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Depression is the leading cause of disability and a major contributor to the overall global burden of disease.

 highlights, despite how common depression is across the life course, critical barriers have prevented depression from receiving sufficient resources and global attention.

 Depression has historically been stigmatized and misunderstood, and it arises due to a combination of biological, social, and psychological factors. Limited access to treatment and lack of cross-disciplinary, collaborative research and care has hindered progress. Additionally, women are disproportionately affected by depression and are twice as likely to have a diagnosis of depression as men, likely due to the combination of health inequities, gender biases, and biological factors.

 when elderly, and it might be a reason more women have dementia than men.

 Developing innovative solutions for depression—especially those focused on women that account for sex and gender differences—are critical to improving individual and collective resilience.

To develop women-focused solutions for depression, it is important to understand the various factors that contribute to women’s greater risk for depression. A health equity and public health lens is imperative. The distinction between sex and gender also needs to be clear, with sex referring to biological differences and gender encompassing socially constructed and enacted roles and behaviors shaped by historical and cultural contexts. Additionally, diagnostic tools, symptom screeners, medications, and other health tools must not have sex or gender bias.

Women in their reproductive years undergo cycle changes in steroid hormones (progesterone/estrogen) over the menstrual cycle. The role of these changes as a factor contributing to depression and mood changes is seen in women with premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS). The estimated prevalence in reproductive women is 5% (PMDD) and 20% (PMS). There is growing evidence that the rise in ovarian steroid hormone production and the effect of their metabolites (in particular allopregnanolone) on central brain receptors as progesterone receptor modulators contribute to the mood symptoms in 

 More research is needed to understand the long-term neurological impacts of birth control and hormone therapy.

 Treatments are now being developed to target these newer proposed actions of hormones on the central brain systems with either 

 (removing the natural fluctuations in hormones) or “correcting” the neurotransmitter or 

 with the use oftargeted specific antidepressants.

The female preponderance in depression occurs largely during the reproductive years, is not evident before puberty, and is less marked after menopause. Societal factors may also play an important role; even in developed countries, women still often take a greater responsibility for child rearing and domestic activities while still being expected to progress their careers—known as a “double day.” Women worldwide are also the majority of caregivers for family members needing health care; often this role is unpaid.

Depression is also linked to intimate partner violence (IPV). 

 globally have experienced physical or sexual IPV.

 Since the outbreak of COVID-19, IPV has escalated and been called the 

 of COVID-19. In numerous countries, there has been a 

, likely fueled by effects and mitigation strategies of COVID-19.

 would be affected by IPV for every 3 months of lockdown.

One particularly devastating yet unaddressed and long neglected impact is the mental and brain health effects—

including traumatic brain injury (TBI) and depression

—resulting from IPV. Numerous studies have found that women exposed to IPV are more likely to develop depression than women who are not exposed.

 This finding is not surprising, given that mental health issues are common sequelae of brain injury that may emerge and worsen years after injury. However, IPV is too often left out of conversations around prevention and treatment of depression.

It is also important to note the connection between depression and chronic health conditions in women, such as heart disease. Since 1989, heart disease has been 

 Women are also more likely than men to die after a heart attack.

Women are more likely to be undiagnosed, misdiagnosed, or poorly treated for their heart disease due to pervasive bias and the male body being the default for biomedical care and research. Additionally, 

the Guidelines for the Prevention of Cardiovascular Disease in Women

 by the American Heart Association show the profound impact of hypertension, diabetes, and depression on women’s hearts.

 It is imperative to understand the huge impact of psychosocial risk factors on women’s hearts and address problems including depression and social isolation.

Understanding the role of depression in dementia for women is also imperative. 

The WHAM Report (Women’s Health Access Matters)

 found that women are 66% of the nearly 7 million people in the United States with Alzheimer disease, and yet just 12% of 2019 NIH Alzheimer disease fund went to projects focused on women.

 Even more, the report showed the following: (1) Doubling the funds for women’s Alzheimer disease research pays for itself 3 times over; (2) this 224% return on investment adds 15% more to our economy than general Alzheimer disease research; and (3) adding $300 million for research on women generates $930 million in economic gains, adds back 4000 years of life, eliminates 6500 Alzheimer disease and related dementias, and saves 3500 years of nursing home care and costs. Depression is 

one of the largest modifiable risk factors

 Thus, understanding the link between depression and dementia and accounting for depression in dementia prevention strategies in women is essential.

