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The menopausal transition is frequently accompanied by adverse physical and emotional changes that can significantly impact a woman's quality of life. Hormone replacement therapy has been the most commonly used menopause-related treatment to date, particularly for the alleviation of vasomotor symptoms; recent studies, however, have questioned its long-term safety for some women. We aimed to develop a cognitive-behavioral group treatment (CBGT) program as an alternative or complementary treatment option for reducing the frequency and intensity of debilitating menopausal symptoms in midlife women. Eight subjects participated in two, 10-week pilot groups (n = 4 participants per group) with participants being drawn from referrals through the Women's Health Concerns Clinic and community advertising efforts. This pilot study confirmed a reduction in the frequency and interference associated with vasomotor symptoms, less depression and general anxiety, and an overall improvement in quality of life. Participants also reported high levels of satisfaction with this type of treatment for menopausal symptoms. Furthermore, there was a trend towards a reduction in sleep difficulties and sexual concerns over the course of treatment. This pilot CBGT program appears to be a promising alternative or complementary treatment for both the physical and emotional symptoms experienced during menopause. Further studies are needed on its efficacy through larger, controlled trials.

The Premenstrual Symptoms Screening Tool was modified for use in adolescents and piloted in 578 girls at three international sites. Nearly one third (29.6%) reported experiencing severe PMS or PMDD, with irritability being the most commonly reported symptom. Rates of menstrual-related pain were high, particularly in those with severe PMS or PMDD. Severe PMS and PMDD present with similar rates and symptoms in adolescents as in adults, and the Premenstrual Symptoms Screening Tool modified for adolescents is a fast, reliable tool to screen for these syndromes in adolescents.

Depression during midlife years may lead to significant sleep disturbances and adversely impact quality of life (QOL). In this report, we examined the effects of treatment with quetiapine extended release (XR), 150–300 mg/day, on sleep and QOL in 23 midlife women with major depressive disorder (MDD). Quetiapine XR improved subjective sleep distress, overall sleep parameters, and sleep-related QOL, ultimately leading to significant improvement in menopause-related QOL. While larger, controlled trials are still awaited, these preliminary results are encouraging and suggest that quetiapine XR may be a useful tool in treating symptomatic midlife women with MDD.

Insomnia is a common and significant healthcare problem, and affects a large percentage of women seen by general practitioners, obstetrician-gynecologists and mental health professionals. Specific risk factors for insomnia may be gender-related, including higher prevalence rates of depression and anxiety among women, environmental and social factors, as well as reproductive-related factors (e.g., peri-menstrual difficulties and menopause-related symptoms). Sleep problems interfere significantly with daytime functioning and overall well-being, and may lead to serious clinical consequences. Treatment options include benzodiazepines, non-benzodiazepines, nonprescription sleep aids, and non-pharmacologic interventions such as sleep hygiene measures. This article reviews the existing literature on the prevalence, clinical characteristics of insomnia in women, and highlights some of the treatment options available. Healthcare providers should be aware of the variety of pharmacologic and non-pharmacologic options for treatment of insomnia and, in particular, be able to weigh their efficacy against the risks of side effects and next-day sedation.

The postpartum period is associated with an increased risk of developing obsessive-compulsive disorder (OCD) in women. Postpartum onset OCD is often undiagnosed and untreated resulting in serious consequences for the patient, her family and the newborn. The symptoms of postpartum onset OCD may consist of obsessional intrusive thoughts about harming the newborn without compulsions or with both obsessions and compulsions. In this review, the phenomenology of postpartum onset OCD is described as well as strategies for screening and diagnosis. The review also characterizes the differences between postpartum onset OCD and postpartum depression and postpartum psychosis and explores strategies for managing postpartum onset OCD patients. Issues regarding pharmacologic treatment of OCD in breastfeeding mothers are also reviewed.

To examine sex- and age-related differences of treatment outcome in a cohort of outpatients with major depressive disorder (MDD), with and without comorbid anxiety, treated with fluoxetine.Outpatients with a SCID-diagnosis of MDD aged 18 to 65 years were treated openly with fluoxetine (20 mg/day) for 8 weeks. The 17-item Hamilton Depression Rating Scale (HAM-D-17) was administered at baseline, and at weeks 2, 4, 6 and 8. Remission of MDD was defined as a HAM-D-17 scoreor =7 at week 8. Rates of remission and change of depressive symptoms of MDD were compared among women aged45 years andor =45 years. The analyses were then repeated in men. The presence of comorbid anxiety disorders was included in the prediction model for change of depressive symptoms of MDD across age and sex.176 women and 153 men were included in this analysis. Remission of MDD occurred in 57.1% and 50% of younger and older women respectively. Similar rates were present in men (57.2% and 49.1%, respectively). Age did not predict remission of depression or change of depressive symptoms of MDD, in both women and men. Anxious and non-anxious subtypes of depression did not present sex- or age-related differences in treatment outcome.In this cohort of outpatients with MDD, we observed no sex- or age-related differences in response to an 8-week treatment with the SSRI fluoxetine. Similarly, there were no age-related differences among women with anxious and non-anxious subtype of depression.

As I have the opportunity to address our readers as your Co-Editor-in-Chief, I would like to first express our immense gratitude to all researchers, clinicians and scientists who have generously agreed to donate part of their precious time and acted as reviewers during 2009—a complete acknowledgement list can be found in this issue. As you all know, the AWMH has experienced an exponential increase in number of submissions; with such increase, a careful screening and reviewing process is absolutely necessary and we could not have achieved our goals to select high-quality, clinically meaningful manuscripts without the support of our referees—thank you all! These are very exciting times for those who have long battled for a journal solely dedicated to Women’s Mental Health. First, the impact factor of our journal has increased significantly over the past few years; second, we are promoting and consolidating “critical thinking” on issues related to women’s mental health across the lifespan—for a sample of that, please refer to thoughtful considerations on the DSM-V approach to female-specific issues in mental health featured in the first issue of 2010. More importantly, the expertise of our Editorial Board and reviewers allows us to continue expanding the scope of our journal. As reflected in this issue of the AWMH, we are committed to publish clinical, epidemiologic and translational research that are innovative and may ultimately promote significant advances in the field of women’s mental health—from menarche to menopause and beyond. I hope you will enjoy this issue of the AWMH and many more to come. Please do not hesitate to share your critiques, thoughts, suggestions...our ‘doors’ are always open!