Depression During and After the Perimenopause: Impact of Hormones, Genetics, and Environmental Determinants of Disease

Considering the role of estradiol in the psychoneuroimmunology of perimenopausal depression

In recent years, a burgeoning field of research has focused on women's mental health and psychiatric conditions associated with perinatal and postpartum periods. An emerging trend points to the link between hormone fluctuations during pregnancy and postpartum that have immunologic consequences in cases of perinatal depression and postpartum psychosis. The transition to menopause (or "perimenopause") has garnered comparatively less attention, but existing studies point to the influential interaction of hormonal and immune pathways. Moreover, the role of this cross talk in perturbing neural networks has been implicated in risk for cognitive decline, but relatively less work has focused on the depressed brain during perimenopause. This brief review brings a psychoneuroimmunology lens to depression during the perimenopausal period by providing an overview of existing knowledge and suggestions for future research to intertwine these bodies of work.

Unraveling the core and bridge menopausal symptoms of perimenopausal women: a network analysis

OBJECTIVE

Perimenopause is the period from the early menopausal transition to 12 months after the final menstrual period. The clustering of menopausal symptoms poses a challenge for perimenopausal management. Core symptoms are targets for interventions that can alleviate other related symptoms. Bridge symptoms are connectors that link related symptom clusters and can improve the effectiveness of interventions. This study aims to construct a network structure of menopausal symptoms and to identify core and bridge symptoms as a reference for future management.

METHODS

Two hundred forty-two Chinese perimenopausal women were included in the survey. The structure and associations of the menopausal symptoms assessed by the Greene Climacteric Scale were analyzed using a network analysis. We generated the network structure graph using R software and checked its accuracy and stability.

RESULTS

In the menopausal transition, the most prevalent symptoms were feeling tired or lacking in energy, excitability, and irritability. Sexual dysfunction was common among early postmenopausal women. Irritability (S = 7.16, C = 0.0167, B = 8) was a core symptom of the network. The depressive symptom cluster was a core symptom cluster, most of which have high centrality indices. Excitability (B = 6) was a bridge symptom connecting the anxiety and depressive symptom clusters.

CONCLUSIONS

Our study has highlighted the crucial significance of irritability and excitability in perimenopausal management. Overcoming the challenges of perimenopausal management requires the public to ameliorate the prejudice and stigma associated with emotional symptoms.

ERβ activation improves nonylphenol-induced depression and neurotransmitter secretion disruption via the TPH2/5-HT pathway

The aim of this study is to investigate the role of estrogen receptor β (ERβ) in nonylphenol (NP) - induced depression - like behavior in rats and its impact on the regulation of the TPH2/5-HT pathway. In the in vitro experiment, rat basophilic leukaemia cells (RBL-2H3) cells were divided into the four groups: blank group, NP group (20 μM), ERβ agonist group (0.01 μM), and NP＋ERβ agonist group (20 μM＋0.01 μM). For the in vivo experiment, 72 adult male Sprague-Dawley rats were randomly divided into following six groups: the Control, NP (40 mg/kg) group, ERβ agonist (2 mg/kg, Diarylpropionitrile (DPN)) group, ERβ inhibitor (0.1 mg/kg, 4-(2-phenyl-5,7-bis(trifluoromethyl)pyrazolo[1,5-a]pyrimidin-3-yl) phenol (PHTPP)) group, NP+ERβ agonist (40 mg/kg NP ＋ 2 mg/kg DPN) group, and NP+ERβ inhibitor (40 mg/kg NP + 0.1 mg/kg PHTPP) group, with 12 rats in each group. Each rat in drug group were given NP by gavage and/or received a single intraperitoneal injection of DPN 2 mg/kg or PHTPP 0.1 mg/kg. Both in vivo and in vitro, NP group showed a decrease in the expression levels of ERβ, tryptophan hydroxylase (TPH1), and tryptophan hydroxylase-2 (TPH2) genes and proteins, and reduced levels of DA, NE, and 5-hydroxytryptophan (5-HT) neurotransmitters. RBL-2H3 cells showed signs of cell shrinkage, with rounded cells, increased suspension and more loosely arranged cells. The effectiveness of the ERβ agonist stimulation exhibited an increase exceeding 60% in RBL-2H3 cells. The application of ERβ agonist resulted in an alleviation the aforementioned alterations. ERβ agonist activated the TPH2/5-HT signaling pathways. Compared to the control group, the NP content in the brain tissue of the NP group was significantly increased. The latency to eat for the rats was longer and the amount of food consumed was lower, and the rats had prolonged immobility time in the behavioral experiment of rats. The expression levels of ERβ, TPH1, TPH2, 5-HT and 5-HITT proteins were decreased in the NP group, suggesting NP-induced depression-like behaviours as well as disturbances in the secretion of serum hormones and monoamine neurotransmitters. In the NP group, the midline raphe nucleus showed an elongated nucleus with a dark purplish-blue colour, nuclear atrophy, displacement and pale cytoplasm. ERβ might ameliorate NP-induced depression-like behaviors, and secretion disorders of serum hormones and monoamine neurotransmitters via activating TPH2/5-HT signaling pathways.

