Marlene P. Freeman, MD, Massachusetts General Hospital
Dr. Freeman discussed the important role mental health providers play in helping women during pregnancy decrease medical and obstetrical risks, such as nutrition and maintaining a healthy weight. Because one-half of pregnancies in the United States are unplanned, consider medications that are compatible with pregnancy, and recommend omega-3 fatty acids and lifestyle changes such as diet.
To diagnose premenstrual dysphoric disorder, Dr. Freeman recommends asking your patient to document and rate daily moods using a mobile app or calendar. In perimenopause, the risk of depression increases because estrogen has antidepressant effects. Although, there are no guidelines for treating depression in women in perimenopause, consider serotonergic antidepressants, supplements such as omega-3 fatty acids, isoflavones, and black cohosh, and sleep aids for patients with insomnia—a common feature of menopause.