Women's Behavioral Health (Podcast)

Women's mood and anxiety disorders evolve across the lifespan, shaped by reproductive and hormonal transitions that can significantly affect mental health. To address these issues effectively, experts emphasize the importance of early identification, treatment continuity, patient education and close collaboration across specialties.

"Women’s mental health is closely intertwined with the body’s hormonal rhythms, with key life stages creating periods of heightened vulnerability for mood and anxiety disorders," explains psychiatrist Adele Viguera, MD, codirector of the Women's Behavioral Health Program at Cleveland Clinic. "Clinicians shouldn't be afraid to treat these conditions. Keeping women stable through transitional periods — particularly pregnancy and postpartum — is one of the most important things we can do for both mother and child.”

In this episode of Neuro Pathways, Dr. Viguera weighs in on the latest pharmacologic treatments for mood and anxiety disorders and highlights the value of psychological counseling. She also discusses strategies for providing integrated, multidisciplinary care and increasing clinician awareness across the reproductive lifespan.

Click the podcast player above to listen to the 25-minute episode now, or read on for a short, edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Podcast excerpt

Podcast host Glen Stevens, DO, PhD: What are the most common mood and anxiety disorders affecting women across the reproductive lifespan, and how do they differ by life stage?

Dr. Viguera: The most common diagnoses that we see are major depression and anxiety disorders like generalized anxiety and panic disorder. We’ve found that women are at increased risk for these diagnoses, starting from puberty all the way up until menopause.

Although a lot of women are relatively unaffected by hormonal transitions, there is a subgroup of patients who are particularly sensitive to the fluctuations seen in puberty, pregnancy and menopause. For some, these are periods of vulnerability.

Premenstrual dysphoric disorder can arise in menstruating women. Pregnancy and the postpartum period can also pose a very high risk for some patients, as can perimenopause. However, it’s worth noting that women who are more predisposed to these subtypes of reproductive-related mood and anxiety disorders tend to be those who already have a preexisting diagnosis of depression or anxiety.

Dr. Stevens: What are your thoughts about using hormone replacement therapy (HRT) to treat mood disorders in menopause?

Dr. Viguera: Thanks to some very progressive women physicians – urologists from all different disciplines – the FDA removed its black box warning on HRT in fall 2025. We're very excited about that…because the label was scaring some patients away from treatment.

However, we would never treat a primary mood disorder with hormones alone….we're not there yet. So, the first-line treatment for someone experiencing depression or anxiety during [menopause] would be an SSRI or SNRI. Now, if depression or anxiety is accompanied by vasomotor symptoms (either hot flashes or night sweats), we might use HRT in combination with an antidepressant.

Interestingly, SSRIs and SNRIs are also used to treat hot flashes, but they’re not as efficacious [as HRT]. Patients whose hot flashes are treated with estradiol see an improvement of about 90%. Vasomotor symptoms treated with an SSRI or SNRI may improve by about 50%.

Now that the black box warning on HRT is no longer there, I'm hoping to see more head-to-head studies that [answer the question]: Should we start with hormones or an antidepressant? But just to be clear – for now, the first-line treatment should be an antidepressant. We [would not introduce] hormones right away.