Clinic knows mind of women

UNC center treats mood disorders

Women's mood disorders, including postpartum depression and severe premenstrual syndrome, are the focus of a new psychiatric clinic at UNC Hospitals.

The move shifts care of such problems from the offices of gynecologists and general practitioners, where symptoms often are not recognized or aggressively treated, to the department of psychiatry.

The UNC clinic was established by Dr. David Rubinow, who took over as chairman of the department of psychiatry in January. Before coming to Chapel Hill, Rubinow spent nearly three decades at the National Institute of Mental Health, part of the federal government's National Institutes of Health, studying how fluctuating levels of women's reproductive hormones such as estrogen can trigger anxiety, irritability and depression.

"It's an area of medicine I really helped to create," said Rubinow, who was chief of NIMH's behavioral endocrinology branch.

Rubinow's first study for NIMH, conducted in the early 1980s, helped establish objective criteria for diagnosing and treating premenstrual syndrome. More recent research has shown that women who develop depression during the transition to menopause experienced relief from symptoms when treated with estrogen therapy. Scientists don't know why some women develop debilitating symptoms, while others aren't noticeably affected by hormonal shifts.

The link between reproductive hormones and mental health is becoming more established.

Dr. Diana Dell, a Duke specialist who treats women's mood disorders, initially trained as an obstetrician. She completed a second residency in psychiatry after she became interested in postpartum depression, which she considers the "most under-diagnosed obstetrical problem in America."

"Anything that draws attention to these legitimate, treatable problems is just super," Dell said of the new UNC-CH center.

Despite broader awareness among both patients and physicians, Rubinow and others who treat hormone-linked mood disorders say the conditions remain under-recognized and undertreated, leading to potentially devastating effects. Postpartum depression, for example, is a leading cause of death in new mothers.

Women and their family and friends may be too quick to dismiss symptoms as "just" PMS or consider anxiety and exhaustion after childbirth the normal state of new mothers, Rubinow said. Some patients and doctors consider menopause a natural process that shouldn't require medical treatment.

"Often these disorders are trivialized or not recognized as severe," Rubinow said.

Last year, for example, actor Tom Cruise made headlines after he blasted Brooke Shields for taking antidepressants to manage depression following the birth of her daughter. Even patients struggling with a hormone-linked mood disorder don't always recognize how serious their problems are.

Rubinow said women have real symptoms and true suffering that should not be belittled.

"I think it does an enormous disservice to women to say that those who become depressed ... should simply learn to live with it," he said. "It's a barbaric notion to suggest that people should not get treatment. It's unconscionably stupid."

Lisa Beisser of Chapel Hill, who suffered postpartum depression after the births of each of her two daughters, said it took her about two months after the arrival of her first child in 2003 to realize the fits of crying, sleeplessness and anxiety she was experiencing were signs of clinical depression.

Beisser had no prior history of depression or mental health problems. But after the arrival of her daughter, Maria, Beisser's mind raced and she was gripped with anxiety that some harm would come to the baby. Some days Beisser was so distraught and overwhelmed she had to call her sister, who lives nearby, to come take care of the baby.

"Some of the worst days of my life were during that time," said Beisser, now 38.

She eventually saw a general practitioner who prescribed the antidepressant Zoloft. Beisser said she felt like her old self again after four months and quit taking it. When she became depressed after the birth of her second daughter, Natalie, in September, Beisser quickly recognized the symptoms and sought treatment immediately. She took another four-month course of Zoloft, which again resolved her symptoms. Both times, Beisser was able to go off medication without difficulty.

"People need to know that treatment is available and that it works," Beisser said.