Women's Mental Health

Mental illness has many gender-specific aspects that clinical research has not always addressed. For example, in conditions such as schizophrenia, the age of onset and pattern of symptoms commonly seen is different for women and men. Women and men may also respond differently to medications or other treatments. In addition, changes in the level of sex hormones such as estrogen are known to affect symptoms.

The Women’s Mental Health team is working on numerous aspects of women’s mental health, the experiences of women with mental illness and potential options for treatment. 

One particular focus of our research is the role of the neuroendocrine system in mental illnesses, and specifically the use of female hormones to improve the results of treatment. We are conducting ground-breaking research into the use of estrogen to improve symptoms in schizophrenia and the use of selective brain estrogens in postmenopausal women. We are also exploring possible links between the oral contraceptive pill and depression.

Another important project is NRAMP, the National Register of Antipsychotic Medications in Pregnancy. This is the first register of its kind worldwide. NRAMP aims to create a database of information about the effects of antipsychotic medications taken during pregnancy and the postnatal period. More information about NRAMP is available here


To find out more about current projects click here. For information about our PTSD clinical trial, please click here


Women’s Mental Health Research Division

 
Director
Professor Jayashri Kulkarni
 
Deputy Director
Dr Caroline Gurvich

Research Manager
Anthony de Castella
Emmy Gavrilidis

Consultant Psychiatrist
Dr Leo Chen
Dr Shalini Arunogiri
Dr Carolyn Breadon
 
Consultant Endocrinologist
Dr Caroline Thew
 
Research Medical Officer
Dr Kerry McGlynn
  
Psychiatry Registrar 
Dr Sarah Rotstein
Dr Hannah Dobson

NH&MRC Early Career Research Fellow
Dr Gemma Sharp
 
Post Doctoral Researcher
Dr Natalie Thomas
Dr Lizzie Thomas
 
Research Assistants
Kate Fortune
Stephanie Greco
 
WMH Clinic Coordinator
Rachana Pattali 

 

Women's Mental Health: current projects

The Women's Mental Health Team coordinates a number of treatment and intervention trials focused on the gender differences in psychiatric care.

 
 

CURRENTLY RECRUITING STUDIES IN WMH

Double Blind Randomised Trial of Tibalone as an Adjunct to Standard Antidepressant Treatment for Relapsed and Persistent Depression in Peri- and Post-Menopausal Women

Click Here

The Alison Project: A randomised double-blind placebo controlled investigation of adjunctive memantine in the treatment of symptoms of complex trauma disorder (also known as borderline personality disorder)

Click Here

Estradiol as a Treatment for Women with Borderline Personality Disorder

Click Here

Bazedoxifene – A New Selective Estrogen Receptor Modulator Treatment for Women with Schizophrenia

Click Here

The Damian Project – The Use Bazedoxifene as a Potential Treatment for Men with Schizophrenia

Click Here

Genital Self-Image and Body Image Concerns

Click Here

NRAMP - The National Register of Antipsychotic Medication in Pregnancy

Click Here

 

 

To participate in a MAPrc Clinical Trial - Click here to email your interest

 

Double Blind Randomised Investigation of Tibalone as an Adjunct to Standard Antidepressant Treatment for Relapsed and Persistent Depression in Peri- and Post-Menopausal Women

 

Hormones and the Mind

The Hormones and the Mind Study is an observational study that commenced in 2018 and tracks how mood, emotion and cognition fluctuate in relation to a women's menstrual cycle.  We are interested in learning more about the relationship between sex hormones and mood and behaviour.  We are interested in learning about why some women are particularly sensitive to menstrual cycle hormone fluctuations and learning more about premenstrual dysphoric disorder (PMDD).
 
To find out more email: maprc-hormonesandthemind@monash.edu

We would like to thank First Response for their sponsorship for part of this study.  

The Alison Project: A randomised double-blind placebo controlled investigation of adjunctive memantine in the treatment of symptoms of complex trauma disorder (also known as borderline personality disorder)

 


 
The Sarah Kelly Jones Scholarship
 
In honour of Sarah Kelly Jones who lost her life to Complex Trauma Disorder earlier this year (2020), we are proud and privileged to establish the Sarah Kelly Jones Scholarship in complex trauma disorder to support a PhD candidate or medical doctor who will conduct focused research in this area to improve our understanding of this disorder and work to establish and promote new treatments for people living with CTD. With the support of the Jones family and many of Sarah's friends and supporters in Perth, W.A, an annual amount will be fund raised and donated to fund this scholarship. We look forward to awarding the scholarship in early 2021 once it has been established and to providing updates on the work conducted in this area. 
 
