SWHR Live Online
Understanding How Perimenopause Impacts Mental Health
January 29, 2008
2:00 pm - 3:00 pm
Peter Schmidt, M.D., a clinician and an investigator at the National Institute of Mental Health, will answer questions about mood disorders in the perimenopause period, a time of significant changes in women’s lives that can impact mental health. Sherry Marts, Ph.D., vice president of scientific affairs for the Society for Women’s Health Research, will participate in the discussion to answer questions about the Society's work in this important area.
View the Moderators' biographies here.
New York:
What is the connection between depression and heart disease in women? Does depression increase your risk for heart disease and is this risk any greater for women than men?
What is the connection between depression and heart disease in women? Does depression increase your risk for heart disease and is this risk any greater for women than men?
Sherry Marts, Ph.D.:
Several studies have shown a connection between suffering one or more episodes of depression and subsquent development of heart disease, including increased risk of death from heart disease. The risk increase occurs for both men and women who have experienced depression, and some studies have found that the risk increase is higher for women.
Several studies have shown a connection between suffering one or more episodes of depression and subsquent development of heart disease, including increased risk of death from heart disease. The risk increase occurs for both men and women who have experienced depression, and some studies have found that the risk increase is higher for women.
New Jersey:
Do women really get more depressed than men? You always hear that. If that's the case, why does it happen to women more?
Do women really get more depressed than men? You always hear that. If that's the case, why does it happen to women more?
Sherry Marts, Ph.D.:
Depression does occur more often in women than in men, and this difference holds across countries and cultures. Why it happens isn't really known. Male brains and female brains differ in many ways, and this is a very active area of research.
Depression does occur more often in women than in men, and this difference holds across countries and cultures. Why it happens isn't really known. Male brains and female brains differ in many ways, and this is a very active area of research.
California:
How soon will it be possible for a psychiatrist to biologically personalize treatments? When will doctors be able to characterize a patient’s unique genetic profile using a blood test to determine what biological type of depression the patient has and which antidepressant is likely to work best?
How soon will it be possible for a psychiatrist to biologically personalize treatments? When will doctors be able to characterize a patient’s unique genetic profile using a blood test to determine what biological type of depression the patient has and which antidepressant is likely to work best?
Sherry Marts, Ph.D.:
I won't venture a guess at how long it will take, but I do know that there are researchers looking for exactly this kind of genetic or other biological marker. The challenge is that depression, like a lot of other diseases and disorders, involves the interaction of many genes and the products of those genes. Similarly, response to medication is governed by lots of genes. Combine the two and you start to see how complex the question becomes. Fortunately, the technologies for doing this kind of analysis and research are getting faster and less expensive all the time.
I won't venture a guess at how long it will take, but I do know that there are researchers looking for exactly this kind of genetic or other biological marker. The challenge is that depression, like a lot of other diseases and disorders, involves the interaction of many genes and the products of those genes. Similarly, response to medication is governed by lots of genes. Combine the two and you start to see how complex the question becomes. Fortunately, the technologies for doing this kind of analysis and research are getting faster and less expensive all the time.
Florida:
Where can I go to find out about research studies on depression that I can take part in?
Where can I go to find out about research studies on depression that I can take part in?
Sherry Marts, Ph.D.:
The website www.clinicaltrails.gov is good place to start. You can search for studies in your area that are looking for participants with your characteristics. Also, the Society for Women's Health research has a website, www.womancando.org, with loads of information about volunteering for research studies.
The website www.clinicaltrails.gov is good place to start. You can search for studies in your area that are looking for participants with your characteristics. Also, the Society for Women's Health research has a website, www.womancando.org, with loads of information about volunteering for research studies.
Philadelphia, PA:
Not a question so much as a comment: With multiple "hot flashes" at night interrupting normal sleep cycles, it has been my observation that sleep deprivation plays a major contributing role in the emotional difficulties many women have during this phase of their lives.
Not a question so much as a comment: With multiple "hot flashes" at night interrupting normal sleep cycles, it has been my observation that sleep deprivation plays a major contributing role in the emotional difficulties many women have during this phase of their lives.
Sherry Marts, Ph.D.:
Good question! The role of sleep disruption in the development of depression in the perimenopause is an active area of research. If sleep disruption is a factor, this could lead to new approaches to prevention or treatment.
