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Transition to menopause associated with new onset of depressive symptoms

Two studies found that women with no history of depression may be at an increased risk of new onset depressive symptoms and disorders as they transition to menopause.

Although the transition to menopause has long been considered a time of increased risk for developing depressive symptoms, there is little scientific evidence to connect the change in reproductive hormones, menopausal status and mental health.

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

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.

" High CES-D scores were more than four times more likely to occur during a woman's menopausal transition compared with when she was premenopausal," the authors report.
Changes in hormonal levels were significantly associated with high CES-D scores after adjusting for smoking, body mass index, premenstrual syndrome, hot flashes, poor sleep, health status, employment and marital status.

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

" In summary, our data indicate that transition to menopause and its changing hormonal milieu are strongly associated with both new onset of high depressive symptoms and new onset of diagnosed depressive disorders in women with no history of depression. Further follow-up study 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," the authors conclude.

In a related study, Lee S. Cohen, 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 premenopausal women with and without a lifetime history of major depression.

The participants in this research were 460 premenopausal 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.

" Premenopausal 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 premenopausal, after adjustment for age at study enrollment and history of negative life events," the researchers found. " The increased risk for depression was somewhat greater in women with self-reported vasomotor symptoms ( for example, hot flashes )."

" The current study suggests that within a similarly aged population of women with no lifetime history of depression, those who enter the menopausal transition earlier have a significant risk for first onset of depression," the authors state. " In the United States only, approximately 1.5 million women may reach menopause each year. A spectrum of symptoms and syndromes has been extensively described in women during the menopausal transition including severe vasomotor symptoms, loss of bone density, sexual dysfunction, a decline in cognitive function, and a potential increased risk for cardiovascular disease. Thus, the comorbidity of these problems with perimenopause-associated depression could affect many aging women, leading to a compounded burden of illness," the authors conclude.

Source: Archives of General Psychiatry, 2006