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The Relationship Between Menopause and Depression

Women experience a more heightened psychiatric morbidity when compared to men and this is evidenced by the fact that women of all ages will have a higher incidence of depression than men (1,2). The lifetime incidence of depression in women is about two times the incidence in males (1,2). There is an increasing body of evidence that suggest that the menopausal transitional period in women and the early postmenopausal years may be associated with a period of vulnerability that places women at an increased risk of experiencing symptoms of depression or developing an episode of major depressive disorder (1,2). For many years, the existence of a casual or direct association between the period around menopausal and the emergence of symptoms of depression has been the talk of much controversy (1,2). There is some suggestive data that estrogen deficiency may increase the susceptibility for depression (1,2). There is also suggestive evidence from observational studies and some small randomized controlled trials that estrogen therapy after menopause will improve mood and cognition (1,2). But the current evidence is conflicting in nature (1,2). It is suggested that low estradiol levels have a decreased vigilance at the neurophysiological level, which is correlated with more depressive and menopausal symptomatology at the level that regulates behavior (1,2). There is some EEG data to show that depression is at the very least correlated to a right frontal and left frontal hypoactiviation (1,2). The neurobiologic effects of estrogen from animal studies include decreased monoamine oxidase activity, which in turn will increase the bioavailability of catecholamines, enhancing serotonin, cholinergic transmission, antidopaminergic effects in specific brain tissues, modulation of GABA receptors, and the modification of sleep and circadian rhythms (1,2). The effectiveness of estrogen on treating depression is understudied (1,2). There are case reports that suggest mood stabilization in post menopausal women with bipolar disorder after introduction of exogenous steroids (1,2). A recent study that involved transdermal estradiol in women with postpartum major depression suggested efficacy as a single agent and as an adjunct to antidepressants (1,2). Another study in women with severe major depressive disorders were treated with large doses of oral conjugated strogen or placebo for 12 weeks (1,2). Estrogen only had a modest but significant effect on mood when being compared with placebo (1,2). However, in other studies, the additional of ethinyl estradiol to imipramine in the treatment of women with major depression for a period of 2 weeks did not improve the efficacy when compared with imipramine alone (2). Another study that added oral conjugated estrogens or placebo to imipramine in women with major depression did not suggest a benefit with estrogen (2). The efficacy of estrogen as an adjunct to antidepressants is highly controversial in nature (1,2).

Risk factors that are associated with depressed mood at menopause include prior depression, prior PMS, hysterectomy, psychosocial stressors, poor health status, poor lifestyle variables such as smoking or a lack of exercise (1,2).

References

  1. Avis NE, Brambilla D, McKinlay SM, Vass K. A longitudinal analysis of the association between menopause and depression Results from the Massachusetts women’s health study. Annals of epidemiology. 1994;4(3):214-220.
  2. Kaufert PA, Gilbert P, Tate R. The Manitoba Project: a re-examination of the link between menopause and depression. Maturitas. 1992;14(2):143-155.

Disclaimer

This information is presented for informational purposes only and is not meant to be a substitute for advice provided by qualified health care professionals. You should contact your qualified health care provider if you have or suspect any health problems. This article is not intended to provide medical advice for its readers


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