Two recent longitudinal studies evaluated the onset of depression during the perimenopausal transition.
The first study followed 436 women without a history of depression, over 8 years. Correlation of hormonal changes with any new onset of depression was recorded. 116 women developed an increase in depressed moods and 59 met the clinical criteria for a diagnosis of depression. 108 women denied depression.
The women who developed depression were 2.5 times more likely to develop clinical depression during the perimenopausal transition compared to premenopause. In addition, their depression symptoms during perimenopause were associated with greater variations in serum estradiol levels, higher body weight, increased hot flashes. The associations with serum estradiol were considered significant.
Freeman E, Sammel L. Lin H, Nelson D. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry. 2006;63:375-382. [Fulltext PDF | Fulltext HTML]
The second study is a prospective cohort of women both with and without histories of depression. The risk of new depression was almost doubled in women entering perimenopause, compared with premenopausal women. This difference appeared to be associated with the presence of hot flashes.
Cohen L, Soares C, Vitnonis A, Otto M, Harlow B., et al. Risk for new onset of depression during the menopausal transition: the Harvard Study of Moods and Cycles. Arch Gen Psychiatry. 2006;63:385-390. [Fulltext PDF | Fulltext HTML]
Comments
Previous studies on the topic of depression in perimenopausal and menopausal women have been inconsistent and difficult to interpret given all the variations in study designs and study population. The two current studies provide clinically useful documentation that perimenopausal women are a group of women vulnerable to depression. One the more interesting aspects of the Freeman et al study was that PMS in the reproductive years was a significant predictor of the onset of depression during perimenopause.
In the Harvard study, while there was a doubling of depression in perimenopausal women, most of the women in the study (83%) in fact experienced no mood changes.
As clinicians, it is important to appreciate that perimenopausal women have increased risk of depression, whether or not they had a previous history of depression; and, greater fluctuations in serum estradiol levels and hot flashes are associated with this perimenopausal depression. At the same time, it appears that most women experience perimenopause without experiencing depression. It may be that there are some perimenopausal women who have a less than optimal adaptive mechanism and are less able to deal with these normal hormonal changes. These are the women we can hope to identify and to help.