Novel, women-focused solutions can reduce the impact of depression and increase global resilience. As a recent 

 finds, women’s health solutions often remain siloed to pregnancy and reproductive-related issues.

There is a dearth of women-focused solutions for chronic health and behavioral health and an even larger gap for solutions at the intersection of both.

 Women-focused solutions that include technology, drug development, and devices are urgently needed. Additionally, convergence solutions that combine multiple domains and technologies, such as blending platform and frontier technologies, are key.

Developing women-focused solutions is not only a medical and moral imperative—there is also significant economic and commercial upside. Emergen Research projects that the global market for women’s health will reach $60 billion in 2027.

 Additionally, women are the chief medical officers of society, controlling 80% of health care decisions in the United States and spending 29% more per capita on health care compared to men.

By developing women-focused solutions for depression that account for various factors, including the relationship between depression with heart disease and dementia in women, we can build a more resilient society and world.

is an Atlantic Fellow for Equity in Brain Health at Global Brain Health Institute, a Thiel Fellow at Stanford University, and a Steering Committee member for OECD-PRODEO Institute Neuroscience-inspired Policy Initiative.

is CEO of PRODEO and cofounder of the PRODEO Institute.

is founder and chief director of the Center for BrainHealth at UT Dallas. She is a distinguished professor at UT Dallas.

is a reproductive endocrinologist at Baylor College of Medicine. He is an active member of the American Society of Reproductive Medicine and the North American Menopause Society, with a special interest in the role of steroid hormones on cognitive function. 

is deputy secretary of public health in the Victorian Department of Health and Honorary Melbourne Enterprise Professor with the University of Melbourne. 

is a NHMRC senior principal research fellow, Alfred Deakin professor of psychiatry at Deakin University, and director of the Institute for Mental and Physical Health and Clinical Translation 

is CEO and cofounder of the Women’s Brain Project.

is colead of the OECD-PRODEO Institute NIPI.He is a senior fellow in brain capital for the Meadows Mental Health Policy Institute. He holds adjunct or advisory roles with IMPACT at Deakin University, the Heka Fund, Brain Health Nexus at Cohen Veterans Bioscience, GBHI, Baylor College of Medicine, Latin American Brain Health (BrainLat), Universidad Adolfo Ibáñez, Chile, University of Texas Health Sciences Center at Houston, the Davos Alzheimer’s Collaborative and the Euro-Mediterranean Economists Association.

1. Herrman H, Patel V, Kieling C, et al. 

Time for united action on depression: a Lancet-World Psychiatric Association Commission.

Midlife vs late-life depressive symptoms and risk of dementia: differential effects for Alzheimer disease and vascular dementia.

4. Savolainen-Peltonen H, Rahkola-Soisalo P, Hoti F, et al. 

Use of postmenopausal hormone therapy and risk of Alzheimer’s disease in Finland: nationwide case-control study.

5. Schmidt PJ, Martinez PE, Nieman LK, et al. 

Premenstrual dysphoric disorder symptoms following ovarian suppression: triggered by change in ovarian steroid levels but not continuous stable levels.

6. Hantsoo L, Grillon C, Sammel M, et al. 

Response to sertraline is associated with reduction in anxiety-potentiated startle in premenstrual dysphoric disorder.

7. Breiding MJ, Smith SG, Basile KC, et al. 

Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization--national intimate partner and sexual violence survey, United States, 2011.

When pandemics clash: gendered violence-related traumatic brain injuries in women since COVID-19.

9. Mlambo-Ngcuka P. Gender-based violence: we must flatten the curve of this shadow pandemic. November 25, 2020. Accessed May 12, 2022. 

https://www.un.org/africarenewal/magazine/november-december-2020/gender-based-violence-we-must-flatten-curve-shadow-pandemic

10. Ellsberg M, Jansen HAFM, Heise L, et al. 

Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational study.

11. Mehta LS, Beckie TM, DeVon HA, et al. 

Acute myocardial infarction in women: a scientific statement from the American Heart Association.