Good question! The role of sleep disruption in the development of depression in the perimenopause is an active area of research. If sleep disruption is a factor, this could lead to new approaches to prevention or treatment.
WDC:
How long should a woman live with depression symptoms before speaking with her doctor--should she wait to see if they go away?
How long should a woman live with depression symptoms before speaking with her doctor--should she wait to see if they go away?
Sherry Marts, Ph.D.:
If you suspect you may be suffering from depression, talk to your health care provider right away. There are a number of treatment options for depression, not all of which involve medication, and it can take time to determine which treatment or combination of treatments will work best. In addition to the suffering caused by depression itself, depression is a risk factor for developing other conditions such as heart disease. Early treatment is best.
If you suspect you may be suffering from depression, talk to your health care provider right away. There are a number of treatment options for depression, not all of which involve medication, and it can take time to determine which treatment or combination of treatments will work best. In addition to the suffering caused by depression itself, depression is a risk factor for developing other conditions such as heart disease. Early treatment is best.
Bloomington IN:
I was told taking a progesterone cream can level out the effects of mood disorders associated with perimenopause. I'm afraid to take any hormone due to the increase chance of developing cancer. How safe and effective are these creams, many, I understand, are sold over the counter?
I was told taking a progesterone cream can level out the effects of mood disorders associated with perimenopause. I'm afraid to take any hormone due to the increase chance of developing cancer. How safe and effective are these creams, many, I understand, are sold over the counter?
Peter Schmidt, M.D.:
Your question raises several important points:
First, studies have shown that short-term estrogen therapy (ET) improves depression in perimenopausal women but no study has systematically evaluated the effects of progesterone as an antidepressant. Some women do report a feeling of calm +/- sedation on progesterone preparations; however, a large number of women complain of negative mood symptoms on these same preaparations.
2) Progesterone is a homone, and you're right to be concerned about long term safety issues. You should speak with your doctor to weigh the benefits and risks of any type of hormone therapy (OTC or prescribed)
3) OTC preparations are un-regulated. The amount and type of hormone (or hormone-like substance) can vary tremendously (if present at all???). Again, good to run this by your health care provider first.
4) If you are concerned about being depressed, then you also should speak with your health care provider about available alternative treatments - some of which do not involve medication. Increasingly we are recognizing that depression may increase a woman's risk for several other medical conditions including heart disease and forms of dementia - so treatment could help reduce these risks
Your question raises several important points:
First, studies have shown that short-term estrogen therapy (ET) improves depression in perimenopausal women but no study has systematically evaluated the effects of progesterone as an antidepressant. Some women do report a feeling of calm +/- sedation on progesterone preparations; however, a large number of women complain of negative mood symptoms on these same preaparations.
2) Progesterone is a homone, and you're right to be concerned about long term safety issues. You should speak with your doctor to weigh the benefits and risks of any type of hormone therapy (OTC or prescribed)
3) OTC preparations are un-regulated. The amount and type of hormone (or hormone-like substance) can vary tremendously (if present at all???). Again, good to run this by your health care provider first.
4) If you are concerned about being depressed, then you also should speak with your health care provider about available alternative treatments - some of which do not involve medication. Increasingly we are recognizing that depression may increase a woman's risk for several other medical conditions including heart disease and forms of dementia - so treatment could help reduce these risks
Boulder, Colorado:
What do you think is the main cause(s) of the mood disorders and the perceived decrease in quality of life in menopausal women? Do you think the mental/emotional changes are due to the physical changes of menopause or that some social/cultural reasons (i.e. being reminded that you're aging) are responsible?
What do you think is the main cause(s) of the mood disorders and the perceived decrease in quality of life in menopausal women? Do you think the mental/emotional changes are due to the physical changes of menopause or that some social/cultural reasons (i.e. being reminded that you're aging) are responsible?
Sherry Marts, Ph.D.:
I think the answer is "yes." That is, I think it is likely that both the physical changes and the impact of social and cultural attitudes toward aging women have an impact. Keep in mind that depression is a physical disorder that produces a spectrum of symptom that includes depressed mood, lack of enjoyment of activities that were previously pleasurable. You can imagine that being surrounded by a culture that celebrates youth and denigrates aging in women might make those symptoms worse.