The intersection between menopause and depression: overview of research using animal models

Menopausal women may experience symptoms of depression, sometimes even progressing clinical depression requiring treatment to improve quality of life. While varying levels of estrogen in perimenopause may contribute to an increased biological vulnerability to mood disturbances, the effectiveness of estrogen replacement therapy (ERT) in the relief of depressive symptoms remains controversial. Menopausal depression has a complex, multifactorial etiology, that has limited the identification of optimal treatment strategies for the management of this psychiatric complaint. Nevertheless, clinical evidence increasingly supports the notion that estrogen exerts neuroprotective effects on brain structures related to mood regulation. Indeed, research using preclinical animal models continues to improve our understanding of menopause and the effectiveness of ERT and other substances at treating depression-like behaviors. However, questions regarding the efficacy of ERT in perimenopause have been raised. These questions may be answered by further investigation using specific animal models of reduced ovarian function. This review compares and discusses the advantages and pitfalls of different models emulating the menopausal stages and their relationship with the onset of depressive-like signs, as well as the efficacy and mechanisms of conventional and novel ERTs in treating depressive-like behavior. Ovariectomized young rats, middle-to-old aged intact rats, and females treated with reprotoxics have all been used as models of menopause, with stages ranging from surgical menopause to perimenopause. Additionally, this manuscript discusses the impact of organistic and therapeutic variables that may improve or reduce the antidepressant response of females to ERT. Findings from these models have revealed the complexity of the dynamic changes occurring in brain function during menopausal transition, reinforcing the idea that the best approach is timely intervention considering the opportunity window, in addition to the careful selection of treatment according to the presence or absence of reproductive tissue. Additionally, data from animal models has yielded evidence to support new promising estrogens that could be considered as ERTs with antidepressant properties and actions in endocrine situations in which traditional ERTs are not effective.

The conversation about family planning and desire for children in mental healthcare: Patients' perspective versus Professionals' perspective in a mixed methods study

BACKGROUND

Reproductive health and mental health are intertwined, but studies investigating family planning needs and desire for children in mental healthcare are scarce.

METHODS

We studied the experiences of (former) patients, those with close relationships with the (former) patients (close ones) and mental health professionals (MHP) on discussing family planning and desire for children in mental healthcare. We combined quantitative (two nationwide surveys) and qualitative data (four focus groups) in a mixed-methods approach with sequential analytical design.

RESULTS

Combined data from focus groups (n = 19 participants) and two surveys (n = 139 MHPs and n = 294 (former) patients and close ones) showed that a considerable group of MHPs (64.0%), patients (40.9%) and close ones (50.0%) found that family planning should be discussed by a psychiatrist. However, several obstacles impeded a conversation, such as fear of judgment, lack of time and knowledge and limited opportunity for in-depth exploration of life themes in therapeutic relationships.

CONCLUSIONS

To increase the autonomy of patients in discussing family planning, we suggest MHPs explore the desire to discuss family planning with all patients in the reproductive phase of life, prior to discussing contraceptive care. MHPs should receive education about psychiatric vulnerability in relation to family planning and desire for children, and patients and close ones should be empowered to initiate a conversation themselves.

Sex differences in the relationship between depression and Alzheimer's disease-mechanisms, genetics, and therapeutic opportunities

Depression and Alzheimer's disease (AD) are prevalent neuropsychiatric disorders with intriguing epidemiological overlaps. Their interrelation has recently garnered widespread attention. Empirical evidence indicates that depressive disorders significantly contribute to AD risk, and approximately a quarter of AD patients have comorbid major depressive disorder, which underscores the bidirectional link between AD and depression. A growing body of evidence substantiates pervasive sex differences in both AD and depression: both conditions exhibit a higher incidence among women than among men. However, the available literature on this topic is somewhat fragmented, with no comprehensive review that delineates sex disparities in the depression-AD correlation. In this review, we bridge these gaps by summarizing recent progress in understanding sex-based differences in mechanisms, genetics, and therapeutic prospects for depression and AD. Additionally, we outline key challenges in the field, holding potential for improving treatment precision and efficacy tailored to male and female patients' distinct needs.

Sex differences in the combined influence of inflammation and nutrition status on depressive symptoms: insights from NHANES

Background

Both nutrition and inflammation are associated with depression, but previous studies have focused on individual factors. Here, we assessed the association between composite indices of nutrition and inflammation and depression.

