Depression risk may fall after women’s periods end
Some women who are depressed as they move toward menopause may notice their symptoms fading or disappearing after a few years, a new study suggests.
Researchers found the proportion of women who reported having depression symptoms dropped consistently, starting 10 years before they had their final menstrual period until eight years after.
“If this is a condition that seems to appear in conjunction with approaching menopause, it may be time limited and the risk may really diminish to low levels once they pass menopause,” Ellen Freeman, the study’s lead author, said.
Freeman is a research professor at the University of Pennsylvania School of Medicine in Philadelphia.
Previous studies found women have a higher risk of depression as they enter menopause, the researchers write in JAMA Psychiatry. But little was known about what happened after a woman stopped getting her menstrual periods altogether.
Freeman and her colleagues studied 203 women between the ages of 35 and 48 who had not gone through menopause in 1996. They followed the women through 2010.
Unpredictable hormone fluctuations plus stress, body image, sexuality, infertility, or aging - any one or a combination of these causes emotional distress that may result in mood swings or, in more severe cases, depression. Determining the cause and extent of your “menopause blues” is very important.
3 Types of Depression
“Depressed” and “depression” are words used to describe three distinctly different conditions:
A depressed mood - This is a normal, brief period of feeling blue or sad that is commonly experienced and rarely requires treatment. The medical term is dysphoria.
Depression as a symptom - Sometimes called an adjustment reaction, this type of depression may be due to a wide variety of medical or psychological problems, or to intense reactions to life events (such as divorce, losing a job, death of a loved one). It is usually short term and most often does not require treatment, although it can progress to clinical depression. The medical term for depression that occurs most of the day, more days than not, for at least 2 years is dysthymia.
Clinical depression - This is a disorder believed to result from a chemical imbalance in the brain. A clinical (major) depression requires treatment.
Women completed a questionnaire every so often to determine if they were depressed.
At the beginning of the study, about 40 percent of them scored high enough on the scale of depression symptoms to show they had at least mild or moderate depression, the researchers found.
Starting a decade before their last menstrual period, women’s risk of depression fell about 15 percent every year during the study.
“One average, for two years after the final menstrual period the risk is still high but after that the risk goes down pretty low,” Freeman told Reuters Health.
The pattern of depression symptoms around menopause was similar for women who did and did not have a history of depression leading up to the study.
But across the research period, women with a history of depression were more than 13 times more likely to report having depression symptoms again compared to women with no history of depression.
Risk of Depression
Cohen and colleagues followed 460 Boston women between the ages of 36 and 45 for up to six years. All of the women were premenopausal at enrollment, meaning that they still had regular periods or had not undergone other changes indicative of transition to menopause.
None of the 460 women had ever been diagnosed with major depression. But those who entered perimenopause during the study period were almost twice as likely as those who didn’t to develop significant symptoms of depression.
The risk was greater in perimenopausal women who also had hot flashes, but it was still greatly elevated in those who did not have this and other common symptoms associated with transitioning to menopause, Cohen says.
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.
For those women, Freeman said, depression should not be treated as a symptom of menopause.
“It would appear that for women who had depression before and have depression again, it’s probably a different underlying process,” she said.
As for women without a history of depression, while the researchers can’t say hormone levels caused depression symptoms, they did find an association between women’s scores and hormone levels.
The existing evidence on a link between rapidly changing hormones and depression is conflicting, Joyce Bromberger said. She studies women’s mental health at the University of Pittsburgh in Pennsylvania.
“But it’s still important to look at,” Bromberger, who was not involved with the new study, told Reuters Health. “It’s just that it’s very difficult to look at hormone patterns over time.”
She said it’s also hard to know how applicable the new findings would be to the average woman, because such a large proportion of participants met the test’s threshold for mild or moderate depression.
“I think we can say that over time that - on average - depressive symptoms go down, but that doesn’t tell us about women who are greater risk,” she said.
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SOURCE: JAMA Psychiatry, online November 13, 2013.
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Maternal Depression During Pregnancy and the Postnatal Period
Risks and Possible Mechanisms for Offspring Depression at Age 18 Years
Importance Some small studies suggest that maternal postnatal depression is a risk factor for offspring adolescent depression. However, to our knowledge, no large cohort studies have addressed this issue. Furthermore, only 1 small study has examined the association between antenatal depression and later offspring depression. Understanding these associations is important to inform prevention.
Objective To investigate the hypothesis that there are independent associations between antenatal and postnatal depression with offspring depression and that the risk pathways are different, such that the risk is moderated by disadvantage (low maternal education) with postnatal depression but not with antenatal depression.
Design, Setting, and Participants Prospective investigation of associations between symptoms of antenatal and postnatal parental depression with offspring depression at age 18 years in a UK community-based birth cohort (Avon Longitudinal Study of Parents and Children) with data from more than 4500 parents and their adolescent offspring.
Main Outcomes and Measures Diagnosis of offspring aged 18 years with major depression using the International Classification of Diseases, 10th Revision.
Results Antenatal depression was an independent risk factor. Offspring were 1.28 times (95% CI, 1.08-1.51; P = .003) more likely to have depression at age 18 years for each standard deviation increase in maternal depression score antenatally, independent of later maternal depression. Postnatal depression was also a risk factor for mothers with low education, with offspring 1.26 times (95% CI, 1.06-1.50; P = .01) more likely to have depression for each standard deviation increase in postnatal depression score. However, for more educated mothers, there was little association (odds ratio, 1.09; 95% CI, 0.88-1.36; P = .42). Analyses found that maternal education moderated the effects of postnatal but not antenatal depression. Paternal depression antenatally was not associated with offspring depression, while postnatally, paternal depression showed a similar pattern to maternal depression.
Conclusions and Relevance The findings suggest that treating maternal depression antenatally could prevent offspring depression during adulthood and that prioritizing less advantaged mothers postnatally may be most effective.
Pearson RM, Evans J, Kounali D, et al. Maternal Depression During Pregnancy and the Postnatal Period: Risks and Possible Mechanisms for Offspring Depression at Age 18 Years. JAMA Psychiatry. 2013;():-. doi:10.1001/jamapsychiatry.2013.2163.