There are Psychiatric illnesses that are hormone-related.
PMS
PMDD
Perimenopausal Depression / Late-onset Borderline
Psychosis Relapse
Depression and the Pill
Premenstrual Dysphoric Disorder
80% of women have some challenges relating to menses, 40% have PMS, 10-15% have PMDD
For PMDD hormone treatments are very important
Suggested the first line
1. OCP –continuous. We favor Zoely – natural estradiol + nomegestrol acetate
2. OCP + estradiol
2nd Line treatments
1. SSRI’s – use short half-life drugs, less agitating ones – citalopram, sertraline. Agomelatine.
pharmacogenomics testing to ensure sensitivity and reactivity to medication.
3rd line treatments
SSRI+ estradiol
SSRI + aldosterone
4th line
GnRH agonist drugs (e.g Synarel) + add back estradiol (chemical menopause)
General Treatment Issues in Women:
Short Half-life SSRI’s
SNRI’s more effective in postmenopausal women
Agomelatine & Votrioxetine is useful for women.
perimenopause and Depression
16 times increased rate of depression in Perimenopausal period
The brain changes occur well before the body changes of menopause
The CNS changes may occur up to 5 years before hot flushes and amenorrhoea
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