Womens Health Concerns Clinic

Hamilton, Canada

Womens Health Concerns Clinic

Hamilton, Canada
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Patel J.P.,McMaster University | Frey B.N.,McMaster University | Frey B.N.,Womens Health Concerns Clinic
Neural Plasticity | Year: 2015

The blood-brain barrier (BBB) regulates the transport of micro- and macromolecules between the peripheral blood and the central nervous system (CNS) in order to maintain optimal levels of essential nutrients and neurotransmitters in the brain. In addition, the BBB plays a critical role protecting the CNS against neurotoxins. There has been growing evidence that BBB disruption is associated with brain inflammatory conditions such as Alzheimer's disease and multiple sclerosis. Considering the increasing role of inflammation and oxidative stress in the pathophysiology of bipolar disorder (BD), here we propose a novel model wherein transient or persistent disruption of BBB integrity is associated with decreased CNS protection and increased permeability of proinflammatory (e.g., cytokines, reactive oxygen species) substances from the peripheral blood into the brain. These events would trigger the activation of microglial cells and promote localized damage to oligodendrocytes and the myelin sheath, ultimately compromising myelination and the integrity of neural circuits. The potential implications for research in this area and directions for future studies are discussed. © 2015 Jay P. Patel and Benicio N. Frey.

Steiner M.,Womens Health Concerns Clinic | Steiner M.,McMaster University | Steiner M.,University of Toronto
Acta Physiologica | Year: 2011

The comorbidity of cardiovascular disease (CVD) and depression/anxiety disorders is well established, but the mechanisms are not well understood. This paper will review the epidemiological and biological evidence for the role of depression in CVD, as well as the pathophysiological process underlying both depression and CVD. The focus will be on the roles of serotonin, platelets, and the immune system, with an emphasis on the relevance of sex differences in both depression/anxiety and CVD as they pertain to women. © 2011 The Author. Acta Physiologica © 2011 Scandinavian Physiological Society.

Green S.M.,McMaster University | Haber E.,Womens Health Concerns Clinic | McCabe R.E.,McMaster University | Soares C.N.,Womens Health Concerns Clinic
Archives of Women's Mental Health | Year: 2013

The menopausal transition is frequently accompanied by adverse physical and emotional changes that can significantly impact a woman's quality of life. Hormone replacement therapy has been the most commonly used menopause-related treatment to date, particularly for the alleviation of vasomotor symptoms; recent studies, however, have questioned its long-term safety for some women. We aimed to develop a cognitive-behavioral group treatment (CBGT) program as an alternative or complementary treatment option for reducing the frequency and intensity of debilitating menopausal symptoms in midlife women. Eight subjects participated in two, 10-week pilot groups (n = 4 participants per group) with participants being drawn from referrals through the Women's Health Concerns Clinic and community advertising efforts. This pilot study confirmed a reduction in the frequency and interference associated with vasomotor symptoms, less depression and general anxiety, and an overall improvement in quality of life. Participants also reported high levels of satisfaction with this type of treatment for menopausal symptoms. Furthermore, there was a trend towards a reduction in sleep difficulties and sexual concerns over the course of treatment. This pilot CBGT program appears to be a promising alternative or complementary treatment for both the physical and emotional symptoms experienced during menopause. Further studies are needed on its efficacy through larger, controlled trials. © 2013 Springer-Verlag Wien.

Hall E.,McMaster University | Steiner M.,McMaster University | Steiner M.,Womens Health Concerns Clinic
Women's Health | Year: 2013

There are sex differences in the prevalence and presentation of many psychiatric disorders. Various trends in symptomatology have emerged that are thought to be linked to periods of hormonal fluctuations such as with menses, pregnancy or menopause. With data from animal and human studies, it has become clear that there is an important interplay between the serotonergic system and gonadal hormones. The majority of the research to date has focused on the influence that estrogen has within the CNS and, in particular, how it leads to an overall increase in serotonin synthesis and availability. In reviewing this female-specific topic we hope to raise awareness to sex/gender differences in psychopathology, help identify at-risk populations and consider development of new treatment options. Future research will also need to consider the influence that progesterone and oxytocin may have on sex-specific psychopathology as well as incorporate neuroimaging and consider the influence of hormones on the serotonergic system at a genetic level. © 2013 Future Medicine Ltd.

