Menopausal hormones may bring on depression.(Gynecology)

The "changing hormonal milieu" of menopause is strongly associated with new-onset major depression as well as depressive symptoms in women with no history of mood disturbance, reported Ellen W. Freeman, Ph.D., of the departments of ob.gyn. and psychiatry at the University of Pennsylvania, Philadelphia, and her associates.

Women are significantly more likely to develop a depressive disorder when their levels of estradiol fluctuate, levels of FSH and LH increase, and levels of inhibin B decrease, as happens during the transition to menopause. It appears that the hormonal changes characteristic of ovarian aging produce "destabilizing effects" that contribute to depression, Dr. Freeman and her associates in the Penn Ovarian Aging Study commented.

This finding should make a substantial contribution to what has been only "limited evidence" in the literature about mood symptoms in the perimenopausal years. "Whether mood symptoms increase in the perimenopausal years and whether the occurrence of depressed mood is independently associated with ovarian changes or is secondary to vasomotor or other bothersome symptoms" has been controversial, they noted.

Dr. Freeman and her associates examined the issue by assessing fluctuations in reproductive hormone levels in 231 premenopausal women aged 35-47 years at baseline who were followed for 8 years. During that interval, 43% of the women entered the transition to menopause.

Hormone assays were conducted in 10 assessment periods, the first 6 at 8-month intervals. Blood samples were collected at the start of menstrual cycles, and subjects also were interviewed concerning their overall health, demographic factors, and menopausal symptoms. Depressive symptoms were assessed using the CES-D (Center for Epidemiological Studies-Depression) scale; either the PRIME-MD (Primary Care Evaluation of Mental Disorders) or the PHQ (Patient Health Questionnaire) was used to ...