I think the answer is "yes." That is, I think it is likely that both the physical changes and the impact of social and cultural attitudes toward aging women have an impact. Keep in mind that depression is a physical disorder that produces a spectrum of symptom that includes depressed mood, lack of enjoyment of activities that were previously pleasurable. You can imagine that being surrounded by a culture that celebrates youth and denigrates aging in women might make those symptoms worse.
Lake Ridge, VA:
Hello, Dr. Schmidt. I have three questions. 1. Can hormone levels effect how well certain medications work i.e. antidepressants etc. 2. Are there reliable tests/ways to determine early perimenopause. I am only 38 and have started having hot flashs but my doctors believe that I am too young for it to be perimenopause 3. If it's not perimenopause...what else might be happening? Thanks.
Hello, Dr. Schmidt. I have three questions. 1. Can hormone levels effect how well certain medications work i.e. antidepressants etc. 2. Are there reliable tests/ways to determine early perimenopause. I am only 38 and have started having hot flashs but my doctors believe that I am too young for it to be perimenopause 3. If it's not perimenopause...what else might be happening? Thanks.
Peter Schmidt, M.D.:
Some studies have shown that levels of hormones can alter both how a drug is metabolized by the body as well as the drug's actions. For example, in some (but not all) studies estrogen therapy in perimenopausal women enhances the antidepressant effects of certain medications (the Selective serotonin re-uptake inhibitors). If not already consulted you might consider speaking with a gynecologist or reproductive endocrinologist, about your symptoms - about 5% of women will have menopause before 45 years (early menopause), and about 1% of women will have menopause before age 40 years. Hot flushes are frequent accompaniments of the menopause transition but they also can occur at other times in a woman's life - for example, some women with PMS experience hot flushes during the premenstrual phase of their cycle but have no evidence of being perimenopausal. Menstrual cycle irregularity, missed periods, are the most reliable predictors of perimenopausal status but plama FSH (Follicle Stimulating Hormone) also can provide information (We use both measures in our clinic at the NIMH).
Some studies have shown that levels of hormones can alter both how a drug is metabolized by the body as well as the drug's actions. For example, in some (but not all) studies estrogen therapy in perimenopausal women enhances the antidepressant effects of certain medications (the Selective serotonin re-uptake inhibitors). If not already consulted you might consider speaking with a gynecologist or reproductive endocrinologist, about your symptoms - about 5% of women will have menopause before 45 years (early menopause), and about 1% of women will have menopause before age 40 years. Hot flushes are frequent accompaniments of the menopause transition but they also can occur at other times in a woman's life - for example, some women with PMS experience hot flushes during the premenstrual phase of their cycle but have no evidence of being perimenopausal. Menstrual cycle irregularity, missed periods, are the most reliable predictors of perimenopausal status but plama FSH (Follicle Stimulating Hormone) also can provide information (We use both measures in our clinic at the NIMH).
Texas:
What are the symptoms of depression around menopause?
What are the symptoms of depression around menopause?
Sherry Marts, Ph.D.:
Symptoms of depression around menopause include: feeling depressed, not enjoying activities that were once pleasurable, sleeping too much or too little, eating too much or too little, and feeling aches and pains more that usual.
Symptoms of depression around menopause include: feeling depressed, not enjoying activities that were once pleasurable, sleeping too much or too little, eating too much or too little, and feeling aches and pains more that usual.
Alexandria, Va.:
Are the symptoms of depression around menopause different from symptoms of depression at other times of life?
Are the symptoms of depression around menopause different from symptoms of depression at other times of life?
Peter Schmidt, M.D.:
Many of the symptoms are similar such as sadness, loss of the ability to enjoy things. However, more than sadness/depression, the women with whom I speak at our clinic describe more prominent irritibity, feeling that they are being short-fused with people, and have excessive worry or anxiety. In addition to these symptoms, physical symptoms may occur including hot flushes, or sleep disturbance - but not always. If you're local you can call our clinic or it's worth checking in with your health care provider.
Many of the symptoms are similar such as sadness, loss of the ability to enjoy things. However, more than sadness/depression, the women with whom I speak at our clinic describe more prominent irritibity, feeling that they are being short-fused with people, and have excessive worry or anxiety. In addition to these symptoms, physical symptoms may occur including hot flushes, or sleep disturbance - but not always. If you're local you can call our clinic or it's worth checking in with your health care provider.