12. Mosca L, Benjamin EJ, Berra K, et al. 

Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the American Heart Association.

Societal Impact of Research Funding for Women’s Health in Alzheimer’s Disease and Related Dementias

14. Livingston G, Huntley J, Sommerlad A, et al. 

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.

15. DeSilva J, Krasniansky A. Building comprehensive women+ digital health: Eight sectors serving women+ needs. Rock Health. September 27, 2021. Accessed May 12, 2022. 

https://rockhealth.com/insights/building-comprehensive-women-digital-health-eight-sectors-serving-women-needs/

16. Femtech Market By Type (Devices, Software, Services), By End-Use (Direct-to-Consumer, Hospitals, Fertility Clinics, Surgical Centers, Diagnostic Centers), By Application (Reproductive Health, Pregnancy & Nursing Care, Pelvic & Uterine Healthcare), By Region, Forecasts to 2027. EMERGEN Research. June 2021. Accessed May 12, 2022. 

https://www.emergenresearch.com/industry-report/femtech-market

17. Femtech—time for a digital revolution in the women’s health market. Frost & Sullivan. January 31, 2018. Accessed May 12, 2022. 

https://www.frost.com/frost-perspectives/femtechtime-digital-revolution-womens-health-market/

18. Gambon E, Stotz C, Sandhu N. Femtech is expansive—it’s time to start treating it as such. Rock Health. August 3, 2020. Accessed May 12, 2022. 

https://rockhealth.com/femtech-is-expansive-its-time-to-start-treating-it-as-such/

Here’s why we should be paying special attention to women's depression treatment.  

Mind-Body Resilience for Women: A Focus on Depression

Based on what we know right now, the US Supreme Court is poised to overturn 

, which allowed a patient and her doctor to make decisions about an abortion. According to the leaked initial draft abortion opinion, the states will decide,

 which likely means that some states will not allow abortion. Other states may allow exceptions for rape and incest. To me, it feels like the Supreme Court burst into the examination room and sat between the patient and her doctor. This is an intrusion into the doctor-patient relationship.

The Supreme Court may not know women who have serious mental illness such as borderline personality disorder, rapid-cycling bipolar disorder, or treatment-refractory depression. However, these disorders are important to consider when deciding to bring a child into the world. This decision takes the doctor completely out of the picture and forces the woman with a disability, with a chronic mental illness, or in poverty to follow the law or else.

Particularly for women with serious mental illness, 9 months is a long time. Many must take medications, and these may have an adverse effect on the pregnancy. They also often experience morning sickness, which will have an impact on the level of psychiatric medication and may result in an increase in symptoms. For example, when my patients with bipolar disorder begin to sleep less, the concern is that this may be the beginning of a significant increase in symptoms.

 It can be very difficult to sleep in pregnancy depending on how much the baby is moving, along with various other issues such as frequent urination and back pain.

 In addition, many chronically ill patients have symptoms even when they are appropriately treated on medications. Pregnancy can also be frightening; there are lots of sensations and discomforts that are not always easy to manage.

 All of this may result in patients needing to be hospitalized to keep them safe during this very challenging time.

With incredible support and resources, having a baby can be a very special experience. For example, I treated a young couple who both had serious mental illness. They married and were very excited about having a child. Both the husband’s and the wife’s parents came to the appointment, and the decision was made that the parents of the couple would lend incredible support. Both moms agreed to be available to go to all appointments and to handle calls if the couple was concerned. The moms also agreed to take turns staying with the couple after the baby was born, because babies do not sleep through the night. Despite this consistent support, there were a few emergency room visits and lots of doctor visits with medication adjustments. In the end, the couple moved in with one of the parents when the baby arrived.

Not all women have this level of support, however—especially now that 1 million individuals have died of COVID-19 in the United States.

 Some young women have lost partners, parents, siblings, aunts, uncles, and grandparents—the support system of other individuals in their family who could have helped them with a new baby. Without a support system to help, having a new baby can be a very trying experience, particularly for women with serious mental illness.

 decided that a woman and her doctor had the right to make this decision about an abortion—a clinical decision that would take into account the patient’s entire medical and mental health history. Now, 50 years later, the Supreme Court is set to overturn 

 removing the doctor completely from the equation and putting the states in charge of an important medical decision. Not only does this undermine the doctor-patient relationship, but will also have a particularly negative impact on patients with serious mental illness.

is a practicing psychiatrist in Atlanta, Georgia.

