Perimenopausal depression link to hot flashes affirmed.(Gynecology)

TUCSON, ARIZ. -- When a female patient presents with hot flashes, consider screening her for depression, Dr. Marlene Freeman advised at a psychopharmacology conference sponsored by the University of Arizona.

The risk of depression is known to increase during perimenopause, and epidemiologic studies have shown that women in early perimenopause have greater rates of persistent mood symptoms (15%-18%) than do premenopausal women (8%-12%).

But a recent study found that the onset of perimenopausal depression was associated only with hot flashes, and not with many of the risk factors that are conventionally suspected, such as parity, previous depression, family history, smoking, duration of perimenopause, endocrine measures, vitamin or mineral supplements, exercise, or medical illnesses (Am. J. Psychiatry 2004;161:2238-44).

"We don't know if all women are going to have a tough time during perimenopause, but for some it can be an exquisitely high-risk time," said Dr. Freeman, director of the Women's Mental Health Program at the University of Arizona, Tucson.

In general, history of major depressive episodes is important to predict future episodes, because some patients with depression have patterns of recurrence. But psychosocial factors--such as aging parents, children leaving home, marital issues, and the individual woman's feelings about growing older and leaving the reproductive years--also may factor into whether a woman experiences depressive symptoms or episodes, Dr. Freeman said.

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