Sarah Kelly Jones
 

 

Estradiol as a Treatment for Women with Borderline Personality Disorder

 

Estradiol as a Treatment for Women with Borderline Personality Disorder


Background:

Borderline Personality Disorder (BPD) is a serious and highly prevalent (5.9%) psychiatric disorder, affecting women more than men. BPD sufferers experience severe emotional instability, social and occupational dysfunction, and engage in chronic self-mutilation and suicidal behaviours, with associated high levels of mortality, morbidity, and health service use. BPD patients are a complex group that are challenging to treat. Current psychological treatments are expensive and difficult for BPD patients to access, and there is currently no clearly designated pharmacotherapy. Underpinned by psychosocial causes, childhood trauma is reported in most patients (>80%) and is linked to abnormalities in the development of the neuroendocrine axes. Significantly, cyclical fluctuations in ovarian hormones affect emotional and cognitive behaviours relevant to BPD. As such, this indicates the neuroendocrine system as a potential therapeutic target for the treatment of BPD symptoms.


Aim:


To determine whether estradiol is effective in treating symptoms of BPD, and specific symptom domains including emotional regulation, cognition, mood and quality of life, as well as biological markers.


Participants:

Women aged between 18-43, who have a current diagnosis of BPD or experience symptoms consistent with BPD are invited to take part in this study.


Methods:

This study is a 12-week randomised, double-blind, placebo controlled trial that will be conducted at the Monash Alfred Psychiatry research centre. Participants will be randomly selected to receive daily either 1) transdermal estradiol 100mcg twice weekly patch, or 2) inactive placebo. Participants will touch base with their study coordinators every two weeks to monitor mood symptoms and adverse events.

 

Project status

If you are interested in learning more about this study please contact the team to register an expression of interest

For more information, please contact the Women’s Mental Health Division via email at maprc.wmhresearch@monash.edu

 

Bazedoxifene – A New Selective Estrogen Receptor Modulator Treatment for Women with Schizophrenia

 Bazedoxifene – A New Selective Estrogen Receptor Modulator Treatment for Women with Schizophrenia

Background:

Although more commonly associated with women, estrogen is also a naturally occurring hormone in the bodies of men, and is already used clinically to reverse bone loss, enhance cardiovascular function, and treat prostate cancer. However, increasing evidence points to the protective role of estrogen in the brain, and for its positive effects on the symptoms of schizophrenia and schizoaffective disorder. However, adverse effects on breast and uterine tissue in females limit therapeutic use of estrogen in this population.


Bazedoxifene is a new hormone treatment that belongs to a group of medications called Selective Estrogen Receptor Modulators (SERMs). Bazedoxifene is thought to have positive estrogenic effects in the brain without affecting peripheral body tissues, thus offering a longer term treatment approach with potential mental health and cognitive benefits.


Aim:


To compare the efficacy of adjunctive bazedoxifene against adjunctive placebo in treating psychosis symptoms and improving cognition in women with schizophrenia.


Participants:

Women aged between 18-65, who have been diagnosed with schizophrenia and schizoaffective disorder, and are not currently using any hormonal therapy are invited to take part in this study.


Methods:

This study is a 12-week randomised, double-blind, placebo controlled trial that will be conducted at two sites in Melbourne - the lead site is the Monash Alfred Psychiatry research centre and a second site is the Monash Medical Centre. Participants will be randomly selected to receive daily either 1) 40mg bazedoxifene, or 2) inactive placebo. Participants will touch base with their study coordinators every two weeks to monitor psychotic and mood symptoms, and blood samples will be collected at three time-points during the study. The occurrence of any unwanted side effects will also be monitored.

Project status

If you are interested in learning more about this study please contact the team to register an expression of interest

For more information, please contact the Women’s Mental Health Division via email at maprc.wmhresearch@monash.edu

 

Genital Self-Image and Body Image Concerns

Genital Self-Image and Body Image Concerns

Over the last 10 to 15 years, we have seen a rapid increase in the number of adolescent and adult women requesting cosmetic genital surgery. Professional medical organisations throughout the Western world have expressed serious concerns about this trend. As the American College of Obstetricians and Gynaecologists state, cosmetic genital surgery is not medically indicated, and long term safety and effectiveness data are lacking. Potential complications include infection, altered sensation, dyspareunia, adhesions, and scarring.


