Early transition to menopause may increase risk for first onset of depression

Women with no history of depression may be at an increased risk of new onset depressive symptoms and disorders as they transition to menopause, according to two studies in the April issue of Archives of General Psychiatry.

As background information in the articles, the authors write that 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, Ph.D., 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.