Advertisement

Major Depression and Menopause

Summary and Comment |
March 21, 2011

Major Depression and Menopause

  1. Deborah Cowley, MD

Major depressive episodes become more common during and immediately after the menopausal transition.

  1. Deborah Cowley, MD

Menopause is thought to increase the risk for depression. However, studies have had conflicting results and methodological flaws, such as measuring depressive symptoms rather than major depression, not controlling for past episodes, not following women prospectively through the menopausal transition, and not extending follow-up into postmenopause. In this 10-year study, researchers examined the development of major depressive episodes through menopause in 221 premenopausal women who were participating in a longitudinal study of health in menopause and aging (144 whites; 77 blacks; age range at study entry, 42–52).

Participants had at least one visit in perimenopause, and 131 had at least one visit in postmenopause. By year 10, 30% of whites and 34% of blacks had at least one major depressive episode. Higher rates of major depression were associated independently with history of major depression, psychotropic medication use, high body-mass index, and upsetting life events (but not with frequent vasomotor symptoms or reproductive hormone levels). Even after adjustment for significant factors, major depression was two to four times more likely during perimenopause and postmenopause than premenopause. Depression was more common in the first 2 years after menopause (but not later) than in perimenopause.

Comment

This carefully done, long-term, prospective, cohort study demonstrates increased risk for major depression during the menopausal transition, especially within the first 2 years after menopause. Other factors (e.g., history of depression, life events) that increase risk at other stages of life also independently increase the risk. Given this relatively small study sample, further studies are needed to determine definitively whether frequent or severe vasomotor symptoms or hormone levels contribute to risk. Clinicians should view the menopausal transition and early postmenopause as a high-risk time for major depressive episodes and consider antidepressants and/or psychotherapy, which remain the mainstay of treatment, given conflicting data about the benefit of hormonal interventions.

Citation(s):

Reader Comments (5)

r.h. raymond

these findings not surprising given that it has been established for a long time that mood disorders in women have a bimodal distribution- menarche and menopause

Competing interests: None declared

Ellen CG Grant

Bomberger et al found women were more likely to have severe depression in the two years after the menopause. Changes in hormone levels can perturbate amine metabolism. It is important that any essential nutrient deficiencies of zinc, magnesium, B vitamins and omega-3 PUFAs are repleted to help to maintain normal brain function.

Competing interests: None declared

Wm. Beckman, RPh

Probably the greatest physiologic change during the peri- and post- menopausal time frame is the major reduction of PROGESTERONE levels, and not the Estrogens. In addition to anxiolytic activity, progesterone has significant anti-depressant activity. Perhaps a phsyiologic, rather than a pharmacologic approach merits strong consideration. After all, a prozac deficiency is yet to be medically established.

Competing interests: None declared

Ellen CG Grant

It is a fundamental mistake to give progesterone at the menopause. Progesterone up and down regulates thousands of genes. Indeed the menopause is a welcome relief from the numerous challenging immunological and biochemical changes activated by progesterone in preparing for and maintaining a pregnancy. Progesterone use increases deficiencies of essential nutrients which are needed to regulate amine pathways. High progesterone levels and low estrogen levels cause depression partly by increasing monoamine oxidase activity. This happens both in the late secrectory phase of a normal menstrual cycle and also during use of strongly progestogenic low dose estrogen oral contraceptives. Grant ECG, Pryse-Davies J. Effect of oral contraceptives on depressive mood changes and on endometrial momoamine oxidase and phosphatases. BMJ 1968:3:77-780.

Competing interests: None declared

Wm. Beckman, RPh

While progestins - commonly used in oral contraceptives and many commercial HRT formulas - have been proven to increase depression, PROGESTERONE has not. Likely its universal agonist activity in receptors throughout the body (vs progestins antagonistic activity in receptors other than uterine and ovarian tissues) promote healthy sleep patterns {Progesterone Prevents Sleep Disturbances and Modulates GH, TSH, and Melatonin Secretion in Postmenopausal Women - J Clin Endocrinol Metab. 2011 Feb 2}, and support libido {Low sexual desire--is it all in her head? Pathophysiology, diagnosis, and treatment of hypoactive sexual desire disorder - Postgrad Med. 2010 Nov;122(6)} in the brain and CNS.

Competing interests: None declared

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement