As the number of women who are experiencing menopause triples, the demand for more effective treatment of symptoms such as mood changes is also expected to increase. To address this situation, a psychiatrist at Yale University School of Medicine has launched a major series of studies on mood disorders and menopausal women that may offer relief for some symptoms of menopause. Angela Cappiello, M.D., Ph.D., chief of the Menopause Mood Disorders Clinic and co-director of the Behavioral Gynecology Program at Yale University School of Medicine, is studying the behavioral impacts of menopause and mood. Her research will focus on women who fall into one of the following categories: healthy menopausal women, women who are clinically depressed, and menopausal women who are no longer depressed but are currently taking anti-depressants.
"My goal is to understand the connection between the mind and the female hormone, estrogen," says Dr. Cappiello, whose study is funded by the Lilly Center for Women's Health. "Female hormones may protect women from stress. Loss of estrogen could cause women to be more vulnerable to stressful life changes that usually occur around the time of menopause, including changes in employment, marriage, and children leaving home."
Dr. Cappiello would like her study to make women aware that they do not have to suffer in silence with menopausal symptoms such as mood changes, depression, hot flashes and insomnia.
"We want to let women know that treatment is available for many of these symptoms," says Dr. Cappiello. "Research on menopause is relatively new. It is getting more attention because more and more women are becoming menopausal and there is greater interest in women's health issues."
An estimated 30 million women are expected to reach menopause in the next 10 years, and more than one-third of a woman's life is post-menopausal, according to Dr. Cappiello.
Menopause is a crucial time in a woman's life, often causing mental as well as physical stress. Previous research has shown that estrogen regulates brain activity and that loss of estrogen can impact mood and behavior. Approximately 85 percent of women have some kind of reaction to estrogen loss and 15 percent of them have more severe symptoms.
Dr. Cappiello's study will look more closely at mood and will examine how a low tryptophan diet affects menopausal women. Tryptophan is an amino acid that is a precursor of serotonin. It is found mostly in dairy foods and poultry. Foods low in tryptopahan include fruits and vegetables such as apples, lettuce and tomatoes. Research involving animals has shown that if they are deprived of serotonin, animals may adapt more poorly to adverse situations. The same is true in humans.
"I'm interested in finding out how hormonal changes affect mood," says Dr. Cappiello. "I will also research whether or not replacing estrogen will help women who are severely depressed."
Dr. Cappiello will carry out three studies of menopausal women. She will conduct biological testing involving a low tryptophan diet and estrogen in women who are not clinically depressed. She will conduct a treatment study of clinically depressed menopausal women, and she will also evaluate the vulnerability to depression in women currently taking antidepressants.
The Menopause and Mood Disorders Clinic is part of the Yale Behavioral Gynecology Program operated jointly by the departments of psychiatry and of obstetrics and gynecology at the Yale University School of Medicine. The clinic, which is located at the West Haven campus of the VA Connecticut Healthcare System, offers comprehensive evaluation and anti-depressant treatment for menopausal women.
