood– January 2014

  14. Am J Psychiatry 2000;157:1445-1452 Women and Mood– January 2014

  15. Pregnancy, Blues and Post Partum Depression RihardJakopič (12 April 1869 – 21 April 1943) Women and Mood– January 2014

  16. Pregnancy is not associated with particularly high rates of depression. They are about equal to or slightly less then “Pre-pregnancy” rates. • However when it occurs, it is essential to address for mom’s health and baby’s health First the good news… Women and Mood– January 2014

  17. Among women with depression, 4.6% had illness episodes during pregnancy and 30% during the postpartum period. • Episodes were 3.5 times more prevalent during the postpartum period than during pregnancy, and the risk was higher with bipolar disorder (Viquera, 2011) Then… the postpartum mood issues Women and Mood– January 2014

  18. Not a psychiatric disorder • Psychoeducation is crucial • Education should involve significant others • MatejSternen (September 20, 1870 – June 28, 1949) The Blues, hormones and toothpaste commercials Women and Mood– January 2014

  19. Post Partum Depression: hormones, history and current issues An estimated 9-16 percent of postpartum women will experience PPD. Among women who have already experienced PPD following a previous pregnancy, prevalence estimates increase to up to 41 percent Women and Mood– January 2014

  20. affect ability to function in everyday life • Problematic with new role adjustments • Redefining spousal and familial relationships, and work role. • Anhedonia, sleep disturbance, irritability, and thoughts of hurting oneself or one’s child; • lead to difficulty in providing developmentally appropriate care to infants; Post-partum Depression and Major Depression Women and Mood– January 2014

  21. Children of mothers with PPD can: • become withdrawn, irritable, or inconsolable; • display insecure attachment and behavioral problems; • experience problems in cognitive, social, and emotional development; • have a higher risk of anxiety disorders and major depression in childhood and adolescence. The issue is just not confined to mom Women and Mood– January 2014

  22. Treat Early • Antidepressant medications • Talk Therapy Treatments Women and Mood– January 2014

  23. The next hormone shift…Menopause! HOT FLASHES MOOD WEIGHT LIBIDO Women and Mood– January 2014



  26. HOT FLASHES AND THE HYPOTHALAMUS Women and Mood– January 2014

  27. The size of a pea… The hypothalamus is the body’s thermostat. The hypothalamus responds to various temperature receptors throughout the body and makes adjustments to maintain a constant core temperature. For example, on a hot day, temperature receptors located in the skin send signals to the hypothalamus to cool the body by increasing the sweat rate. ESTROGEN is one of the receptors! Women and Mood– January 2014

  28. The Peri-Menopause Menopause antidote • HOT FLASHES • Weight Loss/weight gain • Breathing • Exercise • Medications Women and Mood– January 2014

  29. MOOD, LIBDO and WEIGHT Women and Mood– January 2014

  30. Treatments are no different than at any other stage • Psycho-education • Psychotherapy • Exercise • Medication Women and Mood– January 2014

  31. Changes in Estrogen/Male Androgen ratio • Storage of Estrogen in fat cells • But it’s not as easy as blaming hormones • ANTIDOTES • Exercise • Lifestyle • Medical issues: Thyroid, medications • Mood: Atypical depression “How did I gain 5 pounds when nothing else has changed?” Women and Mood– January 2014

  32. Desire • Physical changes • Emotional changes • SWAN study 2400 women … • Lower estrogen: • Lower testosteron • Lubricants • Moisturizers • cling to vaginal wall, mimic natural secretions,longer term effects-3-4 days ie Replens, Lubrin • Low dose vaginal estrogen • Non-FDA • Bupropion • Sildenafil (Viagra) • DHEA Libido: Mood, Estrogen…it’s all connected! Women and Mood– January 2014

  33. Women at different stages…Mood and Hormones always intertwined Pre-teens, PMS, PDD, Pregnancy, Postpartum, Perimenopause Women and Mood– January 2014

  34. Women’s issues are unique…Just as the artists celebrates her form, encourage your patients to celebrate their minds and bodies! Women and Mood– January 2014