New Jersey II:
Does the depression subside/go away during menopause or is depression a characteristic of menopause as well?
Does the depression subside/go away during menopause or is depression a characteristic of menopause as well?
Peter Schmidt, M.D.:
We know that the majority of women do not develop a depression or any other mood disturbance as they go through menopause; however, we also know that some women develop depression during the transition into menopause - sometimes for the first time in their lives.
We know that the majority of women do not develop a depression or any other mood disturbance as they go through menopause; however, we also know that some women develop depression during the transition into menopause - sometimes for the first time in their lives.
Indiana:
Does it matter if you have had kids? Does carrying a child or lots of babies make you more or less likely to have depression later in life?
Does it matter if you have had kids? Does carrying a child or lots of babies make you more or less likely to have depression later in life?
Peter Schmidt, M.D.:
Having children or being pregant neither increases risk nor protects women from depression later in life.
Having children or being pregant neither increases risk nor protects women from depression later in life.
Orlando:
I have several doctors that I go to. If I think I'm experiencing depression or symptoms of depression, can I talk to any of them about it? Or are certain doctors or specialties better suited to respond to concerns like this?
I have several doctors that I go to. If I think I'm experiencing depression or symptoms of depression, can I talk to any of them about it? Or are certain doctors or specialties better suited to respond to concerns like this?
Sherry Marts, Ph.D.:
Do talk to any of your physicians if you have symptoms of depression. Family practice physicians, internists, and ob/gyns should be able to do a screening interview and give you a referral to a psychiatrist. Psychiatrists have the most experience with the different options for treating depression
Do talk to any of your physicians if you have symptoms of depression. Family practice physicians, internists, and ob/gyns should be able to do a screening interview and give you a referral to a psychiatrist. Psychiatrists have the most experience with the different options for treating depression
Seattle:
Is it true that exercising can help the "blues" disappear?
Is it true that exercising can help the "blues" disappear?
Sherry Marts, Ph.D.:
There are studies that have shown that regular exercise may help relieve mild-to-moderate depression.
There are studies that have shown that regular exercise may help relieve mild-to-moderate depression.
North Carolina:
From your perspecitives, what are the big issues or questions needing to be answered regarding perimenopausal depression. What do we know the least about and what is holding us back from making discoveries in these areas?
From your perspecitives, what are the big issues or questions needing to be answered regarding perimenopausal depression. What do we know the least about and what is holding us back from making discoveries in these areas?
Peter Schmidt, M.D.:
Good Question - We know that the majority of women do not develop a depression as they transition through menopause - a subgroup of women are at risk for depression and many of these women have never had a depression before in their life. We need to know how many women are at risk, how to identify those women who are at risk. Additionally, we need to understand the mechanisms underlying this risk including how a change in ovarian hormone level will in some women sufficiently alter brain function to manifest in a change in behavior. Finally, a better understanding of these mechanisms and the markers of susceptibility will permit the development of hormonal therapies that could serve as effective therapeutic alternatives for those women who do develop negative mood symptoms during the perimenopause.
Good Question - We know that the majority of women do not develop a depression as they transition through menopause - a subgroup of women are at risk for depression and many of these women have never had a depression before in their life. We need to know how many women are at risk, how to identify those women who are at risk. Additionally, we need to understand the mechanisms underlying this risk including how a change in ovarian hormone level will in some women sufficiently alter brain function to manifest in a change in behavior. Finally, a better understanding of these mechanisms and the markers of susceptibility will permit the development of hormonal therapies that could serve as effective therapeutic alternatives for those women who do develop negative mood symptoms during the perimenopause.
Anonymous:
What are the biggest challenges you face doing research on the connections between depression and hormones?
What are the biggest challenges you face doing research on the connections between depression and hormones?
Peter Schmidt, M.D.:
Great question - the biggest challenge on a daily basis is getting the word out to women that we have many studies on the relationship between depression and hormones. Women's participation helps us answer these important questions and the women themselves stand to gain substantial benefits.
Great question - the biggest challenge on a daily basis is getting the word out to women that we have many studies on the relationship between depression and hormones. Women's participation helps us answer these important questions and the women themselves stand to gain substantial benefits.
Washington:
How advanced is the research in determining if there are biomarkers or something else you could test for that would tell me if I am at greater risk than the average women of developing depression during perimenopause?
