Onset of Menopause May Trigger Depression

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Onset of Menopause May Trigger Depression

Women may be at an increased risk of developing depressive symptoms during the transition to menopause even if they have no history of depression, findings from two independent studies show.

Although the transition to menopause has long been considered a time of increased risk for developing depressive symptoms, scientific evidence connecting changes in hormonal milieu during this time with depression has been lacking.

Ellen Freeman (University of Pennsylvania School of Medicine, Philadelphia, USA) and colleagues note that in their study, change in menopausal status and variability in hormone levels were associated with high Center for Epidemiological Studies of Depression (CES-D) scale scores after taking into account smoking, body mass index, premenstrual syndrome, hot flashes, poor sleep, healthy status, employment, and marital status.

The researchers evaluated data from 231 premenopausal women who had no history of depression, who ranged in age from 35 to 47 years. Follow-up over an 8-year period showed that high CES-D scores of 16 or above were more than four times as likely to occur in women during the menopausal transition than in premenopausal women.

Moreover, a diagnosis of depressive disorder was 2.5 times more common in women during the menopausal transition than before it.

The researchers conclude in the Archives of General Psychiatry: "Further follow-up is 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 article, Lee Cohen, from Massachusetts General Hospital in Boston, USA, and colleagues looked at the impact of the menopausal transition on depressive symptoms in 460 women, aged between 36 and 45 years, with no lifetime diagnosis of major depression.

They found that premenopausal women entering the perimenopause were twice as likely to develop significant depressive symptoms as women who remained premenopausal, after taking into account age and history of negative life events.

The researchers note that the risk of depression was slightly higher among women who had vasomotor symptoms, such as hot flashes.

"This finding will carry important public health implications," say Cohen et al. They note that a spectrum of symptoms and syndromes have been described in women during the menopausal transition, including vasomotor symptoms, loss of bone density, and sexual dysfunction.

"The comorbidity of these problems with perimenopause-associated depression could affect many aging women, leading to a compounded burden of illness," they conclude.

 Arch Gen Psychiatry 2006; 63: 375-382, 385-390

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