Steiner M.,Womens Health Concerns Clinic | Steiner M.,McMaster University | Li T.,Womens Health Concerns Clinic
CNS Drugs | Year: 2013

Premenstrual dysphoria (PMD) affects 3-8 % of women in their reproductive years worldwide. This paper summarizes the studies establishing the efficacy of continuous, luteal phase, and symptom-onset dosing of selective serotonin reuptake inhibitors (SSRIs) and dual serotonin and norepinephrine reuptake inhibitors (SNRIs) in treating women with PMD. The evidence indicates that for some women, symptom-onset dosing with escitalopram, fluoxetine, and paroxetine controlled release (CR) is as effective as continuous or luteal phase dosing. The wide range of clinical efficacy of SSRIs/SNRIs suggests that they exert their therapeutic effect through multiple pathways. This paper offers a few alternative mechanisms of action to explain the rapid response to SSRIs/SNRIs in women with PMD. © 2013 Springer International Publishing Switzerland.

Soares C.N.,McMaster University | Soares C.N.,Womens Health Concerns Clinic | Frey B.N.,McMaster University | Frey B.N.,Womens Health Concerns Clinic
Psychiatric Clinics of North America | Year: 2010

Women are at a higher risk than men of developing depression and anxiety and such increased risk might be particularly associated with reproductive cycle events. Recent evidence suggests that the transition to menopause may constitute a window of vulnerability for some women for the development of new onset and recurrent depression. Several biological and environmental factors seem to be independent predictors or modulating factors for the occurrence of depression in menopausal women; they include the presence and severity of hot flushes, sleep disturbances, history of severe premenstrual syndrome or postpartum blues, stressful life events, history of depression, socioeconomic status, and use of hormones and psychotropic agents. The regulation of monoaminergic systems by ovarian hormones might explain, at least in part, the emergence of depressive symptoms and/or anxiety in biologically predisposed subpopulations. The use of transdermal estradiol, as well as serotonergic and noradrenergic antidepressants, is an efficacious strategy in the treatment of depression and vasomotor symptoms in symptomatic women in midlife. In this review, the authors discuss the existing evidence of a greater risk for the development of depression during the menopausal transition and the putative underlying mechanisms contributing to this window of vulnerability. Hormonal and nonhormonal treatment strategies for depression and anxiety in this particular population are critically examined, although more tailored treatment options are still needed. © 2010 Elsevier Inc.

Soares C.N.,Womens Health Concerns Clinic | Soares C.N.,McMaster University
Drugs and Aging | Year: 2013

Epidemiologic and clinic data have unequivocally supported the notion that women experience more psychiatric problems at some point in their lives compared with men, particularly mood and anxiety symptoms and sleep problems. It is also known that, for some women, such increased risk might be associated with reproductive cycle events such as the postpartum period or the menopausal transition. These periods are not only marked by substantial hormone variations but also quite often accompanied by stressful events and changes in personal, family and professional responsibilities. The complexity of these reproductive-related 'windows of vulnerability' poses a challenge to physicians and other professionals dedicated to women's health across the lifespan. The menopausal transition and early postmenopausal years constitute a characteristic example; during this period in life, dynamic changes in sex hormones and reproductive function co-occur with modifications in metabolism, sexuality, lifestyle behaviours and overall health, sometimes affecting a woman's quality of life and overall functioning. For most women, however, this transition has little or no significant impact on their mental wellness. A prior depressive episode - particularly if related to reproductive events - is the strongest predictor of mood symptoms or depression during menopausal years. Also, the presence and severity of vasomotor symptoms and other health-related issues appear to modulate the risk for depression in midlife women. Mechanistically, estrogen plays an important modulatory role in mood and cognitive regulation, hence the effects noted when midlife women are exposed to significant estrogen fluctuations or to estrogen-based therapies (use or withdrawal). Transdermal estradiol, as well as serotonergic and noradrenergic antidepressants, have shown efficacy in the management of depression in this population. Other evidence-based treatment options (hormonal, pharmacological, behavioural) are available to clinicians and health professionals who care for this population. © 2013 Springer International Publishing Switzerland.

