Posted by on May 22, 2018 - 9:40am

Postpartum depression is the most common complication of childbirth, with 13% of childbearing parents affected in the first year after giving birth [1]. Most do not receive treatment for postpartum mood disorders.

Risk Factors

Risk factors for postpartum depression include stressful life events and a history of mood disorders, in addition to other known factors related to depression [1]. African-American and Hispanic women experience postpartum depressive more often than white women. Transgender men and other gender nonconforming people have difficulty finding high quality healthcare in pregnancy, which increases their risk of mental health distress [2].

Solutions

Postpartum depression is rarely treated. Studies have shown that women are unsure of how to treat depression during and after pregnancy [3]. Raising awareness with physicians and promoting collaboration between medical, psychiatric, and other wellness professionals is an great way to help patients work through that confusion.

Recent research has looked at potential solutions to pregnancy-related mental health disorders:

  • Postpartum Support International provides resources to mothers in English and Spanish as well as trainings for healthcare professionals.
  • Dr. Katherine Wisner of Northwestern University recently published a study showing that a telephone-based depression care management system, connecting patients to their doctors and information regarding other resources, lessened symptoms of mood disorders [4].
  • Drs. Hoffkling, Obedin-Maliver, and Sevelius published guidelines for physicians caring for gender nonconforming patients around pregnancy [2].

 

The Centers for Disease Control and Prevention has a helpful questionnaire available here if you believe you may be experiencing depression.

 

References:

1.         Wisner, K.L., B.L. Parry, and C.M. Piontek, Clinical practice. Postpartum depression. N Engl J Med, 2002. 347(3): p. 194-9.

2.         Hoffkling, A., J. Obedin-Maliver, and J. Sevelius, From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers. BMC Pregnancy Childbirth, 2017. 17(Suppl 2): p. 332.

3.         Battle, C.L., et al., Perinatal antidepressant use: understanding women's preferences and concerns. J Psychiatr Pract, 2013. 19(6): p. 443-53.

4.         Wisner, K.L., et al., Telephone-Based Depression Care Management for Postpartum Women: A Randomized Controlled Trial. J Clin Psychiatry, 2017. 78(9): p. 1369-1375.

 

Posted by on July 25, 2014 - 2:55pm

By: Christie Hunter

It is becoming a concern in many sectors that the population is aging as the baby boomers are one of the largest segments of the population. One of the parts of this is looking at cognitive ability and mental health in this demographic.  Helping people in their later years to maintain both physical and mental health is a public health issue. Older people are prone to depression and dementia, and research is showing that there are steps that can be taken to help alleviate the symptoms of both of these. This article will highlight some of the research and what this research points to in regard to preventing cognitive decline.

Zanjani, Kruger, and Murray (2012), discuss the organization Mental Healthiness Aging Initiatives.  This organization promotes education, awareness and action in regard to mental health in elderly rural adults. They have found that mental health problems and drug use can be problems found in this population.  In addition, 50% of this demographic may suffer from depression which has been found to decrease life expectancy by as many as 25 years.  Because of these findings, it becomes prudent that focusing on these problems and the problems of aging in general would be well advised.

Research is beginning to also focus more on healthy aging as more of the population is getting older (Bryant, et al., 2012). Successful aging is defined with a number of components.  These include a lack of disability, good general health and mental health, social function, and a lack of dementia.  These authors see attitudes toward aging as being an important factor in these components. Negative attitudes toward aging can lead to depression. On the other hand, positive and optimistic attitudes to aging meant better life satisfaction and better physical health. Health care professionals can increase more positive outlooks on aging by educating patients about activities that can help keep mind and body young.

In the same vein, Carlson, el al. (2012) discusses activities and memory.  Some of the listed activities for better cognitive functioning include reading books, doing crosswords, and taking classes that are often offered through local colleges.  Seniors should also think about volunteer activity, joining into activities at community centers that are geared toward the aging population, and other social connections.  The authors state that more than frequency, intensity, and duration of an activity that the most important component is to engage in a diverse routine of many of these activities for more positive cognitive outcomes.  They suggest that activities like this may be even more important for women than for men, given their longer life expectancies and increased likelihood of decline in cognitive functions.  The authors note that one barrier to this can be that women are more likely to be caretakers which can impede their abilities to find the time to devote to developing healthy brain routines.