How advanced is the research in determining if there are biomarkers or something else you could test for that would tell me if I am at greater risk than the average women of developing depression during perimenopause?
Peter Schmidt, M.D.:
Great question: there are no biomarkers at this time but we're definitely working on that question.
Great question: there are no biomarkers at this time but we're definitely working on that question.
St. Paul:
I have two older sisters, both of whom had depression like symptoms when they went through menopause. Is it hereditary?
I have two older sisters, both of whom had depression like symptoms when they went through menopause. Is it hereditary?
Peter Schmidt, M.D.:
We know that the risk of depression can run in families. Our group at NIMH and our collaborators at University of North Carolina have identified one of the first genetic findings in women with severe PMS. We are currently conducting similar studies in women with depression during the menopause transition; however, at this point our studies are in their early stages.
We know that the risk of depression can run in families. Our group at NIMH and our collaborators at University of North Carolina have identified one of the first genetic findings in women with severe PMS. We are currently conducting similar studies in women with depression during the menopause transition; however, at this point our studies are in their early stages.
Marion, Virginia:
I suffered from depression after having both of my children when I was in my early 30s. I am now approaching menopause. Am I at heightened risk for depression in menopause becuase I had post partum depression?
I suffered from depression after having both of my children when I was in my early 30s. I am now approaching menopause. Am I at heightened risk for depression in menopause becuase I had post partum depression?
Peter Schmidt, M.D.:
We have not found that more than 10% of the women that we see in our NIMH clinic who present with perimenopause depression have histories of postpartum depression (PPD) - so the rate is not greater than in the general population. Having said that no study has followed women with PPD as they transition thru the menopause - so we don't know the whole story yet. In fact one of our studies of PPD at the NIMH involves testing this question - we look at the effects on mood of a medication that temporarily mimics the menopause.
We have not found that more than 10% of the women that we see in our NIMH clinic who present with perimenopause depression have histories of postpartum depression (PPD) - so the rate is not greater than in the general population. Having said that no study has followed women with PPD as they transition thru the menopause - so we don't know the whole story yet. In fact one of our studies of PPD at the NIMH involves testing this question - we look at the effects on mood of a medication that temporarily mimics the menopause.
ct:
I am wondering if it is possible to tell if an eating disorder, unrealized, could have made me depressed, or if depression could make me become eating disordered. I have had recurrent major depression, as of march 07, but also realize I have disordered eating, either 'ednos' or anorexia. I ate poorly as a child, and a greater part of my teenaged years, and was diagnosed 'depressed' in high school, and depressed as an adult. I would like to know which is more important to treat. Thank you.
I am wondering if it is possible to tell if an eating disorder, unrealized, could have made me depressed, or if depression could make me become eating disordered. I have had recurrent major depression, as of march 07, but also realize I have disordered eating, either 'ednos' or anorexia. I ate poorly as a child, and a greater part of my teenaged years, and was diagnosed 'depressed' in high school, and depressed as an adult. I would like to know which is more important to treat. Thank you.
Peter Schmidt, M.D.:
ct - Both conditions can have serious consequences and effective treatments are available. Make sure you and your health care provider discuss your concerns.
ct - Both conditions can have serious consequences and effective treatments are available. Make sure you and your health care provider discuss your concerns.
Moderator:
Note: "ednos" stands for "eating disorder not otherwise specified." It involves disordered eating patterns that do not meet the criteria for any specific eating disorder.
Note: "ednos" stands for "eating disorder not otherwise specified." It involves disordered eating patterns that do not meet the criteria for any specific eating disorder.
Chicago:
Can you help me understand why I often wake up feeling overwhelmed, my thoughts are often negative and angry? Once I am up and moving around there is a noticeable difference in my thought process on the same issues. I'm 52 and still experiencing regular monthly periods.
Can you help me understand why I often wake up feeling overwhelmed, my thoughts are often negative and angry? Once I am up and moving around there is a noticeable difference in my thought process on the same issues. I'm 52 and still experiencing regular monthly periods.
Peter Schmidt, M.D.:
The average age of menopause is 51 years but there is a considerable range in individual women, so at 52 you're still within the normal range. If your symptoms worsen, check in with your gynecologist or other health care provider.