Soares C.N.,Womens Health Concerns Clinic
Menopause | Year: 2014

OBJECTIVE: Menopausal transition and early postmenopausal years have been described as a "window of vulnerability" for the development of depressive symptoms or depression (new or recurrent) in some women. This article aims to review contributing factors to the emergence of menopause-related depression, some of the key challenges to its proper identification and management, and evidence on effective treatment strategies. METHODS: A body of evidence (animal data, epidemiologic studies, and clinical studies) was reviewed to disentangle some of the complex interactions between changes in sex hormones and reproductive function, physical health, and mood in midlife women. Special focus was given to the window of vulnerability framework. RESULTS: Despite evidence of a critical window for new onset of depression, a prior depressive episode (particularly if related to reproductive events) remains the strongest predictor of mood symptoms or depression during midlife years. Vasomotor symptoms, anxiety, and other health-related issues also modulate the risk for depression. Mechanistically, estrogen plays an important role in mood and cognitive regulation. Transdermal estradiol, as well as serotonergic and noradrenergic antidepressants, have shown efficacy in the management of depression in this population. Other evidence-based treatment options (hormonal, pharmacologic, and behavioral) are available to clinicians and health professionals. CONCLUSIONS: A more comprehensive diagnostic approach should be used in symptomatic midlife women. Ultimately, researchers hope to develop preventive strategies and treatments that could be tailored to multiple symptom domains and improve overall functioning. © 2013 by The North American Menopause Society.

Chico E.,University of Toronto | Gonzalez A.,University of Toronto | Gonzalez A.,McMaster University | Ali N.,University of Toronto | And 3 more authors.
Developmental Psychobiology | Year: 2014

Previous research has established that in comparison to adult mothers teen mothers respond less sensitively to their infants. In adults, components of executive functions relate directly to maternal sensitivity. Since teenagers are known to have a less developed prefrontal cortex and greater difficulties in parenting, this study sought to determine whether the association between executive processes and mothering exists among teenagers. Two groups of mothers, teens (n=30) and adults (n=27), who were approximately 4-6 months postpartum, completed tasks assessing spatial working memory and attentional set shifting (cognitive flexibility) using the Cambridge Neuropsychological Test Automated Battery. Mothers were videotaped interacting with their infants and were later coded for various maternal behaviors. As predicted, teenagers performed more poorly than adults on tasks of cognitive flexibility and were less sensitive in their infant interactions. Among both groups there was a negative association between executive function and mothering; however, depending on the age of the mother different executive function tasks were relevant. © 2014 Wiley Periodicals, Inc.

Frey B.N.,Womens Health Concerns Clinic | Frey B.N.,McMaster University | Simpson W.,Womens Health Concerns Clinic | Simpson W.,McMaster University | And 3 more authors.
Journal of Clinical Psychiatry | Year: 2012

Background: Previous studies have shown that onequarter of women with bipolar disorder relapse during pregnancy, and nearly half of bipolar women relapse during the postpartum period. The perinatal period is also associated with an elevated risk for new-onset mood disorder. Bipolar disorder is often unrecognized, and there is often a significant delay between illness onset and proper diagnosis and treatment. The objective of this cross-sectional psychometric study was to investigate the use of the Mood Disorder Questionnaire (MDQ) as a screening tool for bipolar disorder in a community-based population of pregnant and postpartum women.Method: 150 women with a mean age of 30.1 years (standard deviation = 5.5 years; range, 17-43 years) who had been referred to a women's mental health program for psychiatric assessment during pregnancy (n = 95) or the postpartum period (n = 55) were enrolled between June 2010 and December 2011. All women completed the MDQ on the day of their first assessment, and the sensitivity and specificity of the MDQ were calculated against DSM-IV-based clinical diagnoses provided by experienced psychiatrists.Results: A total of 18 women (12% of the sample) were diagnosed with bipolar disorder (6 with bipolar I disorder, 10 with bipolar II disorder, and 2 with bipolar disorder not otherwise specified). The traditional scoring of the MDQ yielded poor sensitivity (39%) and excellent specificity (91%). The best-fitting model was a modified scoring algorithm using cutoff scores of 7 or more symptoms on the MDQ without the supplementary questions, yielding excellent sensitivity (89%) and specificity (84%).Conclusions: The MDQ is a useful instrument for screening for bipolar disorder during both pregnancy and the postpartum period. Considering that perinatal women have an elevated risk of both first-onset and relapse of bipolar disorder, particularly during the postpartum period, routine use of screening tools in perinatal programs is encouraged. © Copyright 2012 Physicians Postgraduate Press, Inc.

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