Dr. Sarrel shares the common psychological issues menopausal women complain about and how they can be treated.
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.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.