The average age of menopause is 51 years but there is a considerable range in individual women, so at 52 you're still within the normal range. If your symptoms worsen, check in with your gynecologist or other health care provider.
Las Vegas:
Are there resources to help me find a good psychiatrist?
Are there resources to help me find a good psychiatrist?
Peter Schmidt, M.D.:
The American Psychiatric Association has lists of available doctors sorted by region at their Web site. Alternatively, you could call the medical school closest to your residence.
The American Psychiatric Association has lists of available doctors sorted by region at their Web site. Alternatively, you could call the medical school closest to your residence.
Hackensack, NJ:
I am 45 and just starting the perimenopausal period and I have noticed a significant shift in my moods particularly, irritability and anxiousness. Plus, I have had an increase in migraine headaches. What can I do to reduce these symptoms? My gynecologist has offered hormone options but I have had a history of hive breakouts during my menstruation (known as autoimmune progesterone dermatitis) so I am a little leary of starting a hormone which could only make these symptoms worse. As you can tell my menstrual experiences have not been easy! So I am concerned about what will happen in the next few years. Any thoughts would be welcome.
I am 45 and just starting the perimenopausal period and I have noticed a significant shift in my moods particularly, irritability and anxiousness. Plus, I have had an increase in migraine headaches. What can I do to reduce these symptoms? My gynecologist has offered hormone options but I have had a history of hive breakouts during my menstruation (known as autoimmune progesterone dermatitis) so I am a little leary of starting a hormone which could only make these symptoms worse. As you can tell my menstrual experiences have not been easy! So I am concerned about what will happen in the next few years. Any thoughts would be welcome.
Peter Schmidt, M.D.:
If any hormone has been implicated in depression during the perimenopause it is estrogen. Estrogen withdrawal can trigger depression in some women and estrogen therapy has an antidepressant effect in perimenopausal depression. Your gynecologist could offer several estrogen preparations that might well improve many or all of your symptoms. You may need to take some form of progesterone but again there are several options including different preparations (some of which might not cause dermatitis) and delivery systems including IUDs and vaginal rings.
If any hormone has been implicated in depression during the perimenopause it is estrogen. Estrogen withdrawal can trigger depression in some women and estrogen therapy has an antidepressant effect in perimenopausal depression. Your gynecologist could offer several estrogen preparations that might well improve many or all of your symptoms. You may need to take some form of progesterone but again there are several options including different preparations (some of which might not cause dermatitis) and delivery systems including IUDs and vaginal rings.
Boston:
During research for a book I am writing and Web site I will be launching this summer related to women's hormonal health, I discovered that the research that is and has been done in Europe is so far ahead of the research being done in the U.S. in this area of medicine. Why do you think this is?
During research for a book I am writing and Web site I will be launching this summer related to women's hormonal health, I discovered that the research that is and has been done in Europe is so far ahead of the research being done in the U.S. in this area of medicine. Why do you think this is?
Peter Schmidt, M.D.:
Certainly there are many centers in Europe with longstanding interests in the roles of reproductive hormones in brain function and behavior. In the U.S. there is a growing interest in this important relationship. Hopefully, your book and Web site will help get the word out and recruit much more interest on this side of the Atlantic.
Certainly there are many centers in Europe with longstanding interests in the roles of reproductive hormones in brain function and behavior. In the U.S. there is a growing interest in this important relationship. Hopefully, your book and Web site will help get the word out and recruit much more interest on this side of the Atlantic.
Moderator:
That concludes our time for discussion today. Thank you to everyone for participating, especially Drs. Schmidt and Marts for taking time out of their busy schedules to answer questions. Dr. Schmidt will continue answering questions offline and his responses will be part of the chat archive, which will be available here on the Society’s Web site for future viewing. To learn about upcoming chats and other women’s health information, sign up for our e-newsletter. Thank you again for joining us.
That concludes our time for discussion today. Thank you to everyone for participating, especially Drs. Schmidt and Marts for taking time out of their busy schedules to answer questions. Dr. Schmidt will continue answering questions offline and his responses will be part of the chat archive, which will be available here on the Society’s Web site for future viewing. To learn about upcoming chats and other women’s health information, sign up for our e-newsletter. Thank you again for joining us.
Please Note: Guests and hosts retain editorial control over discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. Society for Women’s Health Research is not responsible for any content posted by third parties.
