"We are trying to describe all of the biological, psychological and social factors impacting a woman's well-being so we can pursue treatments that address female-specific diseases of the central nervous system in a well-rounded and biologically accurate way," said director Natalie Rasgon, MD, PhD, professor of psychiatry and behavioral sciences.
Rasgon has been at the forefront of the effort to uncover the links between hormones and brain function. In addition to her work in the field of reproductive endocrinology, Rasgon has studied the connection between mood disorders and insulin resistance, a condition that affects glucose metabolism. Her work has shown that most women with mood disorders have this condition and, in turn, women with insulin resistance are more often depressed.
Rasgon has also shown such metabolic dysfunction is found in certain regions of the brain in mood-disorder patients, and the dysfunction appears in the same areas in patients with Alzheimer's disease. The findings, published in the journal Neurobiology of Aging in 2006, suggest mood disorders and Alzheimer's may be linked by a common underlying process. Alzheimer's also strikes women at higher rates than men.
Despite clear gender differences, the recognition of women's mental health as a separate psychiatric specialty is surprisingly new, said Ellie Williams, MD, associate director of the center and clinical associate professor of psychiatry and behavioral sciences.
"When I was a resident 15 years ago, if a patient entering menopause came to me and said, 'What is going on? Do I have a mood problem?' I didn't have much information to give her," said Williams. "We didn't know about the epidemiology of depressive disorders in women in menopause. And we certainly didn't have a concept for treatment."
This lack of information extended across all female-specific disorders, said Williams.
The Stanford Center for Neuroscience in Women's Health brings together two established groups at the medical school that have played pivotal roles in moving the field forward. The Women's Wellness Clinic, founded in 1996 by Regina Casper, MD, professor of psychiatry and behavioral sciences, emeritus, will provide the center's primary clinical services. The clinic offers comprehensive care for women with psychiatric disorders such as premenstrual dysphoric disorder and depression related to pregnancy and menopause.
The research arm of the center will build on the work of the Behavioral Neuroendocrinology Program. Founded by Rasgon in 2002, this program combines endocrine testing, neurocognitive assessment, functional and structural brain imaging and clinical observation to study the interaction between hormones, brain function and mood.
Research on reproductive hormones in women with mood disorders has already led to new treatment strategies. Combining oral contraceptives and other hormonal manipulations with standard psychiatric medications, such as serotonin reuptake inhibitors, has boosted results for women with bipolar disorder and treatment-resistant depression occurring in menopause.
Using PET brain imaging, researchers are also assessing metabolic changes in regions of the brain involved in memory to determine whether estrogen therapy helps prevent cognitive decline in postmenopausal women.
Finally, researchers are evaluating the role of insulin resistance in psychiatric disorders. This work raises the possibility that the medications used to treat metabolic dysfunction may one day be used to manage depressive disorders and possibly prevent or delay the onset of Alzheimer's disease, said Rasgon.
In addition to bringing existing programs under its direction, the Stanford Center for Neuroscience in Women's Health also includes several new groups to cover the full range of issues faced by women in their reproductive years.
A new perinatal psychiatric group will both investigate and treat the mental health concerns of pregnant women. Key areas of interest include postpartum depression, the impact of pregnancy on a pre-existing mood disorder and the impact of this disorder on the health of the baby, including the risks of taking medications during pregnancy.
Through the new Neurocognitive Assessment Clinic, peri- and postmenopausal women concerned about cognitive decline can undergo evaluation and attend seminars on strengthening memory and maintaining cognitive abilities.
Also, a new Stanford Women's Psychotherapy Clinic will build on existing services in the Women's Wellness Clinic to offer cognitive, behavioral and interpersonal therapy. Areas of expertise include mood and anxiety issues related to pregnancy, infertility and menopause.
As the center takes shape, Rasgon anticipates that the close collaboration of its researchers, clinicians and counselors will lead to new opportunities for teasing apart variables affecting a woman's well-being.
"There is a lot of individual variability in the action of hormones and their receptors. And there is a lot of variability in each person's life experiences, from her education and how she was raised to whether she has experienced abuse or is using drugs," said Rasgon.
"These are broad, intertwined issues and we have to think systemically if we are going to solve them."
For information, call 736-2182.
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