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Nearing Menopause? Depression a Risk

Researchers Say Hormonal Changes Appear to Play a Role

Role of PMS and Smoking

In the second, similarly designed study, University of Pennsylvania School of Medicine researchers followed 231 women between the ages of 35 and 47 for eight years.

Once again, the women were premenopausal at entry and they had no prior history of major depression.

Blood samples were taken periodically throughout the eight-year period to determine hormone levels, and researchers also administered standardized tests designed to measure depression symptoms and clinical depression.

Compared to when she was premenopausal, a woman was more than four times as likely to have symptoms of depression during perimenopause. Changes in hormonal levels were significantly associated with the appearance of these symptoms, even after adjusting for other lifestyle factors that have been linked to depression.

A diagnosis of clinical depression was also found to be two-and-a-half times more likely during the transition to menopause.

"We are not saying that hormones are the only things that impact depression risk during this period of a woman's life," says researcher Ellen Freeman, PhD. "But both of these studies support the idea that hormones are directly involved."

Women in the study who reported more premenstrual syndrome (PMS) prior to the transition to menopause had an even greater depression risk than other perimenopausal women.

"We know that some women seem to have an increased sensitivity to hormone fluctuation," Freeman says.

Depression risk among smokers transitioning to menopause was also greater than for transitioning nonsmokers.

Hormone Therapy and SSRIs

Cohen points out that, as is the case with other menopausal symptoms, not all perimenopausal women will experience symptoms of depression.

"Most women do not develop major depression," he says. "But these findings do suggest that when (perimenopausal) women do develop symptoms of depression their family practitioner, internist, or ob-gyn should take this symptom seriously."

Hormone therapy, which is now used primarily for the short-term treatment of hot flashes and night sweats, has been shown in some studies to improve depression symptoms in women approaching menopause.

Treatment with antidepressants may also be appropriate, both researchers tell WebMD.

"For most women with no history of depression, these depression episodes are transient," Freeman says. "That doesn't mean that the available treatments shouldn't be tried. They definitely help a lot of women."

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