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In the years leading up to menopause, research shows that women are at increased risk for depression – even if they do not have a history of mood disorder.
Studies of thousands of women have shown that depressive symptoms are common during perimenopause, three to four years before menopause, when menstruation becomes irregular and stops, and the first year after the last menstrual period.
"Perimenopause is a window of vulnerability for the development of depressive symptoms and major depressive episodes," said Pauline Maki, professor of psychology and psychiatry at the University of Illinois at Chicago College of Medicine. "Kate Spade's recent suicide at the age of 55 shows the severity of mental health problems in middle-aged women, a group that experienced a 45% increase in suicide rate over the past year. last 15 years.
According to Maki, a study of 274 women found that nearly 28% of women suffered from a major depressive episode. Women with a history of depression had an even higher risk of recurrence: a study of 151 women of this type found that 58% had a major depressive episode during perimenopause, Maki said.
"If there is underlying underlying depression to begin with, perimenopause can increase the intensity of depressive symptoms," said Maki. Despite this, she claims that perimenopausal depression has been "largely ignored" by clinicians and the public.
For this reason, researchers are now publishing guidelines for the evaluation and treatment of perimenopausal depression. Maki was one of the leading authors of the guidelines, developed by a group of clinicians and scientists brought together by the North American Menopause Society and the National Network's Working Group on Women and Mood Disorders. on depression centers.
Dr. Susan Kornstein, a professor of psychiatry and obstetrics and gynecology at Virginia Commonwealth University, is another of the lead authors. In a statement, she says the guidelines address "the need for expert consensus as well as clear clinical guidelines on how to assess and treat depression in women during the perimenopause ".
Maki says she hopes the guidelines show that women are not alone in feeling depressed during these years. "If your mood is low, if you feel irritable, I want women to understand that there is consensus that this is normal during menopause," she said.
But Maki also says, "It's something women do not have to live on."
According to Maki, symptoms such as sleep disorders and hot flashes, which affect 80% of menopausal women, often begin during perimenopause and may manifest as symptoms of depression, as directed. "Persistent sleep disturbances caused by hot flashes contribute to the development or exacerbation of depressive symptoms," she said.
To help clinicians unravel the overlapping symptoms, such as sleep disorders, Maki says clinicians should ask patients about menopause and mood symptoms rather than just focusing on symptoms. some sleep. Clinicians should also check if a woman has the main symptoms of depression: a feeling of sadness, anxiety or persistent emptiness and despair, she said.
Although these depressive symptoms often do not meet the diagnostic criteria for depression, even low-intensity depression can reduce a woman's quality of life and sexual intercourse.
According to the researchers, life stressors, such as caring for children and parents, can also have a negative effect on the mood. "When you add hormonal changes that can affect the brain's ability to cope with these stressors, it's not surprising that depression is a common phenomenon among middle-aged women," said Maki. .
"It is important for women and their health care providers to recognize that these symptoms are common during perimenopause and can be treated," she said. The addition of hormone therapy could be helpful. "By treating some of the symptoms of menopause, we can help overcome some of the symptoms of depression."
In addition to hormone therapy, the researchers found that antidepressants, cognitive behavioral therapy and other psychotherapies are effective treatments for depression during perimenopause. "As a vegetarian who does yoga and eats a lot of soy, I am a supporter of complementary and alternative therapies," said Maki. "Unfortunately, there is no evidence that alternative therapies are beneficial for depression, except for physical exercise."
Contact Kristen Thometz: @kristenthometz | [email protected] | (773) 509-5452
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