The opinions expressed are those of the author and do not necessarily reflect the opinions of

1. Gerstein J, Ward A. Supreme Court has voted to overturn abortion rights, draft opinion shows. 

https://www.politico.com/news/2022/05/02/supreme-court-abortion-draft-opinion-00029473

2. Jones I, Chandra PS, Dazzan P, Howard LM. 

Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period

Maternal infanticide associated with mental illness: prevention and the promise of saved lives

Sexuality, pregnancy, and childrearing among women with schizophrenia-spectrum disorders

5. Chuck E, Siemaszko C. Covid’s toll in the U.S. reaches a once unfathomable number: 1 million deaths. 

https://www.nbcnews.com/news/us-news/covids-toll-us-reaches-1-million-deaths-unfathomable-number-rcna22105

If Roe v Wade is overturned, how will patients with serious mental illness be affected?

 The Vanishing White Coat

Leakage of a draft opinion of the majority in the case of 

Dobbs v. Jackson Women’s Health Organization 

has resulted in a consensus that the US Supreme Court will likely reverse the decision of 

, and undo its protections for women and their health care providers to determine the best course of care.

 In my opinion, physicians, including psychiatrists, have a duty to advocate for patients who we counsel and treat based upon the best medical evidence. 

 has been settled law assuring women access to a standard medical procedure for almost 5 decades—or so we thought.

A conservative majority on our nation’s highest court is now poised to outlaw a medical procedure used by many American women every year. What follows in this article is one physician’s description of the probable consequences for American women should 

 be overturned. I leave it to legal scholars and the editorial boards of major newspapers to critique the quality, or lack thereof, with respect to inconsistency and selective reasoning evidenced in the court’s draft decision as written by Justice Samuel Alito.

I began my training at Northwestern University Medical School in 1974, the year following the 

 decision. Construction of a state-of-the-art women’s hospital began in 1972 with the opening of Prentice Women’s Hospital on that Chicago campus in 1975. The hospital was designed with an entire floor dedicated to cases of sepsis. You might ask how large numbers of adult females might have infections in their circulatory system. The answer is quite simple: illegal abortions. While pneumonia, autoimmune disease, and renal calculi (kidney stones) are common causes of sepsis, 

 is no longer a leading cause in the post-

 era. As a result of the constitutional right to this gynecologic procedure, an entire floor of a major hospital became obsolete before it even opened. That portion of the hospital went vacant until it was reconfigured, at least in part, as a fertility clinic. From this physician’s perspective, the result of eliminating safe, legal abortion for many will be a surge of infectious disease, hospitalizations, chronic pain, infertility, and deaths in women of reproductive age.

According to the Guttmacher Institute, an abortion rights advocacy group, although American women across all races undergo abortion services, 49% live below the federal poverty level, and 60% are in their 20s.

 If states ban abortion, it will have the greatest impact upon poor and working-class young adults, as they are least likely to be able to afford travel expenses for an out-of-state procedure. Aside from increased financial costs and inconvenience, I contend outlawing abortion will have many other adverse repercussions for our patients.

According to the Associated Press, at least 26 states are expected to outlaw abortion, if 

 is overturned, some by “trigger” laws in place.

 Although there will be states like California that enact laws to protect 

, there will be others where access to abortion will be more restricted or even banned once there is a fetal heartbeat, as in Texas currently. That has consequences for addressing mental and medical care for our patients.

We can also expect to see health care matters become a subject for criminal prosecution. Recently, a 26-year-old woman who miscarried though reported having induced an abortion was charged with murder by 

. The charges were later dropped as federal law under 

 Will health care providers be required in some jurisdictions to report suspected or confirmed cases of abortion where it is illegal? Will physicians and those who assist in performing abortions be at risk of prosecution? Another ramification of the high court’s pending decision will be to reduce the number of physicians and nurses with proper training to safely and competently perform surgical abortions. Some schools of medicine and nursing will no longer be allowed to have abortion procedures be a component of the curriculum under post-

Many Americans are unaware that “medication abortion” has been the primary means of abortion in the US during the 

The United States Food and Drug Administration no longer requires an in-person doctor’s visit to prescribe this effective and safe pharmaceutical agent.

