Depression during perimenopause: the role of the obstetrician-gynecologist

The effects of physical activity on depression and quality of life in Chinese perimenopausal women

BACKGROUND

Women are more likely to experience depressive symptoms and poor quality of life (QoL) during perimenopause. The effectiveness of physical activity (PA) in perimenopause on mental well-being and health outcomes has been frequently reported. This study aimed to investigate the mediating effect of PA on the relationship between depression and QoL in Chinese perimenopausal women.

METHODS

A cross-sectional study was performed, and participants were recruited through a multistage, stratified, probability proportional to size sampling method. Depression, PA, and QoL were measured by Zung Self-rating Depression Scale, Physical Activity Rating Scale-3, and World Health Organization Quality of Life Questionnaire. The direct and indirect effects of PA on QoL were analyzed by PA in a mediation framework.

RESULTS

1100 perimenopausal women participated in the study. PA mainly plays partial mediating roles in the relationship between depression and physical (ab = -0.493, 95 % CI: -0.582 to -0.407; ab = -0.449, 95 % CI: -0.553 to -0.343) and psychological (ab = -0.710, 95 % CI: -0.849 to -0.578; ab = -0.721, 95 % CI: -0.853 to -0.589; ab = -0.670, 95 % CI: -0.821 to -0.508) domains of QoL. Additionally, intensity (ab = -0.496, 95 % CI: -0.602 to -0.396; ab = -0.355, 95 % CI: -0.498 to -0.212) and duration (ab = -0.201, 95 % CI: -0.298 to -0.119; ab = -0.134, 95 % CI: -0.237 to -0.047) intermediated the relationship between moderate-to-severe depression and physical domain; frequency (ab = -0.130, 95 % CI: -0.207 to -0.066) only had a mediation influence between moderate depression and physical domain; intensity (ab = -0.583, 95 % CI: -0.712 to -0.460; ab = -0.709, 95 % CI: -0.854 to -0.561; ab = -0.520, 95 % CI: -0.719 to -0.315), duration (ab = -0.433, 95 % CI: -0.559 to -0.311; ab = -0.389, 95 % CI: -0.547 to -0.228; ab = -0.258, 95 % CI: -0.461 to -0.085), and frequency (ab = -0.365, 95 % CI: -0.493 to -0.247; ab = -0.270, 95 % CI: -0.414 to -0.144) all interceded between the psychological domain and all levels of depression, except for the frequency between severe depression and psychological domain; in terms of social relationship and environment domains, intensity (ab = -0.458, 95 % CI: -0.593 to -0.338; ab = -0.582, 95 % CI: -0.724 to -0.445), duration (ab = -0.397, 95 % CI: -0.526 to -0.282; ab = -0.412, 95 % CI: -0.548 to -0.293), and frequency (ab = -0.231, 95 % CI: -0.353 to -0.123; ab = -0.398, 95 % CI: -0.533 to -0.279) were mediators only on mild depression.

LIMITATIONS

The cross-sectional study and self-reported data are major limiting factors.

CONCLUSION

PA and its components partially mediated the association between depression and QoL. Suitable prevention methods and interventions for PA may improve the QoL for perimenopausal women.

Exploration on the Improvement of Cognitive Function and Inflammatory Response in Perimenopausal Patients with Mild Cognitive Impairment by Self-Prepared Ningshen Prescription

Objective

To investigate the improvement of cognitive function and inflammatory response in perimenopausal patients with MCI by kidney-tonifying, blood-activating, and mind-nourishing.

Methods

80 perimenopausal patients with MCI who met the diagnostic criteria were divided into a therapy group (n = 40) and a control group (n = 40) according to the treatment method. The control group was given nimodipine (Bayer Pharmaceuticals) 30 mg, 3 times/day orally, while the therapy group was given a decoction of self-prepared Ningshen prescription on the top of the control group (glossy privet fruit, mulberry, aizoon stonecrop, dan-shen root, tuber fleeceflower stem, cyperus rotundus, citron). Patients in the 2 groups were assessed on the MocA scale, ADL scale, and TCM symptom score before and after 2 months of treatment, respectively, to observe whether there was any change in the scale scores and in the levels of inflammatory factors (hs-CRP, Hcy, and IL-1β) Pre- and posttherapy in the 2 groups. Observe the improvement of clinical symptoms and their safety in both groups (liver and kidney function indicators such as ALT, AST and Cr, dizziness, headache, decrease in blood pressure, flushing, and gastrointestinal reactions).

Results

The efficacy of the therapy group was better than that of the control group; the MocA scale and ADL scale scores improved and the TCM symptom score decreased in both groups posttherapy, with the MocA scale and ADL scale scores improving more and the TCM symptom score decreasing more in the therapy group compared with the control group during the same period (p < 0.05). The serum levels of hs-CRP, Hcy, and IL-1β decreased in both groups posttherapy, with the serum levels of hs-CRP, Hcy, and IL-1β decreasing more in the therapy group compared to the control group during the same period (p < 0.05). The difference in adverse events between the two groups was not statistically significant when compared by a chi-square test (p > 0.05). The differences in ALT, AST, and Cr levels between the control group and the treatment group before and after treatment were not significant (p > 0.05).