Methods

Adult participants selected from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018 were chosen. The exposure variable was the Advanced Lung Cancer Inflammation Index (ALI) integrating nutrition and inflammation, categorized into low, medium, and high groups. The outcome variable was depression assessed using the Patient Health Questionnaire-9 (PHQ-9). A multivariable logistic regression model was employed to evaluate the relationship between ALI and the risk of depression.

Results

After extensive adjustment for covariates, in the overall population, participants with moderate and high levels of ALI had a decreased prevalence of depression compared to those with low ALI levels, with reductions of 17% (OR, 0.83; 95% CI: 0.72-0.97) and 23% (OR, 0.77; 95% CI: 0.66-0.91), respectively. Among females, participants with moderate and high ALI levels had a decreased prevalence of depression by 27% (OR, 0.73; 95% CI: 0.60-0.88) and 21% (OR, 0.79; 95% CI: 0.64-0.98), respectively, compared to those with low ALI levels, whereas no significant association was observed among males. Subgroup analyses based on females and males yielded consistent results.

Conclusion

In this study, we observed a negative correlation between moderate to high levels of ALI and the prevalence of depression, along with gender differences. Specifically, in females, greater attention should be given to the nutritional and inflammatory status.

Jidong ovarian aging cohort study: Objective, design, and baseline characteristics

BACKGROUND

Ovarian aging is a continuous process comprising a gradual decrease in both the quantity and the quality of the oocytes. A decline in ovarian function leads to chronic disease and physiological problems. The aim of this study is to establish a cohort for the purpose of examining the ovarian aging process and its relationship with health status and quality of life in women across all age groups.

METHOD

This protocol outlines a community-based, prospective long-term observational study involving 1676 women recruited from Caofeidian District in Tangshan City, Hebei Province, China. Data are gathered by the administration of questionnaires, doing physical examinations, performing blood biochemistry tests, and measuring levels of female hormones. The primary outcomes will be the occurrence of cardiovascular disease, osteoporosis, hypertension, diabetes, hyperlipidemia, and other chronic diseases, assessed according to established diagnostic criteria for each disease. The secondary outcome will be the decline in quality of life during the follow-up period, assessed by the modified Kupperman Index. The study comprises a baseline cross-sectional assessment and a follow-up evaluation. The participants will undergo face-to-face interviews as part of their regular medical examinations until 2026 or until the occurrence of outcome events.

DISCUSSION

The results of the prospective study will indicate the association between ovarian aging and the prevalence of chronic diseases as well as diminished quality of life among women across different age categories.

Prolame produces anxiolytic- and antidepressant-like effects in middle-aged female rats with less uterotrophic effects than 17β-estradiol

Estrogen hormone replacement therapy (EHRT), improving women's life quality at menopause, reduces anxiety and depression symptoms associated with ovarian hormonal decline. However, its potential adverse effects, like thromboembolism and cancer risk, limit its use. Prolame is a synthetic 17β-amino estrogen with antithrombotic actions that exerts anxiolytic- and antidepressant-like effects on young adult ovariectomized female rats. It is unknown if prolame's effects may be observed in age and endocrine conditions emulating menopause. This study aimed to identify the antidepressant- and anxiolytic-like effects of prolame and E2 (used as a reference estrogen treatment) in middle-aged female rats coursing with irregular cycles, in two different conditions: ovariectomized or gonadally intact. Results were compared with those from young adult ovariectomized rats. Prolame (60 or 120 μg/kg), 17β-estradiol (E2, 40 or 80 μg/kg), or vehicle were chronically administered, and their effects were evaluated in the elevated plus-maze, defensive burying behavior test, open field test, and forced swimming test. Uterotrophic actions were estimated by uterine weight related to body weight. Prolame and E2 produced robust anxiolytic- and antidepressant-like effects in young adult ovariectomized rats, but these effects were absent in gonadally intact middle-aged rats. Interestingly, only prolame induced anxiolytic- and antidepressant-like effects in middle-aged ovariectomized rats. Uterotrophic effects of prolame were weaker than E2 effects, notably in middle-aged females. Altogether, present data support the notion that prolame has the potential to be considered an EHRT with relevant psychoactive actions and with apparently lower adverse-side effects, especially in middle-aged populations.

Does a program-based cognitive behavioral therapy affect insomnia and depression in menopausal women? A randomized controlled trial

BACKGROUND

Menopausal women often complain of a range of physical and psychological symptoms known as menopausal syndrome. These symptoms are associated with fluctuating hormone levels, sleep disturbances, and mood swings.

AIM

This study aimed to examine the efficacy of a program-based cognitive behavioral group therapy (CBT) for insomnia and depression among women experiencing menopause.