 Plan C is a 2-drug abortifacient comprised of mifepristone (Korlym, Mifeprex) that blocks progesterone and misoprostol (Cytotec) that induces uterine cramping and bleeding. Plan C is readily available through reputable online sources. While considered safe to use through the first 11 weeks of a pregnancy, medical consultation is advised if symptoms such as heavy bleeding, high fever, or severe pain occur.

Although Plan C may become prohibited in states that ban abortion, history shows us that this will not stop women from using it. I witnessed the need for illegal abortions pre-

, as evidenced by a planned sepsis ward. It is highly likely that women in a post-

 era will terminate unwanted pregnancies despite the increased risk to their health or of resultant criminal charges. The reality is that abortion has taken place throughout history. The religious, moral, or political reasons to restrict or ban abortion will not eliminate it. Do we really want hospitals in Chicago, New York, Dallas, Miami, Phoenix, and many other major cities to have sepsis wards?

Although clinicians should support family planning and appropriate birth control, psychiatrists are acutely aware that mistakes happen and much of life is unplanned. Thus, there will remain a demand for abortion after access to the procedure or pharmacotherapy is restricted in parts of America.

 is likely to be a monumental development that will impact the lives of our patients. Along with the aforementioned resultant infections, hemorrhages, and deaths, there will be an increase in the incidence of reactive depression and debilitating anxiety disorders among women of childbearing age. As a result of studies of psychosocial stressors by researchers such as the psychiatrists Holmes and Rahe, it is well accepted that such stressors can contribute to health problems.

 Psychological distress and depressive symptoms correlate with acute and chronic psychosocial stressors.

 Women who terminate a pregnancy in a post-

 era could be expected to experience complications like infection and bleeding, hospitalization, financial problems, changes in sleep or eating, and legal charges. These are just some of the likely stressors that put women who choose to end a pregnancy in jurisdictions outlawing abortion at increased risk for a clinical depression and/or an anxiety disorder (psychological distress). Because this is a medical issue, I hope that other doctors become advocates for access to abortion as an appropriate and necessary medical procedure.

The opinions expressed are those of the author and do not necessarily reflect the opinions of Psychiatric Times

is director of the Center for Occupational Psychiatry and a retired clinical professor at the UCSF School of Medicine.

Wounded Workers: Tales From the Working Man’s Shrink

1. Gerstein J, Ward A. Supreme court has voted to overturn abortion, draft opinion shows. 

2. Editorial Board. Editorial: Alioto’s draft ruling is so self-contradictory that it calls court’s judgment into question. 

https://www.stltoday.com/opinion/editorial/editorial-alitos-draft-ruling-is-so-self-contradictory-that-it-calls-courts-judgment-into-question/article_73f7ab1a-6078-59d2-a0a8-ecb18800ecf2.html?msclkid=a160a1aaced611ecade257e7f4e7bbe3

3. United States Abortion Demographics. Guttmacher Institute. Accessed May 9, 2022. 

https://www.guttmacher.org/united-states/abortion/demographics

4. Beam A. California leaders commit to putting amendment in state constitution to protect abortion. Associated Press. May 3, 2022. Accessed May 9, 2022. 

https://apnews.com/article/california-reproductive-rights-state-governments-fcfe3d2b24fe6fe502d01d72a891f1c6

5. McShane J. Texas district attorney drops case against woman charged with murder for self-induced abortion. NBC News. April 11, 2022. Accessed May 11, 2022. 

https://www.nbcnews.com/news/texas-district-attorney-says-indictment-woman-charged-murder-self-indu-rcna23782?msclkid=df2b6efed07811ecbf77586ac452f600

6. Aungst C. The facts about Plan C (medication abortion). GoodRx Health. September 17, 2021. Accessed May 11, 2022. 

https://www.goodrx.com/conditions/abortion/plan-c-medication-abortion

7. Haberkorn J. A new focus on pill access. 

https://enewspaper.latimes.com/infinity/article_share.aspx?guid=d7f1108a-ec10-432e-9e21-b7dcc9f00b7a

9. Bailey ZD, Williams DR. Stress, health, and disparities. In: Zigmond MJ, Rowland LP, Coyle JT. 

The protections of Roe v. Wade may be coming to an end. What will this mean for mental health?

