The widespread suspicion that menopause is linked to increased
risk of depression appears to be confirmed by two studies
published in the journal Archives of General Psychiatry
this month. One found that varying hormone levels are
associated with especially high risk, which could provide
ammunition to advocates of hormone replacement therapy
(HRT).
TRANSITIONAL
RISK
While several studies have set out to tackle the link
in the past, findings have been inconsistent. Many began
with subjects who already had a history of depression.
The focus of the current studies
was narrower and looked only at women with no history
of depression. The first, out of Harvard Medical School,
followed patients from the larger Harvard Study of Moods
and Cycles. It tracked 460 women through the menopausal
transition.
Women who remained premenopausal
were only half as likely to develop depressive symptoms
as those who entered menopause during the course of
the study, the researchers found.
The researchers also sought to
differentiate between women who entered menopause naturally
and those who took HRT to ease the transition. While
the overall proportions reporting depressive symptoms
were the same in both groups, the women taking HRT were
less likely to experience severe depression.
TOUGH
TIMES
The study certainly does little to debunk the conventional
wisdom that this can be a difficult period in a woman's
life. The rates of serious mood disturbance were 9.5%
in premenopausal women and 16.6% in perimenopausal women.
Lending credence to a hormonal
basis for these changes was the even higher rates of
depression in women whose menopause involved vasomotor
symptoms, normally known as hot flushes. Among perimenopausal
women, those who experienced hot flushes were about
20% more likely to suffer depression and about 50% more
likely to suffer severe depression.
It's possible that this is due
to interrupted sleep patterns, the authors suggest,
but a hormonal explanation is more likely. In fact,
poor thermoregulation could be a product, not a cause,
of serotonin imbalance.
Despite doubts cast on hormone
replacement therapy's safety in recent years, the authors
say, "the findings described in the current report may
underline the importance of still considering estrogen-based
therapies for the treatment of symptomatic, perimenopausal
women."
TELLTALE
HORMONES
The other study, led by the University of Pennsylvania
Medical School, found three times more depression in
perimenopausal than premenopausal women. This one took
a more detailed look at hormonal fluctuations, though
in a smaller sample of 231 women.
This study also found that women
entering menopause were two-and-a-half times more likely
to be diagnosed with depressive disorder. They were
more than four times as likely to score high on a validated
depression scale.
When hormone levels were studied
in greater detail, a significant correlation appeared
between depression and elevated levels of follicle-stimulating
hormone (FSH) and luteinizing hormone (LH). Women who
had sharply varying levels of these hormones over time
were also more prone to depression, as were those whose
estradiol levels varied significantly.
Women who had just been diagnosed
with depression were 9.3 times more likely than other
women in the study to have elevated FSH, and 4.5 times
more likely to have elevated LH.
But lead author Dr Ellen Freeman
is unwilling to speculate that HRT would have alleviated
their depression. "That's certainly one hypothesis,
but this wasn't a treatment study so we can't know.
We found many factors influencing depression, of which
menopause and hormone status was just one."
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