METHODS

A randomized controlled trial of 88 women experiencing menopause was conducted in Egypt from June to September 2022 in outpatient clinics at Mansoura University Hospitals in Egypt. Participants were randomly assigned to a control group (45 women) and an intervention group (43 women). The intervention group received 7 weeks of CBT sessions. Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Inventory 2nd Edition (BDI-II) were administered before and after the intervention.

RESULTS

In the intervention group, there was a significant difference in scores of the subdomains of PSQI, including sleep efficiency, daytime dysfunction, subjective sleep quality, and sleep disturbance (t = 8.911, 11.77, 7.638, and 11.054, respectively), while no significant difference in domains of using sleep medication, sleep duration, and sleep latency. Significant improvements were observed between pre-and-post-intervention in the intervention group for the total scores of PSQI, ISI, and BDII-II (t = 12.711, 16.272, and 12.384, respectively), indicating a large effect size for the three studied variables (r = .81, .87, .8, respectively).

LINKING EVIDENCE TO ACTION

This study demonstrated the efficacy of group CBT for lowering insomnia and depression in women experiencing menopause. Thus, results indicated the need of considering prompt and appropriate interventions such as CBT as a safe treatment option to prevent the aggravation of sleep and emotional problems for menopausal women.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05920460.

Does menopause hormone therapy improve symptoms of depression? Findings from a specialized menopause clinic

OBJECTIVE

Depressive symptoms are commonly reported during the perimenopause and in the early postmenopausal years. Although menopausal hormone therapy (MHT) is considered the most effective treatment option for vasomotor symptoms, its effect on mood-related symptoms is less established. This study aims to assess interval change in depressive symptoms after initiation of MHT treatment in women seeking care at a Canadian specialized menopause clinic.

METHODS

Women and female-presenting people attending the St. Joseph's Healthcare Menopause Clinic in Hamilton, Ontario, were invited to participate in this study. Participants (n = 170) completed a self-report questionnaire, which included their medical history as well as validated tools for bothersome symptoms at their initial visit. A shortened version was administered at the follow-up visit 3 to 12 months later with the same validated tools. We sought to examine interval changes on the Center for Epidemiological Studies Depression Scale based on type of treatment used and MHT dose, while controlling for relevant demographic variables (smoking, education level, age).

RESULTS

There was a high rate of depressive symptoms in those seeking specialized menopause care (62%). MHT use was associated with significantly improved depressive symptoms, both alone and in addition to an antidepressant medication ( P < 0.001). Younger age, lower education attainment, and smoking were all associated with higher depression scores.

CONCLUSION

This study supports the use of MHT to improve depressive symptoms experienced by those seeking specialized menopause care. Further investigation into timing of treatment initiation may facilitate a personalized treatment approach to improve quality of life of women in the peri- and postmenopausal years.

The menopausal transition period and cardiovascular risk

The menopausal transition period spans, on average, 2-8 years before the final menstrual period and is associated with an increase in clinical and subclinical cardiovascular risk. In this Review, we discuss the metabolic and cardiovascular changes that occur during the menopausal transition period and the role of ovarian ageing, chronological ageing and other ageing-related risk factors in mediating these changes. Disentangling the relative contributions of chronological and reproductive ageing to cardiovascular risk is challenging, but data from longitudinal studies in women transitioning from premenopause to post-menopause have provided valuable insights. We also discuss evidence on how cardiovascular risk is altered by premature or early menopause, surgical menopause, and vasomotor and other menopausal symptoms. Whether targeted interventions can slow the progression of atherosclerosis and subclinical disease during the menopausal transition, thus delaying or preventing the onset of cardiovascular events, remains to be determined. Furthermore, we consider the recommended strategies for cardiovascular risk reduction in women undergoing menopausal transition using the framework of the American Heart Association's Life's Essential 8 key measures for improving and maintaining cardiovascular health, and discuss the cardiovascular risks and benefits of menopausal hormone therapy. Finally, we also discuss novel therapies that might benefit this population in reducing cardiovascular risk.

Effects of Chaihu Shugan San on Brain Functional Network Connectivity in the Hippocampus of a Perimenopausal Depression Rat Model