From a physical and brain functioning aspect, Deslandes, et al. (2009), suggest that exercise is also an important undertaking in aging. Exercise has been shown to be correlated with better brain function. It should be noted that any type of physical activity is preferable to no activity at all. There are specific approaches to helping people become more active.    In addition, water exercises are usually a good alternative for those with arthritis and joint pain and programs specifically for seniors are often found at the local YMCA. Short walks, stretches, even owning a pet can increase physical activity in seniors.

Cook (2007) suggests that any and all of these approaches are a good idea for all ages of people. Routines are easier to adhere to when they have been in place for a longer period of time. Starting at a younger age can benefit the mental health of most age groups. According to Cook (2007) exercises that improve logic, processing, memory, and intellectual development should be the aim. Games focusing on analytical thinking are a good place to start. These include word games like Scrabble, chess and checkers, and even the children’s game Memory. Many times a google search can lead to online computer games and software available to develop these skills.

Aging is an inevitable part of the life cycle. Learning to navigate it can be challenging. Health care professionals should be advised to do what they can to encourage some of the activities outlined above. It is much easier to prevent physical and mental health problems than it is to treat them once they have taken over. The population is aging due to the baby boomers and this fact should not be ignored. Many of these people have lived long successful lives, and helping them to maintain a good quality of life should be a priority.

By Christie Hunter

 

References:

Bryant, C., Bei, B., Gilson, K., Komiti, A., Jackson, H., & Judd, F. (2012). The relationship between attitudes to aging and physical and mental health in older adults. International Psychogeriatrics, 24(10), 1674-83.

Carlson, M. C., Parisi, J. M., Xia, J., Xue, Q., Rebok, G. W., Bandeen-Roche, K., & Fried, L. P. (2012). Lifestyle activities and memory: Variety may be the spice of life. The women's health and aging study II. Journal of the International Neuropsychological Society: JINS, 18(2), 286-94.

Cook, Linda J. (2007). Exercises for mental wellness: Couldn't we all benefit? Journal of Psychosocial Nursing & Mental Health Services, 45(5), 8-9.

Deslandes, A., Moraes, H., Ferreira, C., Veiga, H., Silveira, H., Mouta, R., Laks, J. (2009). Exercise and mental health: Many reasons to move. Neuropsychobiology, 59(4), 191-8.

Zanjani, F., Kruger, T., & Murray, D. (2012). Evaluation of the mental healthiness aging initiative: Community program to promote awareness about mental health and aging issues. Community Mental Health Journal, 48(2), 193-201.

Posted by on July 25, 2014 - 2:51pm

By: Christie Hunter

Recent shootings and homicides on college campuses have been dramatically represented by the media as a sign of failure to treat students. When such a tragedy occurs, it is common to see mental health issues on the forefront. However, such events are relatively rare even though severe, when compared to the general mental health needs of many college students around the world. Although we are beginning to see an increase in the awareness of mental health issues, there remain more opportunities for universities to improve on dissemination of this information through the right channels and to the correct people. In the following article, an examination of the research will highlight the population in need, who can help, and how to obtain mental health for both groups.

Mental health counseling centers and awareness services exist on many campuses. However, if students and staff do not know about these services, do not have the tools to help themselves, and do not have the tools to help someone else in distress, these resources go unused. Hunt and Eisenberg (2010) indicate that while many college students are seen as being more privileged than their non-student peers, there is very little difference in the occurrence of mental health problems between the two groups. According to the authors, college attendance in high school graduates is at 65%. Among people age 18-24, half of all health concerns are related to mental illness. Also, onset generally occurs by the age of 24. This is a prime time for college administrators to recognize and intervene with mental health issues. Untreated mental health affects academic success, productivity, substance abuse, and relationships. Because students are often immersed in campus life including their involvement in academics, recreational activities, social interactions, and work, they are well known by their peers and by staff, who can serve as allies when needed (Wagner and Rhee, 2013).

Hunt and Eisenberg (2010) report that one in three college students have reported that they have experienced depression symptoms that have resulted in a significant life impact. Of those students, 4% admitted to having seriously considered suicide. Anxiety is another common challenge on college campuses. Academics are becoming more competitive as the prospects for employment following college are decreasing. Stress is increasing as a result. While the effects of stress are often minor and  common among college students (go here for further reading),  there is nevertheless a lurking danger, and in severe cases,  treatment is necessary.  Many students are dealing with critical levels of stress on college campuses, and this is a concerning reality.

