Behavioral Health

When it comes to staying healthy, your psychological well being is just as important as your physical health. The two are inextricably linked, and in fact, studies have shown that people who struggle with a behavioral health issue such as depression are more likely to suffer from a chronic physical condition.

Women undergo many hormonal changes throughout life (monthly as well as during and after pregnancy and pre- and post-menopause), and perhaps because of this, they are at a higher risk for depression, anxiety and other mental health disorders. Approximately 12 million women experience clinical depression each year, for example, and about one in eight women will develop clinical depression in her lifetime.


Everyone feels down from time to time, but if that “blue” feeling lasts for several weeks (or months) and interferes with your daily functioning (you feel hopeless and no longer enjoy activities that you used to) then you may be experiencing clinical depression. If this sounds like you, you should know that you’re not alone: About 25 million Americans have a major depressive episode each year; women are 70 percent more likely than men to become depressed and you’re at a higher risk if you have a family history of the disorder. If you’re susceptible, an upsetting event—such as losing a job or getting a divorce—could trigger an extended episode. Thanks to hormonal changes, women are also more prone around puberty, after giving birth, and around menopause.

The most well known kind of depression is major depression. When it happens during or after pregnancy, it’s referred to as perinatal depression; when symptoms crop up weeks or months after giving birth, it’s called postpartum (or postnatal) depression.

Bipolar disorder (aka manic depression) is another type of depression which is characterized by periods of extreme lows as well as extreme highs with elevated, expansive or irritable moods (mania).

Signs and Symptoms

  • Sleeplessness or oversleeping
  • Lack of appetite or overeating
  • Low energy/fatigue
  • Inability to concentrate
  • Decreased interest in doing things you used to enjoy
  • Feelings of guilt, hopelessness, or worthlessness
  • Thoughts of hurting yourself or ending your life

Treatment Options

Many people with depression are reluctant to seek help, either because they don’t realize that they’re depressed or because they’re worried about being stigmatized. But there’s no reason to suffer: Depression is highly treatable.

If your case is mild to moderate, you might do well with talk therapy; it can help you alter your negative thoughts and behaviors, as well as work through difficult personal situations that may be contributing to your problem.
Exercise is also extremely beneficial; for some people, particularly those with mild depression, research shows it may work as well as some medications.

For people who do require medication, there are many options to consider. Most of the newer medications fall into the SSRI (selective serotonin reuptake inhibitor) category. These types of medicines—which include fluoxetine (Prozac) paroxetine (Paxil, Paxil CR, Pexeva), sertraline (Zoloft), citalopram (Celexa), and escilatopram (Lexapro)—usually take at least three weeks to kick in, and you may need a trial of different ones before finding the best fit for you. Your doctor can make adjustments to your regimen as necessary.

If your depression occurs during pregnancy, you’ll want to work extra closely with your physician. Although there are no good controlled prospective studies, there are some retrospective studies and reviews that have linked antidepressants taken during pregnancy to a higher risk of certain health problems in infants. It is however very clear that not treating serious maternal depression or anxiety that occurs during pregnancy can be extremely dangerous for both the mother and baby. Your doctor can help you weigh the pros and cons so that you and your baby stay as safe as possible.

About 13 percent of women develop postpartum depression. When you give birth, your hormone levels quickly shift, which can lead you to feel a little sad or weepy for up to a week–a phenomenon that’s often called the “baby blues.” Postpartum depression is more severe and longer lasting. If you feel like you’re sinking lower and lower—or if you have thoughts of hurting yourself or your baby—call your doctor as soon as possible.


Maybe you get nervous before going on a first date or making a big presentation. That’s perfectly normal. But if you feel anxious in situations that most others don’t find bothersome, or if your anxiety is so severe that it’s making it difficult for you to do your job, sustain relationships, or enjoy life, you could have an anxiety disorder.

About 40 million American adults suffer from anxiety each year, making it the most common mental health problem. Women are twice as likely as men to be impacted. Anyone can develop an anxiety disorder, but family history likely plays a role, as does spending time in a stressful environment. That’s especially true for PTSD sufferers, who develop symptoms after experiencing or witnessing a disturbing event. (It often impacts veterans, sexual abuse survivors, and accident or disaster victims.)

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), social anxiety disorder, and specific phobias. Oftentimes these overlap, so it’s not unusual to have generalized anxiety–which makes you feel extremely worried and tense most of the time–in addition to a specific phobia, such as an intense fear of spiders or public speaking or panic attacks that occur out of the blue. As with depression, anxiety is probably caused by a problem involving mood chemicals in the brain.