In this study, we used Chaihu Shugan San (CSS), a traditional Chinese herbal formula, as a probe to investigate the involvement of brain functional network connectivity and hippocampus energy metabolism in perimenopausal depression. A network pharmacology approach was performed to discover the underlying mechanisms of CSS in improving perimenopausal depression, which were verified in perimenopausal depression rat models. Network pharmacology analysis indicated that complex mechanisms of energy metabolism, neurotransmitter metabolism, inflammation, and hormone metabolic processes were closely associated with the anti-depressive effects of CSS. Thus, the serum concentrations of estradiol (E2), glutamate (Glu), and 5-hydroxytryptamine (5-HT) were detected by ELISA. The brain functional network connectivity between the hippocampus and adjacent brain regions was evaluated using resting-state functional magnetic resonance imaging (fMRI). A targeted metabolomic analysis of the hippocampal tricarboxylic acid cycle was also performed to measure the changes in hippocampal energy metabolism using liquid chromatography-tandem mass spectrometry (LC-MS/MS). CSS treatment significantly improved the behavioral performance, decreased the serum Glu levels, and increased the serum 5-HT levels of PMS + CUMS rats. The brain functional connectivity between the hippocampus and other brain regions was significantly changed by PMS + CUMS processes but improved by CSS treatment. Moreover, among the metabolites in the hippocampal tricarboxylic acid cycle, the concentrations of citrate and the upregulation of isocitrate and downregulation of guanosine triphosphate (GTP) in PMS + CUMS rats could be significantly improved by CSS treatment. A brain functional network connectivity mechanism may be involved in perimenopausal depression, wherein the hippocampal tricarboxylic acid cycle plays a vital role.

Residential greenspace and major depression among older adults living in urban and suburban areas with different climates across the United States

BACKGROUND AND AIM

Residential greenspace could alleviate depression - a leading cause of disability. Fewer studies of depression and greenspace have considered major depression, and, to our knowledge, none have considered how climate, which determines vegetation abundance and type, may change the impacts of greenspace. Our aim was to investigate whether residential greenspace is associated with major depression among older adults and explore effect modification by climate.

METHODS

We used biennial interviews between 2008 and 2016 from the Health and Retirement Study. We calculated greenness within walking distance of home addresses as the maximum NDVI for the year of each participant interview averaged within a 1 km buffer. Reflecting clinical criteria, a score of ≥5 on the CIDI-SF indicated major depression in the preceding 12-months. We characterized climate using Köppen-Geiger classifications. To estimate prevalence ratios, we used Poisson regression. Our models adjusted for sociodemographic characteristics, geography, annual sunshine, and bluespace.

RESULTS

The 21,611 eligible participants were 65 ± 10 years old on average, 55% female, 81% White, 12% Black, 10% Hispanic/Latino, and 31% had at least a 4-year college degree. The 12-month prevalence of a major depression was 8%. In adjusted models, more residential greenspace was associated with a lower prevalence of major depression (prevalence ratio per IQR, 0.91; 95% CI, 0.84 to 0.98). There was evidence of effect modification by climate (P forinteraction, 0.062). We observed stronger associations in tropical (prevalence ratio per IQR 0.69; 95% CI, 0.47 to 1.01) and cold (prevalence ratio per IQR, 0.83; 95% CI, 0.74 to 0.93) climates compared to arid (prevalence ratio per IQR 0.99; 95% CI, 0.90 to 1.09) and temperate (prevalence ratio per IQR 0.98; 95% CI, 0.86 to 1.11) climates.

CONCLUSIONS

Residential greenspace may help reduce major depression. However, climate may influence how people benefit from greenspace.

Military Sexual Trauma and Menopause Symptoms Among Midlife Women Veterans

BACKGROUND

Sexual assault and/or sexual harassment during military service (military sexual trauma (MST)) can have medical and mental health consequences. Most MST research has focused on reproductive-aged women, and little is known about the long-term impact of MST on menopause and aging-related health.

OBJECTIVE

Examine associations of MST with menopause and mental health outcomes in midlife women Veterans.

DESIGN

Cross-sectional.

PARTICIPANTS

Women Veterans aged 45-64 enrolled in Department of Veterans Affairs (VA) healthcare in Northern California between March 2019 and May 2020.

MAIN MEASURES

Standardized VA screening questions assessed MST exposure. Structured-item questionnaires assessed vasomotor symptoms (VMS), vaginal symptoms, sleep difficulty, depressive symptoms, anxiety symptoms, and posttraumatic stress disorder (PTSD) symptoms. Multivariable logistic regression analyses examined associations between MST and outcomes based on clinically relevant menopause and mental health symptom thresholds.

KEY RESULTS

Of 232 participants (age = 55.95 ± 5.13), 73% reported MST, 66% reported VMS, 75% reported vaginal symptoms, 36% met criteria for moderate-to-severe insomnia, and almost half had clinically significant mental health symptoms (33% depressive symptoms, 49% anxiety, 27% probable PTSD). In multivariable analyses adjusted for age, race, ethnicity, education, body mass index, and menopause status, MST was associated with the presence of VMS (OR 2.44, 95% CI 1.26-4.72), vaginal symptoms (OR 2.23, 95% CI 1.08-4.62), clinically significant depressive symptoms (OR 3.21, 95% CI 1.45-7.10), anxiety (OR 4.78, 95% CI 2.25-10.17), and probable PTSD (OR 6.74, 95% CI 2.27-19.99). Results did not differ when military sexual assault and harassment were disaggregated, except that military sexual assault was additionally associated with moderate-to-severe insomnia (OR 3.18, 95% CI 1.72-5.88).

