The female reproductive cycle has many phases. These range from the premenstrual to the peri and postmenopausal phases. There are many variables, which can contribute to these reproductive phases creating psychiatric comorbidities.
In order to understand some of the more salient details of these influential variables, we need to review some basics. Epidemiologic studies over time and with large sample cohorts demonstrate that women are at a significantly greater risk for major depressive disorder when compared to men.
The National Comorbidity survey revealed that between the ages of 15 and 54 years the lifetime prevalence of Major Depressive Disorder is 12.7% for men and 21.3% for women. More recent studies demonstrate a two-fold greater lifetime risk of developing Major Depressive Disorder in women. It has been suggested that the increased prevalence findings are likely to be associated with female-specific reproductive events i.e. Perimenstrual emergence, pregnancy, postpartum events and menopause.
The hormones estrogen and progesterone have been implicated to affect regions of the brain responsible for the modulation of certain moods and behaviors. Receptor sites for these hormones are located in the prefrontal cortex, thalamus, hippocampus and brain stem. Fluctuations in these steroidal gonadal hormones are thought to create a window of vulnerability for psychiatric comorbid states.
These psychiatric states include for example depressive episodes, (ranging from dysphoria to major depressive severity), anxieties (ranging form generalized levels to debilitating panic degrees), somatic symptoms (which can exacerbate preexisting medical disorders – ie. vasomotor symptoms like hot flashes and nights sweats, premenstrual asthma and perimenstrual migraines).
There are psychosocial factors that can also be associated with mood and anxiety based complex symptoms. Sexual maturity stages, increasing social pressures, past traumas, socioeconomic and educational status, stressful life events, medical issues, inadequate social support, marital-sexual issues, divorce, death of a spouse, empty nest issues, caring for aging parents and several health issues may all be factors that lead to an increased susceptibility to hormonally catalyzed psychiatric disorders.
The stages of the reproductive cycle and conforming age ranges vary according to the events involved (i.e. puberty, perimenstrual, childbirth, postpartum and perimenopausal phases of the female reproductive life cycle).
The first phase of change labeled as premenstrual dysphoric disorder (PMDD), begins during the late luteal phase of the menstrual cycle (this lasts 7-10 days and may continue forward into the subsequent follicular phase). These symptoms often adversely affect biopsychosocial function and overall quality of life.
PMDD occurs during periods of progesterone and estrogen instability. Serotonin-mediated systems play a central role in the occurrence of both premenstrual syndrome (PMS) and PMDD. As a result, serotinergic antidepressants have shown to be beneficial for these disorders. Untreated, women with PMS and PMDD were likely to develop comorbid psychiatric diagnoses. For example, comorbid rates of anxiety, mood disturbances and somatoform disorders were 47%, 30% and 28% respectively.
Preexisting issues of these psychiatric disorders present as a significant risk to develop PMDD as well.
Other significant phases of the reproductive cycle including pregnancy, post partum, the menopausal transition and gyn cancer will be discussed in further detail in subsequent articles.
Suffice it to say in closing, that there are several different recommended treatment modalities that may help to measurably benefit these comorbid medical (OB-GYN) and psychiatric diagnoses. These include, but are not limited to- hormone replacement therapy, biological identical hormone therapy, serotinergic antidepressant therapy, psychotherapy, alternative medicine therapies, and other psychotropic medication options as indicated. Each of these alone or in combination may play a useful role in managing the various aspects of these various phases of female hormonal transitional instability and co-occuring psychiatric disruptions.
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Q. What form of treatment for these problems do you provide
A. I provide the comprehensive psychiatric evaluation of these biological and emotional states. Subsequently, any need identified which would benefit from psychopharmacologic interventions, several psychotherapeutic modalities, appropriate laboratory testing and OB-GYN collaborative referral and alternative medical care are readily available. Medication needs and psychotherapies are provided solely by me for better continuity of care and greater patient convenience.
Q. Are there any age limits to the female population that you treat
A. We begin our age appropriate care at 14 years of age and continue it into geriatric care.
Q. How long does it take to see some improvement
A. A patient’s preferences, psychiatric history, depression, anxiety – even psychosis will create the severity that will determine which options to consider and in what sequence. An individualized plan will be formulated. The veracity of improvement depends upon the patient’s issues, priorities and comfort with recommended treatments.
Q. How do I make an appointment Is a referral needed What is the wait time and how are fees handled
A. If you are in the Atlantic City, NJ area, call for an appointment for an evaluation with our office manager at 609-484-0770 or leave a message in our confidential voice mail and we will assist you with your appointment needs. Referrals are generally not required, but you may check with your insurer. The wait time is generally about one week. It is a fee for service basis, but we also again suggest you check with your insurer for details.
Medicare is accepted but at the non-par reimbursement rates.