Many campus administrators and counselors are of the opinion that they are providing appropriate information on mental health to promote awareness and prevention. However, the study by Wagner and Rhee (2013) does not bear this out. Students are likely to report that they do not find the information helpful in self-identification or in recognizing problems in others. This is a mistake given the close relationships that tend to occur on campuses. Students are interested in information on depression and anxiety, grief, stress, sleep, and relationship difficulties in addition to information on how to help others. This is a fertile population to educate as they spend considerable education and social time together.

In a study on school based mental health which is more focused on primary education, there are trends that translate to similar issues at the college level (Weist, 2005). The findings of this study indicate that mental health services were not a focus and were not well funded.  Assessment of needs and linking to services are not done effectively. Educators can certainly be promoters of mental health awareness but time and resources are limited. At the college level, these effects may be amplified. However there is great opportunity to catch mental health concerns early and before they become more severe.

Dogan (2012) points out that many mental health problems emerge in the first year of college because it is a difficult time of transition in the lifespan. There is more freedom, different types of support systems, and increased stress. College students are often struggling to find a good balance between education and social interactions. The authors also found that students are increasingly presenting with more intense problems, and that as time goes on toward graduation, stress levels and mental health issues increase dramatically. Self-referral continues to be the main avenue to first contact, but that parents, staff, and friends are also making referrals.

Given all of the above, there has been a focus on campaigns to increase awareness and to decrease the stigma of diagnosis and treatment (Livingston, et al., 2012). This was shown to make individuals more aware of problems, but did not necessarily decrease stigma which can lower the likelihood that an individual will seek treatment. Perhaps it is important for universities to change the way that they approach promotion of mental health awareness. Asking students and staff what they need for themselves and in order to help others seems to be a significant step. While this may work now, it may need to be fluid and change over the years. It also makes sense for information to be disseminated in such a way that all staff and students know where to turn if experiencing a mental health problem, or when they recognize a problem in another individual. Finally, universities can hope to succeed in the promotion of mental health if they provide the staff the necessary training and resources for that success.

By Christie Hunter

 

References:

Dogan, T. (2012). A long-term study of the counseling needs of Turkish university students. Journal of Counseling and Development : JCD, 90(1), 91-96.

Hunt, J., Eisenburg, D. (2010). Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health, 46(1), 3-10.

Livingston, J. D., Tugwell, A., Korf-uzan, K., Cianfrone, M., & Coniglio, C. (2013). Evaluation of a campaign to improve awareness and attitudes of young people towards mental health issues. Social Psychiatry and Psychiatric Epidemiology,48(6), 965-73.

Wagner, M., & Rhee (2013). Stress, sleep, grief: Are college students receiving information that interests them? College Student Journal, 47(1), 24-33.

Weist, M. D. (2005). Fulfilling the promise of school-based mental health: Moving toward a public mental health promotion approach. Journal of Abnormal Child Psychology, 33(6), 735-41.

Posted by on January 2, 2014 - 11:23pm

Do hormone levels in postmenopausal women affect cognitive function? New research sheds light on the postmenopausal brain.

In a recently published study, researchers found that estrogen levels after menopause may have no impact on cognitive skills, but progesterone levels might. Progesterone had some association with global cognition and verbal memory among newly postmenopausal women.

643 healthy postmenopausal women were part of the study, ranging from 41 to 84 years old. Neuropsychological tests were done to assess cognition and memory, and hormone levels were determined including estradiol, estrone, progesterone, and testosterone. The findings showed no association between estrogen and cognitive skills. However, women with higher levels of progesterone had better outcomes on the verbal memory and global cognition tests, particularly in those who had started menopause less than six years prior. None of the hormones appeared to have any association with depression or mood either.

More research must be done to confirm the new findings regarding progesterone levels. Also, there is no way to directly measure hormone concentrations at the brain level, but this research implies that estrogen therapy may not have a significant effect on cognitive skills. To learn more about when hormone therapy is beneficial , visit Northwestern's menopause website here.

 

Source reference: Henderson VW, et al "Cognition, mood, and physiological concentrations of sex hormones in the early and late menopause" PNAS 2013; DOI: 10.1073/pnas.1312353110.

