Taking a second look at estrogen and breast cancer risks

A new review of data from the Women’s Health Initiative suggests that estrogen therapy during perimenopause may offer some protection from breast cancer for certain women.

Joseph Ragaz, M.D., an oncologist and clinical professor at the University of British Columbia, says in his report that certain women who take estrogen only (but not progestin) for their symptoms may be protected from breast cancer.

Data from the Women’s Health Initiative shows that among 8,500 women with no family history of the disease, use of only estrogen  lowered breast cancer risk by 32 percent when compared with similar women taking a placebo. Among the 7,600 women with no history of benign breast disease, those taking estrogen had a 43 percent lower risk of breast cancer.

Learn more from The New York Times.

New depression treatment at UNC

The UNC Department of Psychiatry is now providing treatment with NeuroStar Transcranial Magnetic Stimulation (TMS) Therapy system. The Neurostar TMS Therapy system is the first and only device of its kind to be cleared for the treatment of depression by the U.S. Food and Drug Administration. It was approved in October 2008.

TMS Therapy is a non-systemic (does not circulate in the bloodstream throughout the body) and non-invasive (does not involve surgery) form of neuromodulation that delivers highly-focused MRI-strength magnetic pulses to stimulate nerve cells in an area of the brain that is linked to depression.  NeuroStar TMS Therapy is a 40-minute outpatient procedure that is prescribed by a psychiatrist, does not require anesthesia or sedation, and patients remain awake and alert.  The treatment is typically administered daily for 4-6 weeks.

For more information about TMS, please contact Shirley Morter, Administrative Director of UNC Mental Health Specialists at 929-7449 or shirley_morter@med.unc.edu.

Learn more about TMS here.

Holding a mother holding a baby

William S. Meyer, MSW, BCD, Associate Clinical Professor at Duke University’s Departments of Psychiatry and OB/GYN and a leader of the Duke Postpartum Depression Support Group, spoke to UNC’s Perinatal Psychiatry Team about treating women with high-risk pregnancies. Meyer about working with women affected by postpartum depression:

We tell them it will get better, because it will. We tell them that regardless of whether they stay at home or work, whether they breast-feed or bottle-feed, they can still be terrific mothers and have happy and thriving babies. Finally, we tell them the most important thing: that they will find it easier to give to their babies if their needs are taken care of first. We encourage them to be assertive and reach out and get assistance from all who can offer it.

Parenting an infant is unusually difficult and demanding. No fewer than 10-15% of new mothers experience significant postpartum anxiety and depression. Consider then just how many women are so affected! If we wish to give this condition the currency and visibility it deserves, and I believe we must, we must do so by emphasizing its high prevalence. Postpartum stress/anxiety/depression is real, it is common, and it is treatable. Let us all strive to reach out to new mothers in need so that they may be provided with good health care, accurate information, adequate resources and support for as long as it may be necessary.

Neural differences seen in women with postpartum depression

Researchers at the University of Pittsburgh Medical Center found that women with postpartum depression have reduced activity in parts of the brain that manage emotional responses and recognize emotional cues in others.

Researchers conducted MRIs on 30 mothers of infants and found that negative emotion faces activated the left dorsomedial prefrontal cortex significantly less in depressed mothers than in healthy moms. These deficits might represent diminished awareness of the emotions of others and less empathy for them, according to researchers.

When the women saw negative images, communication between the left dorsomedial prefrontal cortex and the left amygdala was seen in healthy moms but not in the depressed ones, suggesting that this might be an important neural circuit that regulates emotional response to unpleasant sounds, such as a baby’s cry.

These new findings were published online Sept. 15 by the American Journal of Psychiatry.

Depression and Pregnancy

“In the past, there was a belief that pregnancy was protective, but we know now — especially for women — that in the year surrounding birth they are most likely to have a depressive episode, most likely to seek treatment and most likely to be admitted to a psychiatric hospital.”

— Elizabeth Bullard, medical director of the Perinatal Mood Disorders Inpatient Program at the University of North Carolina at Chapel Hill.

Read more from Time.com

Women’s Health and Wellness Conference

The UNC Center for Women’s Mood Disorders is partnering with the UNC Eating Disorders Program to host “The Mind-Body Solution” on Saturday, November 6, in Chapel Hill.

This conference, featuring UNC faculty and invited speakers from around the world, is targeted toward physicians, psychiatrists, nurses, nutritionists, school coaches and counselors, teachers, lactation consultants and other allied health professionals.

Registration information is available here.

Plenary Sessions
Integrative Medicine: The Heart of Wellness
Ruth Quillian Wolever, PhD

Eating Disorders in Your Practice: No More “Don’t Ask; Don’t Tell”
Cynthia M. Bulik, PhD, FAED

Hormones and Depression in Women: The Brain in Context
David R. Rubinow, MD

User-Friendly Genetics for Clinicians
Patrick Sullivan, MD, FRANZCP

Update on Perinatal Mood Disorders
Adele C. Viguera, MD, MPH

Luncheon Address
Born Round: A Story of Family, Food and a Ferocious Appetite
Frank Bruni, Author

Breakout Sessions: Women’s Mood Disorder Track
Premenstrual Dysphoric Disorder: From Diagnosis to Treatment
Susan S. Girdler, PhD

Update on the Psychopharmacologic Treatment of Depression in Pregnancy and Postpartum
Samantha Meltzer-Brody, MD, MPH

Biobehavioral Correlates of Mother-Baby Attachment, Breastfeeding and Mood: A Two-Person, Single Organ System
Alison M. Stuebe, MD, MSc and
Karen M. Grewen, PhD

Depression & Stress

This ongoing study of stress responses reveals phenotypic differences in women with PMDD and those with a history of Major Depressive Disorder. In contrast to the blunted stress responses seen in women with PMDD, those with MDD histories exhibit hyperactivity in the HPA Axis, as seen by heightened baseline levels of Corticotrophin Releasing Hormone (CRH), Cortisol, β-Endorphin and ACTH. These findings suggest that, in women genetically vulnerable to develop MDD, hyperactivity of the stress axes may continue beyond remission of the depressive episode.

PMDD & Stress Response

In an ongoing study of stress responses, women with PMDD exhibited blunted Sympathetic Nervous System responses to stress when compared with non-PMDD women. This blunted SNS activation could be seen in Blood Pressure, Heart Rate and Plasma Norepinephrine.

Researchers hypothesize that in women genetically vulnerable to develop PMDD, the blunted SNS reactivity is the result of the systems’ attempts to adapt to chronic or severe stress. Read more about it here.

Oral Contraceptives and PMDD

Researchers with the UNC Center for Women’s Mood Disorders are in the middle of a five-year clinical trial using the low-dose contraceptive called YAZ to treat premenstrual dysphoric disorder.

Like other birth control pills, Yaz uses the female hormones estrogen and progestin. Unlike other oral contraceptives, Yaz is administered in a 24-day regimen and uses a unique form of progestin.

For more information about our study and to see if you are eligible to participate, visit us here.

The Biology Behind PMDD