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Depression may hurt reproductive health; tied to earlier onset of perimenopause.(Clinical Rounds)
CHARLOTTETOWN, PEI -- Women's mental health may have direct repercussions on their reproductive and endocrine health, Dr. Roger McIntyre said at the annual clinical meeting of the Society of Obstetricians and Gynaecologists of Canada.
"We've often said menses, pregnancy, and menopause may bring on depression, but it is also possible that depression could unfavorably influence reproductive life events," he said, citing a recent study showing that depression is associated with an accelerated onset of perimenopause (Arch. Gen. Psychiatry 60[1]:29-36, 2003).
Studies have shown that depression may create a toxic environment that could predispose women to medical disorders such as diabetes mellitus, osteoporosis, and cardiovascular disease. All of these disorders have an increased incidence in people with mood disorders, said Dr. McIntyre, head of the mood disorders and psychopharmacology unit at the University of Toronto.
Of particular concern is that depression may be associated with volumetric changes in the brain, such as alterations in discrete neural regions. For example, preliminary evidence suggests depressive symptoms may be associated with decreased size of the hippocampus, a region critical for memory and other cognitive functions (J. Neurosci. 19[12]:5034-43, 1999).
Moreover, recent evidence suggests that antidepressant medication and mood stabilizers such as lithium may improve brain function and increase grey and white matter in the brain.
There are several biologic changes that occur in depression, including increased cortisol levels, which may explain the association between depression and decreased bone mineral density in women, as well as why the most common cause of death in bipolar patients is cardiovascular disease.
"It is intriguing that antidepressants may lower cortisol levels and perhaps reduce toxicity," he suggested. "It is not known whether this mechanism actually reverses brain changes or simply arrests them."
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