Menopause and Depression
Menopause and Depression
Abstracts & Commentary
By Leon Speroff, MD, Editor, Professor of Obstetrics and Gynecology, Oregon Health and Science University, Portland, is Editor for OB/GYN Clinical Alert.
Synopsis: Two cohort studies indicate that new onset depressive symptoms are more common during the perimenopausal transition in a vulnerable population.
Sources: Freeman EW, et al. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry. 2006;63:375-382; Cohen LS, et al. Risk for new onset of depression during the menopausal transition: the Harvard Study of Moods and Cycles. Arch Gen Psychiatry. 2006;63:385-390.
Two longitudinal cohort studies assessed the onset of depressive symptoms and disorders during the perimenopausal transition. The Penn Ovarian Aging Study followed over 8 years 436 women with no history of depression and correlated hormonal changes with the new onset of depressed mood. Fifty percent (116) of the women developed an increase in measures of depression and 26% (59) met the criteria for a clinical diagnosis of depressive disorder. Forty seven percent (108) of the women constituted the no-depression group. Using the women as their own controls, the depression group was 2.5 times more likely to develop clinical depression comparing status during the perimenopausal transition to the premenopausal state. These symptoms during the peri-menopausal transition were associated with greater variability (but no average differences) in estradiol levels, higher body weights, more hot flashes, but only estradiol variations were considered significant by the authors, leading them to conclude that fluctuations of estradiol can be an important destabilizing factor.
The Harvard Study of Moods and Cycles is a prospective cohort of women with and without histories of depression. The onset of new depression in 460 women is documented in this report. In the women who entered the perimenopausal transition, the risk of new depression was almost doubled compared with premenopausal women, from 9.5% to 16.6%. This risk was linked to the presence of vasomotor symptoms.
Commentary
This area of concern has been very difficult to study. Inconsistent results can reflect variations in study designs, selection of subjects, methods used to measure mood, and the definition of menopausal status. These two reports are important because they provide reliable evidence of a vulnerable population of women. Freeman et al found that depressive mood changes were influenced by other factors, including body weight, smoking, PMS, employment, and marital status. Premenopausal PMS was a strong predictor of depressive symptoms arising in the menopausal transition. A concern that raises a cautionary note is the high prevalence of depression in this study.
In the Harvard Study, a statistically significant increase was observed only in the women experiencing hot flushes. Of great importance was the limitation of a statistically significant increase in risk of new depressive symptoms only in women with a history of adverse life events (the events are not defined or specified in the report). Also of note, 83% of the women experienced no mood changes.
I believe that the most important question is whether truly normal women experience an increase in depression during the menopausal transition or are there subtle or even clinically apparent psychological problems that identify a susceptible sub group? The results in these two cohort studies support the argument that there is a vulnerable group of perimenopausal women who are responsible for the increase of new depression observed during the perimenopausal transition. The data are consistent with the idea that fluctuations in hormone levels are related to mood symptoms, but it is impossible to know if this is a true cause and effect relationship.
I want to emphasize that these data support the contention that most (about 85%) women experience the perimenopausal transition without mood difficulties. Some women are at greater risk of new onset depressive symptoms, and this is probably enhanced by hormonal variations and vasomotor symptoms. These vulnerable women are likely derived from a group of premenopausal women with underlying psychological problems (although “problem” may be too strong of a word). It is also possible that perimenopausal hormone changes create a state that makes an individual less able to deal with adverse events in life. The next step is to document whether this population benefits from hormone therapy.
Two longitudinal cohort studies assessed the onset of depressive symptoms and disorders during the perimenopausal transition. The Penn Ovarian Aging Study followed over 8 years 436 women with no history of depression and correlated hormonal changes with the new onset of depressed mood.Subscribe Now for Access
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