CONCLUSIONS

Exposure to MST is common among midlife women Veterans and shows strong and independent associations with clinically significant menopause and mental health symptoms. Findings highlight the importance of trauma-informed approaches to care that acknowledge the role of MST on Veteran women's health across the lifespan.

Menopause-Associated Depression: Impact of Oxidative Stress and Neuroinflammation on the Central Nervous System-A Review

Perimenopausal depression, occurring shortly before or after menopause, is characterized by symptoms such as emotional depression, anxiety, and stress, often accompanied by endocrine dysfunction, particularly hypogonadism and senescence. Current treatments for perimenopausal depression primarily provide symptomatic relief but often come with undesirable side effects. The development of agents targeting the specific pathologies of perimenopausal depression has been relatively slow. The erratic fluctuations in estrogen and progesterone levels during the perimenopausal stage expose women to the risk of developing perimenopausal-associated depression. These hormonal changes trigger the production of proinflammatory mediators and induce oxidative stress, leading to progressive neuronal damage. This review serves as a comprehensive overview of the underlying mechanisms contributing to perimenopausal depression. It aims to shed light on the complex relationship between perimenopausal hormones, neurotransmitters, brain-derived neurotrophic factors, chronic inflammation, oxidative stress, and perimenopausal depression. By summarizing the intricate interplay between hormonal fluctuations, neurotransmitter activity, brain-derived neurotrophic factors, chronic inflammation, oxidative stress, and perimenopausal depression, this review aims to stimulate further research in this field. The hope is that an increased understanding of these mechanisms will pave the way for the development of more effective therapeutic targets, ultimately reducing the risk of depression during the menopausal stage for the betterment of psychological wellbeing.

Epigenetic mechanisms underlying sex differences in the brain and behavior

Sex differences are found across brain regions, behaviors, and brain diseases. Sexual differentiation of the brain is initiated prenatally but it continues throughout life, as a result of the interaction of three major factors: gonadal hormones, sex chromosomes, and the environment. These factors are thought to act, in part, via epigenetic mechanisms which control chromatin and transcriptional states in brain cells. In this review, we discuss evidence that epigenetic mechanisms underlie sex-specific neurobehavioral changes during critical organizational periods, across the estrous cycle, and in response to diverse environments throughout life. We further identify future directions for the field that will provide novel mechanistic insights into brain sex differences, inform brain disease treatments and women's brain health in particular, and apply to people across genders.

Egr1 is a sex-specific regulator of neuronal chromatin, synaptic plasticity, and behaviour

Sex differences are found in brain structure and function across species, and across brain disorders in humans1-3. The major source of brain sex differences is differential secretion of steroid hormones from the gonads across the lifespan4. Specifically, ovarian hormones oestrogens and progesterone are known to dynamically change structure and function of the adult female brain, having a major impact on psychiatric risk5-7. However, due to limited molecular studies in female rodents8, very little is still known about molecular drivers of female-specific brain and behavioural plasticity. Here we show that overexpressing Egr1, a candidate oestrous cycle-dependent transcription factor9, induces sex-specific changes in ventral hippocampal neuronal chromatin, gene expression, and synaptic plasticity, along with hippocampus-dependent behaviours. Importantly, Egr1 overexpression mimics the high-oestrogenic phase of the oestrous cycle, and affects behaviours in ovarian hormone-depleted females but not in males. We demonstrate that Egr1 opens neuronal chromatin directly across the sexes, although with limited genomic overlap. Our study not only reveals the first sex-specific chromatin regulator in the brain, but also provides functional evidence that this sex-specific gene regulation drives neuronal gene expression, synaptic plasticity, and anxiety- and depression-related behaviour. Our study exemplifies an innovative sex-based approach to studying neuronal gene regulation1 in order to understand sex-specific synaptic and behavioural plasticity and inform novel brain disease treatments.

Sex steroids and the female brain across the lifespan: insights into risk of depression and Alzheimer's disease

Despite widespread sex differences in prevalence and presentation of numerous illnesses affecting the human brain, there has been little focus on the effect of endocrine ageing. Most preclinical studies have focused on males only, and clinical studies often analyse data by covarying for sex, ignoring relevant differences between the sexes. This sex- (and gender)-neutral approach is biased and contributes to the absence of targeted treatments and services for all sexes (and genders). Female health has been historically understudied, with grave consequences for their wellbeing and health equity. In this Review, we spotlight female brain health across the lifespan by informing on the role of sex steroids, particularly oestradiol, on the female brain and on risk for diseases more prevalent in females, such as depression and Alzheimer's disease.