Research has shown the primary motivation for these surgeries is aesthetic concern. Our research has focused on investigating the psychological and sociocultural factors underpinning this increase in genital appearance dissatisfaction in women. We firstly examined these factors in adult women, but have subsequently shifted our attention to adolescent girls as this is usually the period when girls first start to develop these concerns. We are also in the process of pilot testing a therapeutic mobile app, based on cognitive behavioural therapy principles, which aims to alleviate women’s genital appearance concerns. We hope that this app will provide an alternative to unproven cosmetic genital surgery and potentially be disseminated nationally and internationally. 

 

For more information, please contact Dr Gemma Sharp via email at gemma.sharp@monash.edu or by phone on (03) 9076 5167

The Damian Project - Bazadoxefine Treatment for Male Schizophrenia

 

The Damian Project - The Use of Bazadoxifene as a Potential Treatment for Men with Schizophrenia

Thanks to the generous support of the Mohr family, and in honour of the memory of Damian Mohr, MAPrc is privileged to be able to conduct this exiciting new trial to explore the use of Bazadoxifene, a Selective Estrogen Receptor Modulator (SERM), as a potential treatment for men with Schizophrenia. 

 

Study Aim

To study the effect of adjunctive Bazedoxifene – a selective estrogen receptor modulator (SERM) in a double blind, placebo-controlled adjunctive study in the treatment of men with schizophrenia. All patients receive standardized antipsychotic medication.

Trial Background

Despite advances in the treatment of schizophrenia, pharmacotherapy remains sub-optimal, and the prognosis for many patients is poor. We have pioneered work showing that estradiol has a positive role in the treatment of psychosis symptoms and cognitive deficits seen in people with schizophrenia. However, with the longer-term work from studies such as the Women’s Health Initiative (1), it has become clear that long-term use of estradiol with progesterone may have associated increased risks of breast and other cancers. Hence, we began working with the Selective Estrogen Receptor Modulator – raloxifene, which appears to be safer for longer term use with respect to the development of breast and other cancers. Building on our and others work, raloxifene used as an adjunctive treatment in schizophrenia appears to produce inconsistent and varying responses in different sub-populations; gender, menopausal status, age, drug dose and delivery mode. We now propose to conduct a double-blind, randomized, placebo-controlled trial of a third generation SERM – Bazedoxifene – which is 4 times more selective for the alpha than the beta oestrogen receptor subtype. Bazedoxifene appears to be safer with respect to long term use than older SERMs, has additional actions on the glucocorticoid receptor, and together this different pharmacology speculatively has greater potential than other SERMs to impact favorably on both psychosis symptoms and cognition in men and women with schizophrenia. This study will test 100 men to determine if Bazedoxifene, as an adjunctive hormone modulator, is effective for positive and cognitive symptoms of schizophrenia.

Trial Design

The trial will follow the parallel comparison design consisting of two arms over 12 weeks (treatment x time). Participants will be randomized to:

1. Bazedoxifene 40mg oral / day
2. Oral placebo (an inert substance with no active ingredients)

Trial Subjects

100 males with a current diagnosis of Schizophrenia, Schizoaffective and Schizophreniform disorder according to the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association.

This trial has Ethics Committee approval from the Alfred Research and Ethics Committee and the Monash University Human Research Ethics Committee and is currently recruiting

To Participate in this Trial or to find out more please email our team at: participate.maprc@monash.edu or call us on +61 3 9076 6564

Download a Trial Flyer HERE

 

 

 

 

 

 

 

NRAMP - The National Register of Antipsychotic Medication in Pregnancy

Overview

Many women throughout Australia and around the world are prescribed antipsychotic medication to treat mental illness. However, there is very little information available about the potential effect of these medications on mother and baby during pregnancy and after delivery.

The National Register of Antipsychotic Medication in Pregnancy (NRAMP) is designed to address this gap in knowledge by collecting information about women who are taking antipsychotic medication and who are pregnant or have had a baby in the last twelve months. It is hoped that this information will ultimately help to improve the experience of pregnancy and birth for women with mental illness, and to contribute to better health and wellbeing for these women and their babies.

We are currently recruiting participants to the study. We would be pleased to hear from women who are pregnant or have had a baby in the last twelve months and are taking antipsychotic medication. If you are interested in taking part in the study, please contact Email: maprc-nramp@monash.edu

HEALTHCARE PROFESSIONALS PORTAL

NRAMP also has information and resources for healthcare professionals.

If you are already registered for access to the NRAMP Healthcare Professionals Portal, please log in from the panel on the right.

If you would like to register for access, please contact: 

Email: maprc-nramp@monash.edu 

With the following information:

  • Name
  • Role and Organisation 
  • Email address
  • Telephone number
  • Clinical Registration Number or Provider Number