Dr. Phillip Sarrel shares what psychological issues women will complain about when going through menopause and the treatment for it.
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The psychological issues that women will complain about are depression, an irritability, anxiety to the extent of panic attacks, and even what’s a fairly rare syndrome called agoraphobia, which is a fear of going out of the house. It does turn out there are some very interesting basic research studies to help understand the mechanisms involved in that. But basically what we’re getting at is that estrogens act in the brain and centers in the brain deprived of estrogen are not able to grow their cells the way they would if stimulated by estrogen. Remember estrogen is a growth-stimulating hormone. It stimulates cells all over the body to grow, and in the brain, its actions in different parts are important relative to the problem of depression, the problem of panic attacks. There is another important issue, and that is the role of estrogen in maintaining brain blood flow. When estrogen levels are low, brain blood flow is decreased, and that we think is part of the irritability and depression problem as well. Clinically, it becomes important if someone’s at menopause and being evaluated to be treated for depression. Most anti-depressants are not as effective when there’s no estrogen. So from a psychiatry/gynecology point of view, I would argue, and the literature can be supportive, that you should replace the estradiol, and then if you need an anti-depressant you can add it, usually at very low doses, and the combination will be effective, whereas the anti-depressant alone you may have to go to very high doses with many adverse side effects and find it very frustrating to help the woman.
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