Association between perimenopausal age and greater posttraumatic stress disorder and depression symptoms in trauma-exposed women

OBJECTIVE

This study aimed to determine the relationship between stages of the menopause transition (premenopausal, perimenopausal, and postmenopausal) on symptoms of posttraumatic stress disorder (PTSD) and depression in trauma-exposed women.

METHODS

A cross-sectional study conducted between 2005 and 2017 recruited and enrolled an urban community sample (n = 6,093) from nonpsychiatric medical clinic waiting rooms of Grady Memorial Hospital, a public safety net hospital in Atlanta, Georgia. Participants were female, 18 to 65 years old, and predominantly Black/African American.

RESULTS

Of the 6,093 participants, 93.8% were Black/African American, 2.5% were White, and 3.8% were of all other races (Hispanic/Latino, Asian, multiracial). Participants younger than 40 years were categorized as premenopausal (n = 3,166), between 40 and 55 years of age were categorized as perimenopausal (n = 2,127), and older than 55 years were categorized as postmenopausal (n = 790). Menopause status was associated with total PTSD symptom severity ( F2,5416 = 9.61, P < 0.001), symptom severity within all three PTSD symptom clusters (avoidance/numbing symptoms: F2,5416 = 7.10, P < 0.001; intrusive symptoms: F2,5416 = 7.04, P < 0.001; hyperarousal symptoms: F2,5409 = 8.31, P < 0.001), and depression symptom severity ( F2,5148 = 11.4, P < 0.001). Compared with both premenopausal and postmenopausal women, perimenopausal women reported significantly worse total PTSD symptoms, symptoms in the hyperarousal cluster, and depressive symptoms.

CONCLUSIONS

The current cross-sectional data show that symptoms of PTSD and depression in women are associated with reproductive age, such that perimenopausal women show higher symptom severity than premenopausal and postmenopausal women. Future longitudinal studies can reveal how changes in hormones over the course of the menopause transition impact the symptoms, neurobiology, and psychophysiology of PTSD.

Sex Differences in the Neurobiology of Stress

This review highlights the existing knowledge and data that explain the physiologic impacts of stress, especially pertaining to neurobiology, and how these impacts differ by sex. Furthermore, this review explains the benefits of interventions aimed at preventing or mitigating the adverse effects of stress, because of both the significant toll of stress on the body and the disproportionate impact of these changes experienced by women.

The prevalence of depression and its association with sociodemographic factors in menopausal women in South Korea

This study examined factors that may be associated with depression among middle-aged women in South Korea using data from the 2018 (7th) wave of the Korean Longitudinal Survey of Women and Families. A sample of 6,399 women aged 35-64 years was included. Multivariate logistic regression was performed to identify factors associated with depressive symptoms, as measured by the CES-D-10 scale (Center for Epidemiological Studies Depression), in pre- and post-menopausal women. Results indicated that being single, having poorer self-rated health, and having a lower economic background were associated with an increased risk of depression in both groups. Being unemployed also increased the risk of depressed mood in pre-menopausal women, while factors significantly associated with an increased risk of depressive symptoms in post-menopausal women included having a lower level of education, musculoskeletal pain, and having pain or discomfort. Thus, these factors should be considered when developing interventions to improve the mood and quality of life of middle-aged women. Interventions in the local community may include health services (hormone therapy), educational learning programs, counselling, and improved access to leisure activities.

Differential effects of western versus mediterranean diets and psychosocial stress on ovarian function in female monkeys (Macaca fascicularis)

Ovarian dysfunction increases risk for chronic diseases of aging including cardiovascular disease, depression, cognitive impairment, as well as bone and muscle loss which promote frailty. Psychosocial stress can disrupt ovarian function, and recent observations suggest that consumption of a Western Diet may also. Determination of causal relationships among diet, psychosocial stress, and ovarian physiology is difficult in humans. Long-tailed (a.k.a. cynomolgus) macaques (Macaca fascicularis) are an excellent translational model for the study of diet and psychosocial effects on ovarian physiology and aging-related processes. They have 28-day menstrual cycles with hormonal fluctuations like those of women, and similar physiologic responses to alterations and/or cessation of cyclicity. We examined ovarian function in 38 middle-aged socially housed females fed either a Western or Mediterranean diet for 31 months (≈ a 9-year period for humans). During the last year, we examined cycle length and peak progesterone per cycle using blood sampling (3/week) and vaginal swabbing for menses (6/week). Repeated measures analysis revealed a circannual pattern consistent with increased menstrual cycle disturbance during the late Summer and early Fall (F(11,348)= 4.05 p < 0.001). In addition, both Western diet (F(1,34)= 3.99; p = 0.05) and the stress of low social status (F(1,34)= 3.99; p = 0.04) reduced mean progesterone levels. Thus, on average, subordinates in the Western group had the lowest average progesterone levels (10.02 ng/pl). Compared to Western diets, Mediterranean diets exhibited protective effects via menstrual cycle regularity. For dominant monkeys, consuming Mediterranean diets resulted in significantly greater likelihood of having regular menstrual cycles. Mediterranean diets also protected individuals from shorter than normal menstrual cycles. The relationships between diet and menstrual regularity were partially mediated by both adrenal reactivity and social isolation. This study demonstrates the additive negative effects of poor diet and psychosocial stress on ovarian physiology in mid-life and lays the groundwork for future investigations to uncover their impact on metabolic signatures of accelerated aging. The results also suggest that - compared to Western-style diets - a Mediterranean diet may exert a protective influence against ovarian dysfunction and its pathologic sequelae.