Posted by on May 31, 2013 - 8:09am

Did you know that 15% of women are diagnosed with Hypoactive Sexual-Desire Disorder (H.S.D.D)?  This disorder is characterized by a lack of female desire coupled with significant emotional distress, primarily in post-menopausal women.  A recent article in The New York Times placed Dutch psychopharmacologist Adriaan Tuiten in the spotlight for his new research studies on sex differences.  Tuiten, who has spent his career studying biological and psychological interactions, may have unlocked some the intricacies of female desire via his study on possibly the first, successful female-desire drug.

The publicized misnomer that this drug will be a “female Viagra” simplifies its actual complexity.  Ongoing studies in this field since 1998 unequivocally show that the male and female impetus for desire differs significantly, especially in the brain.  While both male and female desire stem from similar areas of the brain, studies show that, over time, female desire wanes at a significantly higher rate than observed in males.

How can women combat this atrophy of desire?  Tuiten tested and observed 420 female subjects beginning in the fall of 2011 to answer just that.  His drugs Lybrido and Lybridos are expected to be presented shortly to the F.D.A., and may be on the market by 2016 following a larger-scale trial.

Guest Author:  Megan Castle

 

 

 

Posted by on December 28, 2012 - 11:01am

I ran across this very powerful article written by Liza Long for Gawker. Liza is a mother. A mother dealing with a child's mental health issues, like many women in this country.

Although I have avoided most coverage of the tragedy in Connecticut, I have spent a great amount of time thinking about the present state of mental health care and access in the United States. This piece addresses both the importance of having access to health care needs, but also the numerous and painful difficulties of a mother dealing with a violent child.

I highly recommend reading not only the article, but some of the 900+ comments. The commentary speaks volumes about the issues mothers deal with and the impact mental health care (and lack thereof) can have on families.

Posted by on October 3, 2012 - 11:47am

The following is written verbatim from the the Lesbian Community Cancer Project:   Within the last decade, the relationship between mental health and sexual orientation has been researched more comprehensively. Studies have found that women who engage in same-sex sexual behavior and/or identify as lesbian, gay, bisexual or queer (LGBQ), are at greater risk for mental health concerns than women who do not engage in same-sex sexual behavior. Specifically, women who identify as LGBQ often experience feelings of depression, anxiety and stress based on living in a stigmatized and homophobic culture, and may engage in risky behaviors (e.g., alcohol, drug, or tobacco use) to relieve these emotions. These risky behaviors are ultimately associated with negative psychological, health and job-related outcomes.

LGBQ women are also at increased risk of interpersonal victimization (i.e., verbal, physical and sexual abuse) compared to their heterosexual counterparts. As a result, LGBQ women may experience internalized homophobia (i.e., negative feelings or attitudes towards oneself for identifying as LGBQ, based on living within a homophobic society), which is also linked to depression, anxiety, stress and greater alcohol/drug use. For individuals who identify as trans-masculine or trans-feminine, the risks of mental and behavioral health concerns increase significantly.

It is important to know that, while these mental health concerns may be overwhelming or discouraging, these feelings and stressors are not your fault. Remember that places like Howard Brown Health Center (HBHC) are here for you, and provide health and wellness services that are specialized for the LGBTQ community.

Reference:  The Impact of Minority Stress on Mental Health and Substance Use Among Sexual Minority Women by Keren Lahavot and Jane M. Simoni.

Posted by on December 9, 2010 - 11:57am

The holiday season is a wonderful time to spend with family and friends but it can be stressful, especially if you have an anxiety disorder.   The latest e-newsletter from the Institute for Women's Health Research focuses on the most common anxiety disorders, especially in women.  Click HERE to view our December e-newsletter.

Posted by on December 8, 2010 - 7:35am

Young women with the menopause-like condition, primary ovarian insufficiency, are much more likely than other women to experience depression at some point during their lives, according to a study from the National Institutes of Health. The finding suggests that all women diagnosed with the condition should be evaluated for depression.

Depression is a serious medical illness affecting the brain which involves more than feeling blue or sad for a few days. Symptoms include persistent feelings of sadness, difficulty sleeping or over sleeping, energy loss, and feelings of worthlessness.

Primary ovarian insufficiency, or POI, results in a menopause-like condition years before normal menopause begins — sometimes as early as the teens or twenties. Women with POI stop producing normal amounts of reproductive hormones, develop hot flashes, and typically become infertile. The study authors evaluated 174 women with POI and found that 67 percent either were currently clinically depressed or had been depressed at least one time in their lives.

The researchers noted that this proportion was more than twice the rate of depression found by a national survey of women in the general population.

