1. Home>
2. Specialties>
3. Psychiatry>
4. Summary and Comment

Major Depression and Menopause

Major depressive episodes become more common during and immediately after the menopausal transition.

Menopause is thought to increase the risk for depression. However, studies have had conflicting results and methodological flaws, such as measuring depressive symptoms rather than major depression, not controlling for past episodes, not following women prospectively through the menopausal transition, and not extending follow-up into postmenopause. In this 10-year study, researchers examined the development of major depressive episodes through menopause in 221 premenopausal women who were participating in a longitudinal study of health in menopause and aging (144 whites; 77 blacks; age range at study entry, 42–52).

Participants had at least one visit in perimenopause, and 131 had at least one visit in postmenopause. By year 10, 30% of whites and 34% of blacks had at least one major depressive episode. Higher rates of major depression were associated independently with history of major depression, psychotropic medication use, high body-mass index, and upsetting life events (but not with frequent vasomotor symptoms or reproductive hormone levels). Even after adjustment for significant factors, major depression was two to four times more likely during perimenopause and postmenopause than premenopause. Depression was more common in the first 2 years after menopause (but not later) than in perimenopause.

Comment: This carefully done, long-term, prospective, cohort study demonstrates increased risk for major depression during the menopausal transition, especially within the first 2 years after menopause. Other factors (e.g., history of depression, life events) that increase risk at other stages of life also independently increase the risk. Given this relatively small study sample, further studies are needed to determine definitively whether frequent or severe vasomotor symptoms or hormone levels contribute to risk. Clinicians should view the menopausal transition and early postmenopause as a high-risk time for major depressive episodes and consider antidepressants and/or psychotherapy, which remain the mainstay of treatment, given conflicting data about the benefit of hormonal interventions.

— Deborah Cowley, MD

Published in Journal Watch Psychiatry March 21, 2011

Citation(s):

Bromberger JT et al. Major depression during and after the menopausal transition: Study of Women's Health Across the Nation (SWAN). Psychol Med 2011 Feb 9; [e-pub ahead of print]. (http://dx.doi.org/10.1017/S003329171100016X)

Reader Remarks:

Review and add to remarks on this article

• Severe depression and nutritional deficiencies
  Ellen CG Grant, 22 Mar 2011 10:55 AM EST
  Specialty: Neurology
  Bomberger et al found women were more likely to have severe depression in the two years after the menopause. Changes... [more]
• Physiologic reason for Post-Menopausal Depression?
  Wm. Beckman, RPh, 22 Mar 2011 10:55 AM EST
  Specialty: Pharmaceutical Medicine
  Probably the greatest physiologic change during the peri- and post- menopausal time frame is the major reduction of PROGESTERONE levels,... [more]
• Post menopausal progesterone use is a fundamental mistake
  Ellen CG Grant, Kingston-upon-Thames. KT2 7JU, UK, 22 Mar 2011 1:15 PM EST
  Specialty: Neurology
  It is a fundamental mistake to give progesterone at the menopause. Progesterone up and down regulates thousands of genes. Indeed... [more]
• Progestins are inappropriate, Progesterone is not
  Wm. Beckman, RPh, 23 Mar 2011 7:46 AM EST
  Specialty: Pharmaceutical Medicine
  While progestins - commonly used in oral contraceptives and many commercial HRT formulas - have been proven to increase depression,... [more]
• validates previous findings
  r.h. raymond, urban private practice, 5 Apr 2011 12:09 PM EST
  Specialty: Obstetrics & Gynecology
  these findings not surprising given that it has been established for a long time that mood disorders in women have... [more]

Image Gallery