This chapter reviews the most common psychological features of menopause and recent research regarding anxiety, depression, and social factors. Women's religious and spiritual beliefs play an important role in their views of life and medical illness. Commonly used tools that assist in gathering spiritual and religious information from patients are the FAITH and HOPE questionnaires. The FAITH tool addresses issues of religious faith and may be more useful when the clinician is aware that the patient is religious. Spiritual counseling is full of ethical challenges, including issues of autonomy, authority, confidentiality, and coercion. Cross-cultural studies indicate that women from different cultures cope with menopause differently. Anxiety disorders should be treated with medicines indicated for that purpose, including benzodiazepines, selective serotonin-reuptake inhibitors (SSRIs), and tricyclic agents. Physicians treating patients during menopause should be alert for psychological and spiritual issues, and be familiar with treatment options, including pharmacotherapy, exercise, and counseling.

This chapter describes current knowledge about two drug treatments of depression, anxiety, pain and sleep disorders as these psychiatric syndromes often accompany the functional somatic syndromes. Monoamine oxidase inhibitors (MAOIs) came from the antitubercular drug iproniazid that appeared to alleviate depression in patients with tuberculosis. Psychotic depression, i.e., major depression with delusions and/or hallucinations, responds better to a combination of an antidepressant and an antipsychotic than to either drug given separately. Short-lived anxiety suggests use of benzodiazepines with shorter half-lives, while with the longer lasting anxiety, benzodiazepines with longer half-lives could be used. Antidepressants such as tricyclic agents, selective serotonin reuptake inhibitors and trazodone have shown usefulness for patients with generalized anxiety disorder. All the benzodiazepines used for anxiety also serve as hypnotics. Carbamazepine, an anticonvulsant agent, has shown efficacy especially for neurogenic pain, at doses of 200-1200 mg/day, in divided doses.