Signs and Symptoms

Symptoms vary depending on the type of anxiety disorder, but they often include:

  • Persistent worrying and obsessing about things that might go wrong
  • Irritability and restlessness
  • Insomnia
  • Muscle tension
  • Chronic headaches
  • Excessive sweating
  • Heart palpitations
  • Shortness of breath

People with PTSD may also experience:

  • Flashbacks
  • Nightmares
  • Angry outbursts

Treatment Options

Cognitive behavioral therapy (CBT) is a therapeutic intervention that may help you change the way you think about distressing situations so you can learn to react to them differently. Deep breathing techniques, progressive relaxation and meditation can also help. If you have PTSD or a specific phobia, your doctor may recommend exposure therapy, during which you literally learn to face your fear (or a virtual version of it).

Interestingly for people with a moderate to severe anxiety disorder, taking an SSRI antidepressant medication daily can be very helpful. Your doctor may also prescribe a benzodiazepine (such as Valium or Xanax), which may be used sporadically (such as when you have trouble sleeping or are about to board a flight) or daily, depending on what your doctor deems appropriate for you. These medications are particularly useful for people who experience panic attacks—a sudden, overwhelming sense of fear that can make you feel like you can’t breathe or that you’re having a heart attack. PTSD sufferers are sometimes also given a drug that suppresses nightmares by blocking adrenaline.

As with depression, getting regular exercise (especially aerobic activity) can help keep your symptoms in check.

Eating Disorders

Anorexia Nervosa

Eating disorders go way beyond dieting or overeating. The majority of people with eating disorders are female, but men can develop them, too. These conditions usually crop up during the teens and 20s, but it’s possible to experience symptoms at any point in life; recent research shows that some women are developing them for the first time in their 50s. Your family history can make you more susceptible, as can having certain hobbies or jobs (dancer, athlete, actor) that emphasize physical appearance.

While only 0.6 percent of people develop a condition called anorexia nervosa, the disease can be devastating. People with this disorder are obsessed with being thin, typically have an intense fear of gaining weight and often believe they are much heavier than they actually are. As a result, they restrict their food intake so much that they can become dangerously malnourished.

Signs and Symptoms

People with anorexia may:

  • Look extremely thin
  • Feel dizzy or faint
  • Lack energy
  • Claim to eat more than they actually do
  • Refuse to eat and say they’re not hungry
  • Stop menstruating
  • Become depressed


People with binge-eating disorder, on the other hand, have episodes in which they feel compelled to consume excessively large quantities of food; they tend to be overweight or obese. Many people with this condition face a vicious cycle: They binge, feel guilty or shameful about what they ate, then attempt to soothe their emotions by eating some more. About 2.8 percent of people experience binge-eating disorder.

Signs and Symptoms

Binge-eating disorder sufferers may:

  • Appear overweight or obese
  • Eat a lot, even when they’re not hungry
  • Feel physically uncomfortable from overeating
  • Hide food from others and consume it when they’re alone
  • Become depressed

Bulimia Nervosa

Bulimia nervosa is a condition that has characteristics of both anorexia and binge-eating disorder. Sufferers eat extremely large amounts of food (binge), and then attempt to gain control of the situation and their bodies by vomiting, misusing laxatives, excessively exercising and/or taking diuretics. Similar to anorexics, bulimics are obsessed with becoming thinner, but their weight is often normal. The lifetime prevalence of bulimia is 0.6 percent.

Signs and Symptoms

People with bulimia may:

  • Frequently overeat, then purge
  • Misuse laxatives, diuretics, or enemas
  • Become depressed

Treatment Options

If you have anorexia, gaining weight and avoiding medical complications are important goals, as is addressing the underlying psychological issues. Both nutritional counseling and psychotherapy are part of the process. During therapy (individual, group, and/or family), you will learn about what may be driving your condition. For some people, it may be an underlying pursuit of perfection or desire for control. Since anorexia often goes hand-in-hand with anxiety and depression, your doctor might also recommend an antidepressant or mood stabilizer.

Treatment for binge-eating disorder and bulimia is similar to anorexia, though it will be tailored to your specific condition. For example, someone with binge-eating disorder may need help losing weight rather than gaining it. People with these problems also sometimes benefit from medication; Prozac is the only drug officially approved by the FDA for bulimia.

How North Shore-LIJ Can Help

North Shore-LIJ’s Zucker Hillside Hospital offers behavioral health services to address the diverse mental health needs of the communities we serve by providing a continuum of high-quality psychological services and behavioral health resources, including emergency, inpatient and outpatient services for women of all ages. Behavioral health concerns impact all age groups—from children and adolescents through later life, and so we partner with patients and families to build for the growing behavioral health needs of our community.

Find a North Shore-LIJ Behavioral Health Specialist here.
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