I diagnose and treat hormonally induced conditions which cause anxiety and mood disturbance including: premenstrual syndrome, premenstrual dysphoria disorder, polycystic ovarian syndrome, perimenopause, menopause, premature ovarian failure and medication side effects including those arising from the birth control pill. These are phrases which women often reveal to me during an initial consultation:
Women in their thirties, forties, fifties & sixties work with me to deconstruct the biochemical gestalt of changes which have begun to thwart their happiness, confidence, autonomy and purpose. Helping my patients gracefully navigate this nuanced transition is by far the most meaningful and inspiring area of my work. I also work with women in their teens and twenties to provide a second opinion regarding cognitive and emotional health concerns. Using a collaborative model, I accept referrals from primary care providers, specialists and mental health professionals in order to assess and support the biochemical aspects of anxiety, depression and life stress such as divorce and career change.
Many of my female patients have been told that they are suffering from an 'anxiety disorder', and have often been prescribed anxiolytic and antidepressant medications as the primary treatment option. These women seek out alternatives to these options, not because they are looking for 'alternative' medicine, but because these medications have not worked, or because they prefer a medial paradigm which honors the complex factors which are contributing to their present state. There is so much more to understanding and treating female anxiety than merely assigning a label to a constellation of physiological, mental, emotional, sociological and spiritual unrest. Women with a history of anxiety experience a higher surge of mood changes and anxiety in perimenopause. First-onset psychiatric diagnosis most commonly occurs for women after age 40, often signifying the first of many hormonally-induced neuropsychiatric changes to come. If an anxious woman is hormonally imbalanced, she may be incapable of resilience and transforming her life, even in spite of superb counseling and support.
I also work with young women who have a new-onset psychiatric diagnosis since starting either starting their period or since starting the birth control pill. Because gynecology, as a medical discipline, does not address the impacts of hormonal changes on mood and cognition (and because psychiatry does not acknowledge the impacts of hormones on female mood and cognition), our work was born out of necessity. We are empathic to the families of teenagers and young women as they interface with conventional gynecology but encounter limited options, such as the birth control pill + antidepressants or antipsychotics, and are happy to work integratively with a woman's existing health care team, since this is the type of care which all women deserve. We are often able to offer them a detailed assessment which determines the root cause of their symptoms, as well as a treatment plan which makes them healthier, provides better results with lower side effects and has much greater safety profile.
Young women with 'anxiety disorders' in my practice are given space to self-reflect and to discuss the potency of the issues and insights they are facing. Lifestyle design, nutrient depletion, dietary choices, co-occurring sleep disorders and hormonal imbalances can present as obstacles towards helping this type of individual. Anxiety also can portend deeper issues, whispering of inconvenient insights about one's life design and potential failures if something does not change. This type of anxiety merits your full attention and courage to solve, and constructively honoring this insight cultivates a woman's voice and strength. A lack of social support can further tip the scales in women facing generalized anxiety disorder.
At any age, anxiety and depression often converge. Depression in mid-life is a strong independent risk factor for developing Alzheimers disease and other chronic diseases. Coming full circle, chronic diseases such as metabolic disorders can also cause mood disturbances and fatigue. The symptom of fatigue can merit an in-depth assessment. If you find yourself asking 'why am I always tired and have no energy', exhaustion, depression and even relationship stress may be aggravated by hard-to-detect hormonal depletion. In many cases, simple treatment can result in profound improvement in mental and emotional well-being.
Gamma-aminobutyric acid (GABA) is a key calming neurotransmitter whose synthesis and receptor activation are modulated by estrogen and progesterone in women. As these hormones are disrupted (by aging, stress & medications), anxious features can readily surface, and are no longer so easy to reduce. Anxiety is largely impacted by the amygdala, part of the brain which ascribes emotional meaning to incoming experiences. Research has demonstrated that sustained amygdala activation via dopamine, epinephrine and serotonin causes the fight-or-flight phenomenon experienced as anxiety. This process thereby causes a decrease in the synthesis of oxytocin, the neuroendocrine hormone well known for social bonding and connectedness, while ramping up corticotropin-releasing hormone, the neuroendocrine hormone which increases the production of cortisol. Each of these pathways, as well as their interconnected wiring, can be addressed through targeted therapies.
The personalization for care within functional medicine affords many options for treatment. My patients & I essentially collaborate together to co-create the best hybrid plan needed for their situation, budget and diagnosis. Many of my patients are prescribed a combination plan of medications as well as holistic therapies while undergoing life transitions. Both natural and medication-inclusive therapy programs are available to restore my female patients' capacity for emotional vitality which in turn offers a well-spring of new life opportunities. I manage tapering of antidepressants and generally co-manage tapering of controlled psychiatric medications as part of an integrative care team. I employ neurofeedback, photobiomodulation, targeted nutrients, hormone balancing where appropriate, female-centric counseling and lifestyle support, as well as prescriptive care and referrals to psychotherapists, counselors and other sources of inspiration. Prescriptions for low-dose naltrexone and oxytocin are provided for specific conditions. I also prescribe Nature, social service and time with animals as transformational aspects of healing.
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