Risk of depression is lower in menopausal women after their final menstrual period (FMP) but a history of depression increases the risk of depressive symptoms both before and after menopause, according to a new study from researchers at the Perelman School of Medicine at the University of Pennsylvania (http://www.med.upenn.edu/). The study, published in this week's issue of JAMA Psychiatry (archpsyc.jamanetwork.com/article.aspx?articleid=1772342), shows that the FMP is pivotal in the overall pattern of decreasing the risk of depressive symptoms in middle-aged women, with higher risk before and lower risk after the final menstruation.
"Some women begin to experience depressive symptoms as they approach menopause and, although only a small percentage experience difficulty or changes in mood around that time, it's important that health care providers be able to tell their patients what to expect," said lead author Ellen Freeman, PhD (http://www.med.upenn.edu/apps/faculty/index.php/g275/p14176), research professor of Obstetrics and Gynecology at Penn Medicine. "What this study shows is that in general, women can expect the risk of depressive symptoms to decrease in the second year after their final menstrual period. It is important to note that most women who experience depression during menopause do so before the transition as well. For this group, there may be some decrease postmenopause, but the risk for recurring episodes remains high."
Previous research has shown an increased risk of depression associated with a woman's transition to menopause, but until now the risk of depression in the first years following the transition has not been examined. In an effort to identify changes in the risk of depression and the link between a history of depression prior to menopause, researchers examined depressive symptoms during a 14-year period in women who were premenopausal at baseline and then progressed through menopause.
Results of the study show scores on a depression scale were higher 10 years prior to the final menstrual period, and decreased for up to eight years after. Subjects who experienced their first symptoms of depression as they approached menopause had a significantly lower risk of recurring symptoms the second year after their final menstrual period. However, among women with a history of depression, the likelihood of continued symptoms of depression was 13 times higher overall and 8 times higher after menopause compared to women with no history of depression.
"Studies show that as a woman approaches menopause changes in reproductive hormones contribute to an increased risk of depression, so it's not surprising that after menopause the risk of depression decreases," said Freeman. "However, understanding the risk of depression for these patients is important because of its association with other health conditions such as cardiovascular disease, metabolic syndrome and osteoporosis."
The authors suggest a clinical review of depressive symptoms is necessary to provide treatment when symptoms are debilitating, and to evaluate the effect of depression on other disorders. Depending on a patient's history of depressive symptoms, antidepressant or psychotherapy may be appropriate.
Other study authors from Penn include Mary D. Sammel, ScD, David W. Boorman, MS, and Rongmei Zhang, PhD.
The study was supported by the National Institutes of Health (RO1 AG12745; RR024134).
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