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19. Mental Health & Menopause with Dr. Danette Conklin
64 Plays9 months ago
September is Perimenopause Awareness Month! And we are diving into all things perimenopause and menopause.
Are you experiencing increased anxiety, depression, or changes in your mental health during this transition? Dr. Danette Conklin, PhD, Director of Behavioral Health in Bariatric Surgery & Weight Management at University Hospitals, and an expert in midlife wellness for women, shares valuable tips to help you navigate these challenges.
As a healthcare professional, her primary skills include conducting behavioral health evaluations for bariatric surgery, providing behavioral health interventions for weight management, and conducting research in women’s health and healthcare disparities.
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Transcript
Introduction to Dr. Danette Conklin and Her Focus
00:00:00
Speaker
Hello and welcome back to Arbo Manatee. I am thrilled to have Dr. Danette Conklin. She's a psychologist specializing in midlife women's health. She's an expert in cognitive behavioral therapy and she's going to tell us what that is in a moment. And she researches women's health and healthcare care disparities. Just to mention, she does work for an amazing employer, but her opinions do not necessarily reflect those of her employer, just as a disclaimer. And we're so excited to have you here, Dr. Conklin. Thank you for your time, and welcome to Arbal Manatee. Thank you. It's a pleasure to be here, and thank you for inviting me, Dr. Pope.
00:00:35
Speaker
So let's dive right in.
Mental Health During Menopause
00:00:37
Speaker
What would you like all women to know about mental health and perimenopause and menopause? What is something that you see in the office regularly and you just wish that everyone out there knew? Well, what I wish that every woman knew is that if they are noticing changes in their body, if they're noticing that they have a low tolerance for frustration compared to how they usually would handle frustration or certain situations or they're seemingly, you know, ah seem that they're getting more depressed or more anxious and feel like they're losing their mind. They're not losing your mind. Yeah. Yeah. And do you see depression as much as you see anxiety? Is it a mix of both or do you see them together? How do you tease those two things apart?
00:01:26
Speaker
Oh, it's it's definitely a mix. I tease them apart just by diagnostic criteria. And I would say that many women will tell me that they can't turn their mind off. That is actually more common than I would say depression in my experience. Anyway, the depression would be more like not being motivated to do things, having a hard time getting moving.
00:01:49
Speaker
But a lot of times, you know women, when they're experiencing depression during perimenopause or postmenopause, it is highly likely that they have a history of major depression or some type of anxiety disorder. And if people have a history of depression or mood changes or anxiety, do you expect it to get worse during menopause? Or you know what should people be on the lookout for? like Maybe they're already on medications, are they going to need more? Or what are the things that you've seen?
00:02:18
Speaker
Well, what I've seen, and this actually has come through research as well that we've conducted, is that the depression just feels more severe. The anxiety is more intense. So and especially for women who have a history of sensitivity to hormone fluctuation, hormone changes, it is like, at least I would say this is kind of being a bit modest, but two times likely to have more severe depression if they have a history of major depression. And there's not as much research there about anxiety.
00:02:51
Speaker
Yeah, I always wonder that, like why is there not as much out there about anxiety? Even we see this in postpartum depression, we see anxiety is also very common, but nobody really talks about postpartum anxiety, just talk about depression.
00:03:06
Speaker
It is common even just like you said, even with postpartum anxiety, it's not talked about as much. It's almost like it's downplayed compared to yeah depression and actually anxiety can be just as debilitating because it can cause women to avoid things and go places to isolate. It could cause, you know, women to just not perform as well because they're just so nervous and anxious and catastrophizing so many things. And I think it's good practice to assess for anxiety, you know, in perimenopause, postmenopause, and certainly in postpartum
Anxiety and Depression in Menopause
00:03:43
Speaker
as well. Yeah. What would tip somebody off to say, okay, this is not just being a worried wart or this is not just your typical kind of worrisome-ness? What would tip someone off that this is actually anxiety, this is something that could benefit from treatment?
00:04:00
Speaker
Oh gosh, that's a good question. So the things that come to mind would be just kind of like a change in how you're seeing the world, how a woman is seeing the world, such as being afraid that something bad is going to happen and that's not typically their emo or just being more anxious about different things and having a hard time stopping the worry, afraid something bad's going to happen. And also a lot of times the anxiety can be so intense that it affects the relationships with others. They're always afraid and want to basically warn people not to do things, you know, And you mentioned earlier of people not being able to turn their minds off. Is that the anxiety or what is that? Can you explain that a little bit more? Yeah, I can. It's called ruminative anxiety, but it's a little complicated because let's say if a woman has a diagnostic history of bipolar disorder,
00:04:54
Speaker
It could have something to do with their mind just racing and that could also be a bipolar disorder symptom. So then you just have to kind of you know do a differential diagnostic interview to see are they meeting criteria for bipolar disorder or anxiety disorder or is it a combination? That's just intensifying when their hormones
Cognitive Behavioral Therapy as a Treatment
00:05:17
Speaker
are changing. And you specialize in something called cognitive behavioral therapy. Can you tell our listeners what that is or CBT?