Legislating Medical Procedures

A study on best practices in the identification and management of perinatal depression raised more questions than answers.

The study aimed to examine the guidelines for managing perinatal depression in obstetric and pediatric settings, as well as the evidence supporting these guidelines. To do this, the investigators conducted a search for best practices in the Guideline International Network using the term 

; conducted additional searches on Google and other websites; and had discussions with experts in perinatal depression. To be included, guidelines had to describe the management of perinatal depression in obstetric or pediatric care settings; be written in English; and have been published between 1990 and 2021. The investigators found 25 guidelines published by 17 organizations—with 6 organizations publishing more than 1 guideline—that met the aforementioned criteria for inclusion. They then examined the research supporting these guidelines through searches in PubMed and Google Scholar, and conducted a literature review.

The investigators found that most guidelines (n =18, 72%) made recommendations for screening for perinatal depression, and 16 (89%) made several recommendations, including for screening timeframe, setting, and instrumentation. Just over one-third of the guidelines (n = 9, 36%) recommended assessment by severity and instrumentation to confirm depression after screening, and 3 (33%) made several recommendations. Suicide assessment was also analyzed, with 13 guidelines (52%) addressing suicide assessment, 6 (46%) of which recommended immediate evaluation. More than 50% of the guidelines (n = 7, 54%) recommended referring the patient to a psychiatrist or other mental health clinician to monitor the patient’s well-being.

The majority of guidelines (n = 21, 84%) made recommendations for treatment, with most (n = 20, 95%) offering several recommendations and 14 (67%) making recommendations by severity. Most (90%) recommended psychosocial interventions such as cognitive behavioral therapy or psychodynamic therapy; 60% recommended pharmacological treatment such as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs); 40% recommended psychoeducation throughout the perinatal period; and 19% recommended alternative treatments like bright light therapy and electronic mental health support (ie, self-guided applications). The investigators also noted that literature on reassessment, remission, and care management was limited, and that they identified no literature discussing treatment adjustments for perinatal depression that was unresponsive to psychotherapy or pharmacology.

Overall, the investigators noted that evidence was inadequate or contradictory across all areas, and that of the limited number of studies available, most include small sample sizes or are not of sufficient quality to meaningfully inform clinical practice.

“Clinicians may use these recommendations to guide their practice, but they should be aware of the limitations of the evidence supporting these guidelines and remain alert to new evidence. There is a clear need for researchers and policymakers to prioritize this area in order to develop evidence-based guidelines for managing perinatal depression.”

Management of depression during the perinatal period: state of the evidence

Recommendations are often vague, contradictory, according to investigators.

Study Examines Best Practices for Managing Perinatal Depression

Throughout medical school, I found myself the happiest during my OBGYN rotation, especially in labor and delivery. Nothing can describe the pure joy that comes with being there for the most important day of someone’s life. Although medical providers are technically not family members, in OB, when delivering someone’s child, it feels so close. Most of the sentiments I came across in this field can only be wrapped up by the word 

. However, when OB is sad, it is devastating.

It was not until later this year in my rotation through the emergency department that I examined someone and knew she was miscarrying. The ensuing silence was deafening. No amount of empathy can ease the pain for someone losing a much-wanted child along with the hopes they had for their future, for that day in labor and delivery when they would have started or grown their family.

Many of us pursue medicine because we envision ourselves helping others. I had not yet had an experience in which I felt more helpless—although I am sure I will. Patients go through the most at the end of the day, and it is an honor to be trusted to care for them in these moments. OBGYN, and medicine in general, will always be worth it. But moments like these deserve time for reflection. As providers, we see so much. We empathize with patients who are going through hardship hundreds of times every day. The hardest moments we witness, however, should be a reminder to extend that empathy to ourselves so we can continue to care for others.

is a third-year medical student at the University of South Carolina School of Medicine Greenville. She received her BA in Romance Languages and Literatures and International Studies from the University of Michigan and practiced as a licensed esthetician prior to medical school. She hopes to pursue OBGYN and incorporate her love of psychiatry into her practice.

