Women’s Mental Health: Common Conditions and Treatment in Philadelphia

For many women, different stages of life can pose new challenges for both the body and brain, with seismic hormonal changes backgrounding already stressful periods of life. During their fertile years in particular, women are more likely than men to be affected by mental health conditions such as depression, and psychiatric symptoms can contrast from those in men. Quality psychiatric care involves working with a specialist who considers biological experiences—like menstruation, pregnancy and menopause—as factors that may influence symptoms, proper diagnosis and effective treatment. This is why, more than ever, women are seeking psychiatric treatment from women’s mental health experts, as opposed to general psychiatric providers.

Emily Bernstein, MD, the Director of Women’s Mental Health at Rittenhouse Psychiatric Associates, provides that specific care both in-office on the Main Line of Philadelphia and throughout the entire states of Pennsylvania and New Jersey via telemedicine (virtual) appointments. Dr. Bernstein is a woman’s mental health specialist who for over 10 years served as the director of Women’s Behavioral Health at Crozer Medical Center, and joined Rittenhouse Psychiatric Associates in 2023. Dr. Bernstein trained locally at the University of Pennsylvania, where she obtained both her Bachelor’s and Medical Degrees, and where she additionally completed her Psychiatric Residency. She believes in personalized, holistic and evidence-based treatment, prioritizing the complete person, not just focusing on an illness. This allows her to provide quality psychiatric care to women from late adolescence and family planning through post-menopause.

We discussed the most common mental health challenges facing women at various stages of life with Dr. Bernstein, and how a multidisciplinary treatment plan can help someone navigate these conditions.

Premenstrual Mental Health

Premenstrual syndrome (PMS)—which causes symptoms like irritability and mood swings—affects over 90 percent of women, but despite its prevalence, the full scope of psychiatric symptoms has been historically overlooked and undertreated.

“Many women can have premenstrual symptoms, but symptoms that get to the point of interference with typical functioning are not normal,” explains Dr. Bernstein. “That’s when symptoms become a diagnosable condition, and when evaluation and treatment would be recommended.”

That diagnosis is Premenstrual Dysphoric Disorder (PMDD): a condition in which menstruation brings hormonal changes that severely impact psychiatric health in some women. To an untrained eye, PMDD symptoms can look like clinical depression—so it’s essential to work with a provider like Dr. Bernstein, who understands contemporary women’s health and can identify the root issue.

The key distinction that Dr. Bernstein looks for to diagnose PMDD in her patients is the timeline. Where depression is a chronic and ongoing condition, PMDD emerges according to the menstrual and hormonal calendar. “You can almost set your watch to PMDD,” says Dr. Bernstein. “It’s that cyclical nature of PMDD that really sets it apart.”

Because the disorder involves both gynecology and psychiatry, a treatment plan for PMDD should include medical provider collaboration—multidisciplinary communication is essential. While Dr. Bernstein has insight into a patient’s risk factors for PMDD, gynecologists and general primary care providers have insight into physiological conditions that can influence a patient’s menstrual cycle. That’s why a full work-up by an obstetrician or gynecologist is recommended to supplement a psychiatric diagnosis of PMDD, and why patients are often referred to Dr. Bernstein and Rittenhouse Psychiatric Associates by their primary and other specialty care providers.

“For example, a woman may have a condition called polycystic ovarian syndrome. This illness causes hormonal issues that can overlap with psychiatric symptoms,” explains Dr. Bernstein. “There are treatments that I can do on my end, and others that a gynecologist can do on theirs. We need to talk to each other to coordinate this type of quality care.”

Pregnancy Treatment Planning

Over time, our understanding of how psychiatric medications may affect women and their pregnancies, and the importance of maintaining stable mood and anxiety throughout pregnancy, has evolved. Dr. Bernstein makes it her responsibility to educate both patients and their physicians on best practices for psychiatric medication management during pregnancy and postpartum.

“It used to be that most obstetricians would tell women to get off all their psychiatric medications,” says Dr. Bernstein. “There’s been a huge amount of education and acceptance. Now, obstetricians are much more willing to work with a woman and work with their psychiatrist to be able to continue psychiatric medications.”

In fact, during pregnancy, these medications and treatments can become even more integral for women’s mental health. According to Dr. Bernstein, women with a history of mental illness face an increased risk of experiencing mental health complications during and after pregnancy. If those complications go untreated, a woman and her pregnancy are both at risk: During pregnancy, untreated depression can lead to premature birth, low birth weight or other complications.

Of course, Dr. Bernstein and providers at Rittenhouse Psychiatric Associates work to meet every patient’s preferences, and some patients prefer to stop taking their psychiatric medications during pregnancy. Dr. Bernstein might work to meet these wishes by increasing therapy or discussing other options. “It has to be a partnership, and we can decide together what the best path is,” says Dr. Bernstein.

Postpartum Depression

 The transition into motherhood can be overwhelming, and the hormonal shift of giving birth can escalate these feelings, so a woman’s mental health in this period requires specific care.

