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Depression Risk Nearly Doubles When Women Enter Menopause


 

Women entering menopause are nearly twice as likely to develop depression as are women the same age who are not yet making the transition to menopause, reported Dr. Lee S. Cohen and his associates in the Harvard Study of Moods and Cycles.

“Transition to menopause has long been considered a period of increased risk for depressive symptoms,” Dr. Cohen and his colleagues wrote, but studies on the issue have yielded conflicting results. This is partly because of methodological inconsistencies, including a tendency to define menopause based on questionable criteria such as the subjects' age alone, and the lack of standardized assessment of psychiatric symptoms, the researchers said.

In contrast, their study involved a population-based, cross-sectional sample of women aged 36 to 45 years who were prospectively followed every 6 months for several years.

Changes in menstrual cycle length and menstrual flow amount and duration were carefully tracked, and depressive symptoms were assessed using the Structured Clinical Interview for DSM-IV, as well as the Center for Epidemiologic Studies Depression Scale. Significant adverse life experiences and vasomotor symptoms also were assessed, said Dr. Cohen and his associates at Harvard Medical School, Massachusetts General Hospital, and Brigham and Women's Hospital, all in Boston.

The 460 study subjects had no history of major depression. A total of 134 were still premenopausal at the end of the last follow-up period, which occurred between 59 and 92 months after study enrollment. The remaining 326 women had entered menopause during that interval.

The rate of new-onset major depression was 16.6% in the menopausal women, compared with 9.5% in those who had not yet entered menopause, after the data had been adjusted to account for age at study enrollment and history of negative life events. “To our knowledge, this prospective documentation of increased risk for depression among women without a history of depression is unique,” the investigators said (Arch. Gen. Psychiatry 2006;63:385–90).

This correlation between onset of depression and transition to menopause was noted both in women who used hormone therapy and in those who did not.

New-onset depression was more likely to develop in women who reported vasomotor symptoms than in those who did not. This association between depression and vasomotor symptoms is not yet fully understood. It is possible that hot flushes disrupt sleep “enough to adversely affect daytime functioning and to impact quality of life.” Alternatively, “abrupt changes in neuromodulatory function and/or in reproductive-hormone levels could contribute to the constellation of mood and vasomotor symptoms,” Dr. Cohen and his associates said.

Abrupt changes in hormone levels could contribute to mood and vasomotor symptoms. DR. COHEN

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