It’s a fledgling program but psychiatrist C. Neill Epperson, MD, has big plans for her newly created Penn Center for Women’s Behavioral Wellness, one of a handful of female-centric outpatient mental health programs in the U.S. Although the center sees women of various ages, there’s a special emphasis on the menopausal years, when previously healthy women have a two-fold increase in risk for depression. “Psychiatrists don’t always consider the hormonal component, but at our center we recognize that sometimes treating mood disorders with hormone therapy rather than antidepressants makes the difference,” she says.
Epperson and her team also understand that menopause can worsen the condition of women with a history of mental troubles. “Someone with bipolar disorder can be thrown way off when she experiences the night sweats and sleep disruption typical of menopause, even if her condition was under control before,” Epperson says. Making it easy for patients to find them, the center’s three psychiatrists and one psychologist have extra offices in the hospital’s ob-gyn department. They are also reaching out to hospital cardiologists, since untreated depression in the postmenopausal years substantially increases a woman’s five-year risk of fatal heart attack.
What to look for closer to home: You’ll have to do some sleuthing to find out if a mental health program
understands the role of changing hormones, says Peter Schmidt, MD, chief of the section on behavioral endocrinology at the National Institute of Mental Health, which has an excellent menopause and mental health clinic. “A psychiatrist should discuss not only your behavioral issues, but also your medical and gynecological histories,” he says. Ask, too, about the lines of communication between the psychiatrist and your other caregivers. “In midlife too many symptoms overlap, so medical care really needs to be coordinated across your health care providers,” Schmidt says.
Sources: American Heart Association; National Osteoporosis Foundation; Society of Interventional Radiology; AAGL; Association for Health Care Journalists; David Winchester, MD; Nieca Goldberg, MD; Jennifer Mieres, MD; Elvira Lang, MD; John Nestler, MD; Subhash Kukreja, MD; Nelson Watts, MD; Judy Kneece, RN; Constance Lehman, MD; Carolyn Kaelin, MD; Peter Schmidt, MD; Nanette Santoro, MD; Bernard Harlow, PhD; Wulf Utian, MD, PhD.