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Women and Mood . Di Thompson, MD Medical Director, Behavioral Health and Integrative Services Penrose-St Francis. Everything was fine until she turned twelve!. Adolescence/first period PMS Pregnancy Post-partum Peri -menopause.

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women and mood

Women and Mood

Di Thompson, MD

Medical Director, Behavioral Health and Integrative Services

Penrose-St Francis

everything was fine until she turned twelve
Everything was fine until she turned twelve!

Adolescence/first period

PMS

Pregnancy

Post-partum

Peri-menopause

Women and Modd– January, 2014

slide5
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

slide6
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

pms versus pmdd american psychiatric association dsm 5 2013
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

hormones and behavior any theories
Hormones and Behavior…any theories?

Women and Mood– January 2014

treatment for pms and pmdd
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

premenstrual dysphoric disorder

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

is there a pill to stop the food cravings
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

advice for your patients
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

how about those food cravings
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

metabolism on mars and venus
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

am j psychiatry 2000 157 1445 1452
Am J Psychiatry 2000;157:1445-1452

Women and Mood– January 2014

pregnancy blues and post partum depression rihard jakopi 12 april 1869 21 april 1943
Pregnancy, Blues and Post Partum Depression RihardJakopič (12 April 1869 – 21 April 1943)

Women and Mood– January 2014

first the good news
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

then the postpartum mood issues
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

the blues hormones and toothpaste commercials
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

post partum depression hormones history and current issues

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

post partum depression and major depression
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

the issue is just not confined to mom
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

treatments
Treat Early
  • Antidepressant medications
  • Talk Therapy
Treatments

Women and Mood– January 2014

the next hormone shift menopause
The next hormone shift…Menopause!

HOT FLASHES

MOOD

WEIGHT

LIBIDO

Women and Mood– January 2014

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MENOPAUSE: 12 CONSECUTIVE MONTHSPERIMENOPAUSE: IRREGULAR MENSES, FLUCUATIONS, UP TO 6 YEARS BEFORE AND ENDS WHEN NO MENSES FOR 1 YEARPREMATURE MENOPAUSE: AGE 40 OR YOUNGER

WHAT IS MENOPAUSE?

Women and Mood– January 2014

estrogen is mother s little helper
PROMOTES BONE GROWTH

PREVENTS VAGINAL ATROPHY

INCREASES FUNCTION OF NEUROTRANSMITTERS

AIDS IN TEMERATURE REGUALATION

ESTROGEN IS MOTHER’S LITTLE HELPER!

Women and Mood– January 2014

hot flashes and the hypothalamus
HOT FLASHES AND THE HYPOTHALAMUS

Women and Mood– January 2014

the size of a pea

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

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The Peri-Menopause Menopause antidote
  • HOT FLASHES
    • Weight Loss/weight gain
    • Breathing
    • Exercise
    • Medications

Women and Mood– January 2014

mood libdo and weight
MOOD, LIBDO and WEIGHT

Women and Mood– January 2014

treatments are no different than at any other stage
Treatments are no different than at any other stage
  • Psycho-education
  • Psychotherapy
  • Exercise
  • Medication

Women and Mood– January 2014

how did i gain 5 pounds when nothing else has changed
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

libido mood estrogen it s all connected
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

women at different stages mood and hormones always intertwined

Women at different stages…Mood and Hormones always intertwined

Pre-teens, PMS, PDD, Pregnancy, Postpartum, Perimenopause

Women and Mood– January 2014

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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

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