00:05:24
Speaker
Yes, I can. Well, it's definitely non-pharmacological. And it's the least invasive. And it really is kind of like just examining our thoughts, our emotions, and our actions. And all three of those tend to interact with one another. And it could be something positive as an outcome, or I never want to overshadow the positive. And I'll always want to reinforce the positive, but sometimes, you know, it's not that. Yeah. And if someone comes to you, I guess I do have quite a few patients who say that they've noticed changes in their mental health, specifically anxiety, but they don't want to start a medication. They don't want to worry about side effects from that medication.
00:06:08
Speaker
And then also for depression, it's just so hard for women going through midlife because they notice the weight changes of midlife and they don't want to start an antidepressant that's going to make them gain weight. So I do have a lot of patients who ask for something that's not an antidepressant. and So I do tend to refer to psychologists like yourself and others that we have here in Cleveland and that cognitive behavioral therapy. You know, how long does that take? Like if I'm going to send someone or refer someone, what what should I be telling them to expect? Oh, wow. That's a real good question.
00:06:38
Speaker
And you know hate not to give a definite answer, but it does depend. It depends on how severe it is. It depends on if it's recurrent or not. But we could make a lot of progress, I say, in six sessions. There could be a lot of progress made, I would say, as a general rule of thumb, you could say six to 12 sessions. Okay. And you're teaching them skills that then they can use to cope beyond that point, I would assume it starts to kind of become part of their thinking. You're rewiring the way that they're thinking about the negative thoughts or the anxiety thoughts.
00:07:13
Speaker
Yeah, I mean, that's right on, Dr. Pope. So let's say, for instance, to me, this is a classic example, the word menopause. you know We have done a lot of menopause in groups. When we say the word menopause, what comes to mind? Old, not needed anymore. you know That's all negative. And so we want to help women to reframe that.
00:07:35
Speaker
And so that's even part of cognitive behavioral therapy is reframing the idea of menopause. yeah Oh, absolutely. And um I would ask you if you had three tips that you wanted to tell women, you know, to protect their mental health as they're going through this life stage, what would you tell them to do? First of all, it's hard to narrow it down to three because there's so many things you can do.
00:07:57
Speaker
and Sure. But I would say, you know, generally, and if I kind of like think about all the women that I've seen, I would say, take inventory and see what's going on in your life that's increasing the anxiety or depression or making you feel overwhelmed. And then look at that list and see which is contributing more or less.
00:08:19
Speaker
And then I would say, let's start marking them off the list. Let's start problem solving, you know, from there. So those would be, I would say, maybe the top three. One that any woman can carry with them day and night, wherever they are, is deep breathing. Okay. You know, and deep breathing does so many things. Decreases stress, which increases hot flashes. So if you decrease your stress and do deep breathing, that's going to help with hot flashes. It also helps reduce anxiety.
00:08:45
Speaker
and manage depression. So I would say definitely do deep breathing. And, you know, the other thing that I would certainly say is, you know, for women to educate themselves to get information from their providers or certain websites or books, because that way you know you'll know that, oh, gosh, this is normal.
00:09:03
Speaker
Oh, I'm not the only one going through this, so kind of normalize it a bit. Okay, that makes sense. Oh, I love that. I want to ask you a little bit about your research and health disparities
Racial Disparities in Healthcare
00:09:13
Speaker
too. I feel like that's an area that's near and dear to my heart. And here in Cleveland, we have a lot of health disparities, unfortunately, whether you're looking through maternal health or infant mortality, I mean, you name it, unfortunately, we've got health disparities here.
00:09:26
Speaker
And it's a good place to be doing research and advocacy. And I would love to hear how that's translated into your work in midlife women's health and menopause. Well, what I've been doing so far is research in health disparities and hormone therapy prescribing, you know, so doing this research. Yes. And we have found a lot of disparities in this research. There's definitely a racial disparity and differences, you know, in terms of like insurance type education. So a lot of your standard ones, social determinants of health, yeah we're seeing where they're just not getting as much education comparatively.
00:10:04
Speaker
to other races or income levels or education levels. Yeah. And so I, I've talked to some women in the area about this and we talked a lot about kind of a mistrust with the healthcare system and how, you know, when you have heard all of the craziness that came out from the women's health initiative that scared everybody off of hormones and you already mistrust the healthcare system. It's like you have a whole nother layer.
00:10:32
Speaker
that you have to break through if you want to make individualized decision about hormones. I don't know if you agree with that or disagree, but we just talked a lot about, you know, historical mistrust and and how that ends up really just making it hard to have relationships with healthcare professionals and how you have to kind of create this extra sort of, I don't know, this extra layer of trust forming relationship building in order to kind of break through all of this horrible history that
Building Trust in Healthcare
00:11:02
Speaker
exists. Yeah, no, I agree. And the good thing for me is that as a psychologist, I tend to have more time with people, you know, just like any relationship, we have to build trust and they have to feel safe with us. And some women feel that things are being forced on them. So I will say that, you know, a good listening to me is the top priority.