Conclusion

Ning Shen prescription can effectively prevent the continued development of cognitive dysfunction in perimenopausal patients with MCI, delay its natural course, and can improve the patients' ability to perform daily activities and improve their TCM symptoms.

The 'new normal' includes online prenatal exercise: exploring pregnant women's experiences during the pandemic and the role of virtual group fitness on maternal mental health

BACKGROUND

Prenatal anxiety and depressive symptoms have significantly increased since the onset of the coronavirus (COVID-19) pandemic In addition, home confinement regulations have caused a drastic increase in time spent sedentary. Online group fitness classes may be an effective strategy that can increase maternal physical activity levels and improve mental health outcomes by providing an opportunity for social connectedness. The present study explores the experiences of pregnant women who participated in an online group exercise program during the pandemic and identifies relationships with maternal mental health and well-being. In addition, we present person-informed recommendations on how to improve the delivery of future online prenatal exercise programs.

METHODS

Semi-structured interviews were conducted with pregnant women (8-39 weeks of pregnancy) who participated in an online group exercise program, from March to October 2020 in Spain. A phenomenological approach was taken, and open-ended questions were asked to understand women's experiences throughout the pandemic and the role the online exercise classes may have had on their physical activity levels, mental health, and other health behaviours such as diet. A thematic analysis was performed to evaluate data. In addition, women completed the State-Trait Anxiety Inventory and these data supplemented qualitative findings.

RESULTS

Twenty-four women were interviewed, and the anxiety scores were on average 32.23 ± 9.31, ranging from low to moderate levels. Thematic analysis revealed that women felt safe exercising from home, an increased availability of time to schedule a structured exercise class, and consequently an improvement in their adherence to the program and other behaviours (i.e., healthier diet). Women emphasized feeling connected to other pregnant women when they exercised online together, and overall, this had a positive effect on their mental well-being. Women suggested that future online exercise programs should include flexible options, detailed instructions and facilitation by a qualified exercise professional.

CONCLUSION

Pregnant women are receptive to online group exercise classes and expressed that they are an accessible option to accommodating physical activity during the pandemic. In addition, the online group environment provides an important sense of connectivity among pregnant women exercising together and this may mitigate the detrimental effect of COVID-19 on maternal mental health.

The important roles of microRNAs in depression: new research progress and future prospects

MicroRNAs (miRNAs) are non-encoding, single-stranded RNA molecules of about 22 nucleotides in length encoded by endogenous genes involved in posttranscriptional gene expression regulation. Studies have shown that miRNAs participate in a series of important pathophysiological processes, including the pathogenesis of depression. This article systematically summarized the research results published in the field of miRNAs and depression, which mainly involved three topics: circulating miRNAs as markers for diagnosis and prognosis of depression, the regulatory roles of miRNAs in the pathogenesis of depression, and the roles of miRNAs in the mechanisms of depression treatment. By summarizing and analyzing the research literature in recent years, we found that some circulating miRNAs can be potential biomarkers for the diagnosis and prognostic evaluation of depression. miRNAs that disorderly expressed during the disease play important roles in the depression pathogenesis, and miRNAs also play roles in the mechanisms of psychotherapy and drug therapy for depression. Elucidating the important roles of miRNAs in depression will bring people's understanding of the pathogenesis of depression to a new level. In addition, these miRNAs may be developed as new biomarkers for diagnosing depression, or as drug targets, or these molecules may be used as new drugs, which may provide new means for the treatment of depression. KEY MESSAGES: • The research results of miRNAs and depression are reviewed. • Circulating miRNAs can be potential biomarkers for depression. • MiRNAs play important roles in the depression pathogenesis. • MiRNAs play important roles in drug therapy for depression.

Acupuncture: A Promising Approach for Comorbid Depression and Insomnia in Perimenopause

Comorbid depression and insomnia are ubiquitous mental complaints among women going through the perimenopausal stage of life and can result in major decline in quality of life. Antidepressive agents combined with/without hypnotics, and/or hormone therapy are currently the most common treatment for perimenopausal depression (PMD) and insomnia (PMI). Balancing the benefits of these pharmacotherapies against the risk of adverse events (AEs) is a difficult task for both clinicians and women. There has been a growing body of research regarding the utilization of acupuncture for treatment of PMD or PMI, whereas no studies of acupuncture for comorbid PMD and PMI have appeared. In this review, we summarize the clinical and preclinical evidence of acupuncture as a treatment for PMD or PMI, and then discuss the potential mechanisms involved and the role of acupuncture in helping women during this transition. Most clinical trials indicate that acupuncture ameliorates not only PMD/PMI but also climacteric symptoms with minimal AEs. It also regulates serum hormone levels. The reliability of trials is however limited due to methodological flaws in most studies. Rodent studies suggest that acupuncture prolongs total sleep time and reduces depression-like behavior in PMI and PMD models, respectively. These effects are possibly mediated through multiple mechanisms of action, including modulating sex hormones, neurotransmitters, hypothalamic-pituitary-adrenal axis/hypothalamic-pituitary-ovary axis, oxidative stress, signaling pathways, and other cellular events. In conclusion, acupuncture is a promising therapeutic strategy for comorbid depression and insomnia during perimenopause. Neuroendocrine modulation is likely to play a major role in mediating those effects. High-quality trials are required to further validate acupuncture's effectiveness.