Menopause linked with the onset of depression

Two new studies say women with no history of depression may be at an increased risk of depressive symptoms and disorders as they enter menopause.

This will be no news to thousands of women who have for centuries suffered from the miserable side effects of the hormonal changes happening to their body often dismissed by the medical profession as some form of female weakness.

Ellen W. Freeman, Ph.D., from the University of Pennsylvania School of Medicine, Philadelphia, and colleagues evaluated data from 231 pre-menopausal women who had no history of depression at the start of the study.

The authors say it has long been recognised that the menopause is for many women a time of increased risk for developing depressive symptoms, but there is little scientific evidence to connect the change in reproductive hormones, menopausal status and mental health.

The participants ranged in age from 35 to 47 and were followed for eight years.

At set intervals, blood samples were obtained to determine hormone levels, and trained research interviewers obtained overall health and demographic information, including any menopausal symptoms experienced.

Depressive symptoms were assessed by using the Center for Epidemiological Studies of Depression scale (CES-D), and the Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to identify clinical diagnoses of depressive disorders.

The authors say that high CES-D scores were more than four times more likely to occur during a woman’s menopausal transition compared with when she was pre-menopausal.

Changes in hormonal levels were significantly linked with high CES-D scores even after adjusting for smoking, body mass index, premenstrual syndrome, hot flashes, poor sleep, health status, employment and marital status.

According to the authors, a depressive disorder was two-and-a-half times more likely to occur in the menopausal transition compared with when the woman was pre-menopausal and the hormone measures were also significantly associated with this outcome.

The researchers say more research is now needed to determine the extent to which these reports of depressed mood are limited to the perimenopausal period and to determine whether the identified risk factors are associated with more persistent depression.

In a related study, Lee S. Cohen, M.D., from Massachusetts General Hospital, Boston, and colleagues from the Harvard Study of Moods and Cycles examined the association between the menopausal transition and onset of first lifetime episode of depression among women with no history of mood disturbance.

The Harvard Study of Moods and Cycles is a study of pre-menopausal women with and without a lifetime history of major depression.

The participants in this research were 460 pre-menopausal women, 36 to 45 years of age, with no lifetime diagnosis of major depression, residing in seven Boston area communities. The incidence of new onset of depression was based on structured clinical interviews, CES-D scores, and self-administered questionnaires.

The researchers found that pre-menopausal women with no lifetime history of major depression who entered the perimenopause were twice as likely to develop significant depressive symptoms as women who remained pre-menopausal

They also found the increased risk for depression was greater in women who suffered with vasomotor symptoms such as hot flashes.

According to the authors in the United States alone, approximately 1.5 million women may reach menopause each year and experience a range of symptoms and syndromes including severe vasomotor symptoms, loss of bone density, sexual dysfunction, a decline in cognitive function, and a potential increased risk for cardiovascular disease.

When the risk of depression is added to this list many aging women, they say carry a compounded burden of illness.

Both studies are published in the April issue of the Archives of General Psychiatry.