00:11:25
Speaker
that they feel heard, they know, like, if they do not want hormone therapy, just say, okay, we have other options, you know, and let them try other options because maybe they'll work. And if they don't work, you know, then see if they want to try something else or something else until, you know, they hit the jackpot yeah and they'll be like, wow, you know, we've hung in there and now I'm feeling so much better and I'm going to tell all my friends.
00:11:48
Speaker
don't know That's interesting. And it's another conversation that's kind of come up is that for women of color, they do have a higher risk of breast cancer. And so I've had a lot of my patients of color who have told me, I'm not interested in estrogen. My mother had breast cancer. She passed from it. I don't want that. And just maybe the appointment prior to that, I was just explaining the women's health initiative to someone and saying,
00:12:11
Speaker
don't have to be scared about estrogen. And now I'm having to kind of reframe and say I get why you're scared of estrogen. It's complicated. And you're right. Maybe it is just about having time to be able to listen and talk to everyone and meet them where they are. is Exactly. Yeah, that's exactly. That's all I'm saying. Yeah. And then they know that she respects me or he respects me. And that's a big first step right there.
00:12:32
Speaker
I mean, right, we should be getting at least that from our health care professionals, but it's unfortunately sad that oftentimes people walk away not feeling that sort of respect. Right, exactly. So I mean, to me, that's an easy fix, right? You know, if we just kind of sat down as providers and ah health care practitioners and let's go back to the basics.
00:12:53
Speaker
yeah you know listen I mean, you go home from work and if you you have a partner, do you want them to listen to you? Do you feel better when they listen to you? Well, it's the same thing with patients. It's no different. Exactly. Yeah, for some reason, unfortunately, I feel like at that skill is not that easy to teach. I don't know, or somehow it's not emphasized in training programs. I'm not sure what that is. And yeah, we we should be looking right from the beginning in medical school and those who are going to pre-med, you know, we look at chemistry grades and test scores and we don't look at really training people and evaluating them on their listing skills and how they can build reports. with people. And to me that's just kind of like the foundation right there in terms of them not only patients not only trusting you but also even coming to you when they do have problems.
00:13:43
Speaker
and say maybe they want an extra appointment or certainly in terms of like, you know, coming back for more appointments, because it's like, not only do I trust you, but you're also helping me. So yeah you have me for life now. I'm going to keep coming back and keep coming back whenever I have something going on, because if Dr. XYZ can help me, he or she will. If not, I trust that they will say, you know, I'm sorry, I can't help you with that, but I'll find someone who can. Oh, that's so good.
00:14:12
Speaker
Well, I really appreciated your time and your insight into this area. I think it's it's so important and mental health is stigmatized. I think, unfortunately, still this day and age in the US and I feel like We need to pay more attention to it. We need to normalize it and speak about it more so that when people are going through struggles, um they can get help faster and they don't have to live through it alone, especially. Any last words or anything else you would like to share before we close
Life Changes and Mental Health Post-Menopause
00:14:40
Speaker
up? Yeah, I do. And so thank you for asking that. You know, when you were asking me about the mental health during post-menopause, and my apologies for this, but
00:14:49
Speaker
with all the physical changes that are happening with yeah women, whether it is memory problems or forgetfulness, vaginal changes, mood changes, you know, yeah weight changes, there's so many changes, empty nesting, all these life transitions, all of those, especially if they're compounded, will affect a woman's mood. And these are are issues that are relevant to a woman's life during this this time period.
00:15:14
Speaker
That's so true. And I think we forget about those significant life changes that tend to happen around this time as well. I don't know if you see this with your patients who are going through menopause, but I have a lot of my patients who their daughters are going through puberty the same time that they're going through menopause. And it's like,
00:15:32
Speaker
They're trying to deal with their children's changes and, you know, the stresses that lie there in and then their own health and then not to mention even, you know, cancers start to increase around that age. So people might go through some different scares and yeah, there's a lot. They might be taking care of their own parents and really living through that double burden.
00:15:53
Speaker
Yeah, yeah, exactly. And then now, you know, we're hearing more and more that adult children are moving back home, probably temporary, but you know, still doing it. But like you said, the sandwich decoration and potentially more medical problems and all types of life transitions happen during that time period. They need a therapist. They need to see a psychologist like you. We're helpful. Yes, we all benefit. We all benefit. So, no, it's wonderful work that you do and I really appreciate your time tonight and I appreciate all that you continue to do and I can't wait to see what you do next with your research. Thank you. I appreciate it. Thank you again for inviting me today, Dr. Pope. Thank you. My pleasure.