As more research is conducted within the field of women's mental health, there are times when recommendations may change depending on the available data.  We will discuss a case here to illustrate this point.
Maguire and Mody's report, GABAA R Plasticity during Pregnancy: Relevance to Postpartum Depression, in the July 2008, Neuron, provides evidence that an abnormal Gamma-aminobutyric acid (GABAA) receptor subunit in pregnant mice may be a useful model for postpartum depression. The report describes how GABAA receptors, specifically, the delta-subunit-containing GABA receptor, are a preferred target for neurosteroids. They designed a study to identify functional changes in these receptors during pregnancy and postpartum and then looked at possible behavioral correlates in the mice.Â
Our Perinatal and Reproductive Psychiatry team often discusses clinical cases in Rounds, a confidential forum in which we can get advice and consultation from peers who also work in the area of Women's Mental Health. We discussed a patient's situation recently that highlighted the controversial area about how to prevent mood episodes in a woman planning for pregnancy.
The risk of depression after removal of both ovaries (also called bilateral oöphorectomy or surgical menopause) is a major factor for women to consider when they confront medical problems that require removal of the uterus (called a hysterectomy). Many women are advised to consider having their ovaries removed when they are having the uterus removed. Sometimes removal of the ovaries is required to fully treat the condition leading to surgery, but other times it is suggested as a precaution to reduce the risk of ovarian cancer. Removal of both ovaries in a premenopausal woman results in an abrupt withdrawal of estrogen, progesterone, and testosterone. Therefore removing both ovaries (rather than just one or neither ovary) may have significant effects on mood and well-being in women.
Most obstetricians are now familiar with the potential for what has become known as neonatal distress syndrome (or "adaptation" syndrome) following third trimester exposure to SSRIs. Some patients still worry about the possibility of their baby developing neonatal distress syndrome, especially if anything unusual happened during the post-delivery experience of an earlier pregnancy. Women may be concerned about whether and to what degree the medication they were on played a role in their infant's distress and whether to continue that medication during a subsequent pregnancy. The following case may help illustrate the decision-making dilemmas.
A study published in the Archives of General Psychiatry shows that children of women who experience the death of a close relative may have an increased risk of developing schizophrenia later in life. Â This study was conducted with records of children born in Denmark between 1973 and 1995, which were then linked to the central registry containing inpatient and outpatient treatment records. It consisted of 1.38 million individuals, including 21,978 children whose mothers experienced death of a close relative during the pregnancy, and 14,206 children of mothers who experienced illness of a close relative during the pregnancy.
CYP3A4 is an intestinal enzyme that is part of the Cytochrome P450 metabolic system. It is important in many drug-drug and drug-food interactions, and it is one of the first enzymes to break down medications when they enter the body.
Parental use of physical punishment early in childhood may be associated with subsequent maladaptive behaviors such as child aggression and impaired social information processing. There are links between certain childhood behaviors and risk for parental use of physical punishment, although cause and effect are difficult to establish with these associations. Higher rates of physical punishment correlate with maternal depression and domestic violence.
For decades, estrogen was used as a component of hormone replacement therapy to treat menopausal symptoms and for anticipated preventative health benefits in women with prostesterone, or as a monotherapy hormone treatment in women after hysterectomy, but after studies reported that long-term estrogen increase the prevalence of cardiovascular events and breast cancer, many patients and researchers have looked into alternative treatments such as food or products containing phytoestrogens. Phytoestrogens are weak plant-derived estrogens that are structurally similar to estrogen hormones produced by the body.
Mood disorders and symptoms during pregnancy and the postpartum period are not uncommon and affect women across the world. Â In spite of relatively high rates of depression among childbearing women, there are often inadequate resources for treatment, particularly in poorer countries. In countries lacking resources, health care is often managed by community health workers or individuals with basic health care training who provide care to difficult-to-reach populations. There are often few mental health professionals, leaving many women without adequate treatment. In an attempt to provide treatment to a greater number of women, some investigators are attempting to train community health workers to provide some psychotherapy as part of their standard duties.
