Major Depression and Menopause

Major depressive episodes become more common during and immediately after the menopausal transition.

Menopause is thought to increase the risk for depression. However, studies have had conflicting results and methodological flaws, such as measuring depressive symptoms rather than major depression, not controlling for past episodes, not following women prospectively through the menopausal transition, and not extending follow-up into postmenopause. In this 10-year study, researchers examined the development of major depressive episodes through menopause in 221 premenopausal women who were participating in a longitudinal study of health in menopause and aging (144 whites; 77 blacks; age range at study entry, 42–52).

Participants had at least one visit in perimenopause, and 131 had at least one visit in postmenopause. By year 10, 30% of whites and 34% of blacks had at least one major depressive episode. Higher rates of major depression were associated independently with history of major depression, psychotropic medication use, high body-mass index, and upsetting life events (but not with frequent vasomotor symptoms or reproductive hormone levels). Even after adjustment for significant factors, major depression was two to four times more likely during perimenopause and postmenopause than premenopause. Depression was more common in the first 2 years after menopause (but not later) than in perimenopause.

Comment: This carefully done, long-term, prospective, cohort study demonstrates increased risk for major depression during the menopausal transition, especially within the first 2 years after menopause. Other factors (e.g., history of depression, life events) that increase risk at other stages of life also independently increase the risk. Given this relatively small study sample, further studies are needed to determine definitively whether frequent or severe vasomotor symptoms or hormone levels contribute to risk. Clinicians should view the menopausal transition and early postmenopause as a high-risk time for major depressive episodes and consider antidepressants and/or psychotherapy, which remain the mainstay of treatment, given conflicting data about the benefit of hormonal interventions.

— Deborah Cowley, MD

Published in Journal Watch Psychiatry March 21, 2011

Journal Watch on line 21 maart 2011

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