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Edited by Ellen Leibenluft, M.D. Washington, D.C., American Psychiatric Press, 1999, 166 pp., $26.50 (paper).
Mood and anxiety disorders are the most common psychiatric illnesses psychiatrists and other physicians treat. Moreover, most anxiety disorders, as well as depressive disorders, are at least twice as common in women (except for obsessive-compulsive disorder). Therefore, to learn that women suffer from these disorders on the basis of their unique anatomical, biochemical, and physiological differences is not only important for more effective treatment planning but also extraordinarily useful in explanations to our women patients and their significant others about differences in etiology and outcome, beyond life stressors and gender roles.
Editor Ellen Leibenluft, Chief of the Unit on Affective Disorders, Pediatric and Developmental Neuropsychiatry, National Institute of Mental Health, has invited nationally recognized colleagues to inform readers of the most current knowledge related to gender differences in women across the menstrual and life cycles, beginning at puberty. In the first chapter, the latest techniques in neuroimaging enable Nepoulos and Andreasen to explain gender differences in brain structure and function, explaining what clinicians observe in patients, including the observations that psychological events can affect the brain’s plasticity and, therefore, function.
Moreover, one of the areas with greater activation in women compared with men during induced sadness was the mesial prefrontal cortex, an area that has been shown to be hypoactive in patients with depression.…Although they represent only indirect evidence, these findings suggest that women may have some vulnerability to depression based on differential functioning of the limbic system. (p. 23)
Chapter 2, by Young and Korszun, focuses on the gender differences in reactions to stress, the hypothalamic-pituitary-adrenal axis, and the role of hypercortisolemia in depression, particularly related to women’s experiences with depressive episodes. "This result indicates that depressed women, but not depressed men, have increased central HPA drive in the evening" (p. 35). The researchers clearly present scientific evidence for why women respond differently to stress.
In chapter 3, Altemus and Arleo explain the roles of reproductive hormones in the development and course of mood and anxiety disorders in women. Equally important, they explain how these hormones affect women’s brains and functioning beyond reproductive issues.
A few clinical studies have yielded findings consistent with these data, suggesting that estrogen can blunt anxiety. Subclinical anxiety symptoms are reduced in postmenopausal women receiving estrogen replacement therapy…and estrogen appears to blunt autonomic (heart rate and blood pressure) responses to stress in postmenopausal women.…There have been no clinical studies of the effects of estrogen treatment in patients with clinically diagnosed anxiety disorders. (p. 63)
In chapter 4, Yonkers and Bradshaw explain the effects of estrogen and its different forms and of progesterone at different menstrual and postmenstrual cycles on women’s mood disorders and indicated treatment needs.
An early investigation evaluated the effects of estrogen versus placebo on personality and functional impairment in older women (ages 60–91 years).…The Hospital Adjustment Scale (HAS)…was used to measure changes in interpersonal relationships and functioning, self-care, social responsibilities, and activities. Compared with women assigned to placebo, women assigned to estrogen improved on all measures and sustained better functioning over time. However, it was not clear whether the benefit seen with estrogen was secondary to estrogen’s mood-elevating properties or attributable to its salutary effects on cognitive functioning. (p. 113)
Finally, in chapter 5, DeBattista, Smith, and Schatzberg explain the recent research concerning estrogen’s effects on the neurotransmitters serotonin, dopamine, norepinephrine, and monoamine oxidase: "However, even though women are twice as likely as men to suffer from depression, they are four times as likely to be on an antidepressant" (p. 149).
This text is definitely worth the time of every clinician to read, probably more than once, in order to understand and carefully and appropriately evaluate women patients’ mood and anxiety disorders as well as evaluate their general health, including hormonal health status, before prescribing psychiatric medications. Furthermore, carefully obtaining family psychiatric histories and then giving women patients the latest scientific information and explanations about their prognosis at this stage of their lives and possible future medical concerns is now possible for informed physicians. This excellent text should be mandatory reading and the subject of resident journal clubs and state psychiatric meetings. This knowledge imparted to patients and the public can decrease the stigma of mental illness and increase the status of psychiatrists as physicians. All involved will be well served, first of all our women patients!
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