"Because of the strong association with depression, our results indicate all women diagnosed with POI should be thoroughly evaluated for depression," said Lawrence M. Nelson, M.D., co-senior author of the study and head of the Integrative and Reproductive Medicine Group at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "Simply asking patients if they are depressed is not sufficient. Primary care physicians should evaluate their patients with a diagnostic screening test to determine if treatment or referral to a mental health specialist for further evaluation is needed."

The study's first author was Peter J. Schmidt, M.D., of the National Institute of Mental Health (NIMH).   The study appears in The Journal of Clinical Endocrinology and Metabolism.

The study was unable to determine why women with POI are more likely than other women to experience depression. The investigators cited results of a previous study, which had suggested that depression might trigger physical changes that ultimately lead women to develop POI. However, in the current study, more than 73 percent of women with POI first experienced depressive symptoms after developing the irregular menstrual cycles believed to be an indicator of impending POI.

The findings also did not support the hypothesis that most women with POI become depressed after they are told of their diagnosis, when they learn that they will likely be infertile. In the current study, more than 68 percent of patients with POI who had depression had become depressed after the onset of irregular menstrual cycles, but before receiving the diagnosis of POI.

In a previous study, Dr. Schmidt found that women entering natural menopause at an appropriate age are at greater risk of depression late in the menopause transition, when estrogen levels are particularly low.

"Future studies are needed to help determine whether hormonal changes, perhaps combined with a particular genetic makeup, might predispose some women to depression," said Dr. Schmidt.

The authors also noted that studies of women undergoing natural menopause have found that estrogen supplements relieve symptoms of depression in some women. The authors added that it is possible that estrogen supplements might relieve symptoms of depression in women with POI.

NIMH provides information about women and depression in its booklet Women and Depression: Discovering Hope.

Posted by on November 26, 2010 - 10:17am

Scientists discover how estrogen works and flip its switch to reap benefits without risks

CHICAGO --- Estrogen is an elixir for the brain, sharpening mental performance in humans and animals and showing promise as a treatment for disorders of the brain such as Alzheimer’s disease and schizophrenia. But long-term estrogen therapy, once prescribed routinely for menopausal women, now is quite controversial because of research showing it increases the risk of cancer, heart disease and stroke.Northwestern Medicine researchers have discovered how to reap the benefits of estrogen without the risk. Using a special compound, they flipped a switch that mimics the effect of estrogen on cortical brain cells. The scientists also found how estrogen physically works in brain cells to boost mental performance, which had not been known.

When scientists flipped the switch, technically known as activating an estrogen receptor, they witnessed a dramatic increase in the number of connections between brains cells, or neurons. Those connections, called dendritic spines, are tiny bridges that enable the brain cells to talk to each other.

“We created more sites that could allow for more communication between the cells,” said lead investigator Deepak Srivastava, research assistant professor in neuroscience at Northwestern University Feinberg School of Medicine. “We are building more bridges so more information can go from one cell to another.”

Previous research has shown an increase in dendritic spines improves mental performance in animals. In humans, people who have Alzheimer’s disease or schizophrenia often have a decrease in these spines.

“We think there is a strong link between the number of dendritic spines and your mental performance,” Srivastava said. “A major theory is if you increase the number of spines, it could be a way to treat these significant mental illnesses. “

Northwestern scientists also found strong clues that estrogen can be produced in cortical brain cells. They identified aromatase, a critical protein needed to produce estrogen, to be in precisely the right spot in the brain cell to make more dendritic spines.

“We’ve found that the machinery needed to make estrogen in these brain cells is near the dendritic spines,” Srivastava said. “It’s exactly where it’s needed. There’s a lot of it in the right place at the right time. “

Next, Srivastava said, he wants to further identify the key molecules involved in the dendritic spine production and target them in the same way as the estrogen receptor in order to ultimately be able to treat schizophrenia and other mental disorders.

Nick Brandon, head of psychiatry at Pfizer Inc., whose group collaborated with the Penzes lab for this work, added, “We are very excited by the emerging data in this area. There is a great deal of literature and precedent for a role of estrogen and estrogen signaling in major mental illnesses. This adds to our understanding of the specific neuronal functions. As we understand the effects of these specific estrogen receptor beta compounds in preclinical models, we are discovering effects on specific neuronal functions, which could be relevant for the treatment of cognitive disorders, depression and schizophrenia. “

Marla Paul is the health sciences editor. Contact her at marla-paul@northwestern.edu

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