When helping patients in the hardest moments of their lives, it is important to have empathy for them—and for ourselves.

Psychological Reflections on Miscarriage

Senior citizens sit at the center of life’s oldest paradox. For many, the closer they come to death, the more their emotional well-being seems to increase. After a lifetime of losing loved ones, suffering defeats, and experiencing physical decline, older adults still manage to take life’s punches in stride. Resilience with aging is what gives seniors an edge. How they have adapted to the aging process speaks to their incredible 

. And it begs the question: What can the rest of us learn from them?

Resilience is the ability to quickly recover from stress, whether physical, mental, or emotional.

Efforts by neuroscience to study why some people are more resilient than others have generally led to elusive answers. For example, a study observed brain images of people who had suffered abuse as children. The intent was to compare brain changes between those who went on to develop 

 as adults and those who developed resilience.1 Surprisingly, brain changes associated with maltreatment were noticed equally in both groups of people, whether or not they exhibited psychiatric symptoms. The authors speculated that there may be other molecular alterations or neurobiological changes that helped them adapt to stress.

Resilience is thought to involve 3 main brain regions: the prefrontal cortex, the hippocampus, and the amygdala. Research indicates that resilient people have greater connectivity between areas of the prefrontal cortex to the areas of the brain linked to emotions. Their hippocampi and amygdalae are less stimulated.

The prefrontal cortex is involved in decision-making and emotional control. Activity in the orbitofrontal network especially plays a role, particularly as it involves reward-related memories. One study suggested that activating this system can improve the body’s stress response and lead to greater psychological resilience.

In the hippocampus, gray and white matter volume is larger in resilient adults, with more connectivity between the limbic system and central executive network.

As part of the brain’s limbic system, the amygdala plays a huge role in decision-making by helping us process information and rewards, assess threats, and regulate emotions.

 It also ties emotions into certain memories. 

 is higher when there is less connectivity between the amygdala nuclei and the ventral default-mode network.

Resilience involves several neurotransmitters. These include norepinephrine, neuropeptide Y, galanin, corticotropin-releasing hormone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), dopamine, serotonin, abrineurin (BDNF), and allopregnanolone (ALLO).

Resilience does not imply a reduction in the response to stress. Rather, more of our brain is involved in adapting to it. As described in 1 article, it is an “active process that implies ongoing adaptive plasticity without external intervention.”

Of the mice subjected to stress in 1 study, those with higher levels of resilience engaged 3 times the numbers of genes in their stress response than those with lower resilience.

 Researchers also identified a potassium channel in the Ih channel gene in the brain, which experienced increased activity in the brains of mice with higher resilience.

, genetics, and environment, resilience is shaped by other factors including personality, temperament, physical fitness, and social support. All of this can shape how we react to stress and whether we view it as challenging or threatening. Manageable stress can hone and improve our performance, while situations experienced as threatening may significantly impact one’s physical and mental health.

Whether our resilience level is genetically endowed or something that is learned has long been the subject of debate. It may be a mix of the two. There is strong evidence to suggest that strategies can be employed to build the muscle of resilience.

 To see ways to build resilience, see the 

One study analyzed the effects of positive memory recall on a group of teens at risk of depression.

 The practice of recalling good memories resulted in lower cortisol and negative mood levels over the course of a year. By actively shifting focus away from memories of stressful events, these teens learned to actively create resilience.

What can we learn about resilience from senior citizens? 

Special Populations

Mind-Body Resilience for Women: A Focus on Depression

The Vanishing White Coat

Legislating Medical Procedures

Study Examines Best Practices for Managing Perinatal Depression

Psychological Reflections on Miscarriage

The Science of Resilience and Wisdom

Addressing the Youth Mental Health Crisis With Coordinated Systems of Care

From the Pages of Psychiatric Times: April 2022

Disentangling the Web: Comorbidity Issues in Gender-Diverse Youth

Moving On From National Minority Health Month