Menopause may raise risk of depression.

Risk may be lessened with hormone-replacement therapies.

WASHINGTON, April 5 (UPI) — The hormonal change a woman faces during menopause doubles her risk for developing clinical depression, new research suggests, but the risk may be lessened by the use of hormone-replacement therapies.

The findings in the Archives of General Psychiatry run counter to a commonly held notion: The stress some middle-aged women experience, such as the death of a parent, divorce, moving or changing jobs, spurs the onset of depression in those who had never had the disease.

Instead, it could be the hormonal fluctuations and a lack of estrogen that can make women entering menopause — called the perimenopausal phase — up to twice as likely to have depression as premenopausal women. Such fluctuations also trigger common menopausal symptoms such as night sweats, hot flashes and mood swings.

“(Depression in menopause) needs to be taken seriously,” said Dr. Lee Cohen, associate professor of psychology at Harvard Medical School and the lead study author of one of the observational trials. “It shouldn’t be attributed to ‘going through the change’ … if untreated, it can have serious consequences.”

For years, depressive symptoms leading up to menopause were considered “part of the territory” of menopause, he said.

Clinical depression affects about 10 to 14 million people annually, and women are more than twice as likely to develop the condition, according to the National Alliance on Mental Illness. Most of the women who enter menopause each year do not have depression or depressive symptoms, but for those who do, the new research lends validity to their sometimes debilitating illness — much as recent studies and news coverage have brought attention to post-partum depression. However, these studies are observational, and more research is needed to make stronger conclusions.
Cohen’s study followed nearly 500 women before menopause and for three years after menopause. Among women who experienced blood vessel issues — such as hot flashes — the risk of developing depression increased. Both estrogen and serotonin play a role in the brain’s ability to control body temperature and regulate reproductive hormones, the study authors said. If those hormonal levels dip and peak, mood changes can occur.

The study also found women taking hormone replacements experienced milder depressive symptoms than those who did — not surprising, Cohen said, given the well-established anti-depressive benefit of estrogen. Still, taking hormone-replacement therapies comes with its own set of risks, including cardiovascular and blood clot troubles, so women need to discuss the pros and cons of beginning hormone therapy with their physicians, Cohen said.

Many women choose natural supplements to combat symptoms such as hot flashes, a waning libido and depressive symptoms. However, herbal supplements do not need to undergo the controlled trials required of Food and Drug Administration-approved drugs; no credible studies have shown herbal supplements to work, said Cohen.

After adjusting for negative life events — divorce, death of a loved one — Cohen found the connection between menopause and depression remained. However, experiencing major life stressors while going through menopause can lower a woman’s quality of life, which may also lead to depression, Cohen said.

“It’s almost a perfect storm. You may have a confluence of factors that increase your risk further for developing major depression,” he said.
A second study, published alongside Cohen’s in the Archives of General Psychiatry, reached a similar conclusion. It discovered women on the cusp of menopause were 2.5 times more likely to be depressed than premenopausal women. Neither study determined whether the depression risk extends past menopause, but Cohen said his research team is applying for a grant to continue follow-up with the women in his study.

Dr. Ellen Freeman, of the Department of Obstetrics/Gynecology and Psychiatry at the University of Pennsylvania’s School of Medicine in Philadelphia and lead author of the second study, said both studies lend credence to women who may face symptoms of depression such as persistent sadness, hopelessness and loss of interest in hobbies and activities while transitioning to menopause.

“If they feel down and depressed, that’s valid. They’re not crazy,” Freeman
said. “It’s worth talking to their doctor about and getting medical treatment.”

Copyright 2007 by United Press International. All Rights Reserved.

SOURCE: Science Daily

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