While many women experience the “baby blues”—symptoms like sadness and emotional instability that go away on their own within two weeks after birth—for about 10 to 15 percent of women, these problems persist or intensify after two weeks. At that point, the symptoms warrant clinical attention and fall into the category of postpartum depression.

“If symptoms continue and worsen after that two-week mark, that’s when we get concerned that this is a full-blown depressive episode,” explains Dr. Bernstein. When untreated, these symptoms might last for up to 3 years post-birth and strip the joy from what could be a beautiful period of parenthood.

Fortunately, women’s mental health experts like Dr. Bernstein can help mitigate the risk and symptoms of postpartum depression. Women with pre-existing conditions like bipolar disorders, anxiety or depression are 30 to 35 percent more likely to experience postpartum depression—so providers can provide extra monitoring and care to those patients during this phase.

When postpartum depression arises in a patient, thanks to pre-pregnancy planning, Dr. Bernstein can use her thorough knowledge of that patient’s background to guide treatment. Because she has a sense of each patient’s typical function, she recognizes when it’s interrupted, and aims to get them back to their normal self.

“Treatment is very dependent,” says Dr. Bernstein. “That’s why it’s so important to get to know each woman and their history, so I know how to get them back to their baseline.”

Menopausal and Perimenopausal Mental Health

During the menopausal period, hormonal change occurs in what might be an already stressful phase of life—so it can be a high-risk time for mental illness, and an important time to connect with a women’s health expert.

“There are some women whose brains are more sensitive to hormonal changes that happen during menopause,” she says. In these patients, Dr. Bernstein has seen self-isolation, mood changes, declines in focus and memory, and insomnia. Sometimes, these undesirable symptoms can lead to other issues: Chronic insomnia caused by menopause can elevate a patient’s risk of depression, and for some of Dr. Bernstein’s patients, heightened anxiety might be the root of focus and memory challenges.

While women with histories of mental illness often experience inflamed symptoms during menopause, according to Dr. Bernstein, symptoms sometimes emerge without a history of psychiatric illness. In particular, patients who find themselves without strong social connections during menopause might be more easily overwhelmed by these hormonal changes. These patients can often be treated on an as-needed basis.

“For some women, we can treat them for a period of time, until symptoms improve and the transition period is over,” says Dr. Bernstein, referring to the transition into menopause where hormonal changes are at their most impactful. “They won’t have to stay on medications forever.”

How to Seek Treatment

For women, psychiatric symptoms that interrupt your daily life aren’t an inevitable piece of menstruation, reproduction or menopause—they’re a sign that you should get help from a qualified psychiatric provider. To find that person, you’ll want to make sure that they approach medication thoughtfully and contextually: Medication can be an important piece of treatment, but a holistic treatment approach is recommended.

Rittenhouse Psychiatric Associates’ founder, Dr. Chris Pagnani, ties this thoughtful concept into the mission of the practice, and providers like Dr. Bernstein uphold that mission. Dr. Pagnani trained at The Johns Hopkins Hospital in Psychiatry, and has been an Instructor there for the last 12 years. He additionally supervises residents at Jefferson Hospital, for the Department of Psychiatry. He and his team of 25 providers, most of whom teach or have taught at institutions like Johns Hopkins or The University of Pennsylvania, discuss diet, exercise, substance use, relationships, work, medical conditions and any history of traumas with patients, so that the entire patient can be treated, not just an illness. This is truly what separates their practice from other mental health providers in the Philadelphia area.

The practice offers treatment for children, adolescents and adults for a range of psychiatric conditions, including: Anxiety Disorders (Generalized Anxiety Disorder, Panic Disorder, Obsessive Compulsive Disorder, Phobias), Mood Disorders (Major Depressive Disorder, Bipolar Affective Disorder, Dysthymic Disorder, Pre-Menstrual Dysphoric Disorder, Post-partum Depression), Substance Use Disorders (Alcohol Use Disorder and Opiate Use Disorder) and ADHD (among others). They also offer Neurodiversity evaluations for accommodations and the “deprescribing” of psychiatric medications when appropriate (for example, tapering someone off of a psychiatric medication, when they’ve taken it for long periods of time, and are having difficulty discontinuing). An example could include a patient who has taken Ambien for sleep for years and wishes to come off of it.

Rittenhouse Psychiatric Associates offers telemedicine (virtual) appointments throughout all of Pennsylvania and New Jersey and face-to-face psychiatric appointments in Philadelphia, Pa., on the Main Line in Paoli, Pa., and in Collingswood, N.J. They are a fee-for-service practice, but patients with commercial insurance can often submit their receipts directly to their insurance companies, for a partial reimbursement of the visit fee (often upwards of 60 to 70 percent).

For more information about women’s mental health, visit Dr. Bernstein’s recommended texts and websites on her profile page. To begin your wellness journey, reach out to Rittenhouse Psychiatric Associates at scheduling@rittenhousepa.com or 267-358-6155 (x 1). You can also fill out the patient information contact form at rittenhousePA.com . Follow them on Instagram @Rittenhousepsych, Youtube, or Facebook @Rittenhousepsych.

This is a paid partnership between Rittenhouse Psychiatric Associates and Philadelphia Magazine