Association of lifespan reproductive duration with depression in Swedish twins: The role of hormone replacement therapy

OBJECTIVE

To examine the association between reproductive duration and postmenopausal depression (taking the use of hormone replacement therapy [HRT] into account).

METHODS

In this population-based cohort study, 11 320 postmenopausal women (mean age 63.6 years) were followed for up to 18 years. Reproductive duration was categorized into three groups: short (≤34 years), average (35-39 years), and long (≥40 years). Depression was ascertained from the Sweden National Patient Registry.

RESULTS

During the follow up, 593 (5.24%) women developed depression. In the multi-adjusted generalized estimating equation model, the odds ratios (ORs) of depression were 1.28 (95% confidence interval [CI] 1.05-1.55) and 1.25 (95% CI 1.01-1.55) for women with short and long reproductive durations, respectively, compared with those women with average reproductive duration. Women with a non-typical reproductive duration (≤34 or ≥40 years) who received HRT were at a higher risk of depression (OR 1.82, 95% CI 1.42-2.33). There was a significant additive interaction between non-typical reproductive duration and the use of HRT on depression (attributable proportion 0.26, 95% CI 0.03-0.50).

CONCLUSION

Women with a short or long reproductive duration, especially those with a history of HRT use, have a higher risk of depression after menopause compared with those with an average reproductive duration.

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.

Positive associations between menstrual lifespan, geriatric depression and healthy longevity in Chinese oldest-old and centenarian women

OBJECTIVE

Menstrual lifespan (ML) is an important biological characteristic for women. Rare evidence has established the associations between menopause age (MI), geriatric depression and healthy longevity. This study aimed to address these associations in Chinese oldest-old and centenarian women, and explore their related factors in order to provide strategy support for healthy aging.

METHODS

The China Hainan Centenarian Cohort Study provides a population-based sample in Hainan, China. A total of 723 women including 318 centenarian women and 405 oldest-old women aged 80-99 years were included in this study. Data on demographic information were collected using a structured questionnaire. Physical examination and blood samples were obtained following standard procedure. Geriatric Depression Scale (GDS-15) was used to evaluate depressive symptoms for all participants.

RESULTS

The proportions of participants with depression and longevity were 19.78 % (143 older adults) and 43.98 % (318 older adults), respectively. After adjusting for a wide range of other covariates in multiple logistic regression analyses, ML was positively and significantly associated with depression and longevity [Exp(β) 1.076 and 1.121; P < 0.05 for all]. In multiple linear regression analyses, there were significantly positive associations of ML with GDS-15 (β = 0.061) and age (β = 0.238, p < 0.05 for all) after adjusting for all covariates.

CONCLUSIONS

This study provides epidemiological evidence that menstrual lifespan has positive associations with geriatric depression and healthy longevity in Chinese oldest-old and centenarian women. Future researches should focus on the effects of intervening MI on psychological health and successful longevity.

The role of diet in managing menopausal symptoms: A narrative review

Menopause is a natural stage that occurs when women stop menstruating, during which many women experience physical and psychological symptoms that can affect their quality of life and ability to work. Dietary modifications and food supplements may be explored by some women as alternatives to hormone replacement therapy, although existing reviews and expert position statements have given this limited consideration. This narrative review summarises the current evidence for dietary patterns, and botanical and food supplements, in the management of common menopausal symptoms, including vasomotor symptoms (VMS; hot flushes; night sweats), changes in bodyweight and composition, psychological symptoms (depression; anxiety; cognitive changes), sleep disturbances, joint pain, skin changes and urogenital symptoms. Soy isoflavones may reduce the frequency and/or severity of VMS, although results are inconsistent, and it is unclear whether dietary and supplemental sources have comparable effects. Adopting a healthier dietary pattern may support a healthy bodyweight and benefit VMS. However, evidence suggesting dietary patterns may benefit depression, anxiety, and cognition remains largely observational. While some botanicals, such as black cohosh and St John's Wort, have been reported in some studies to alleviate symptoms (such as VMS and depression), these are not currently recommended due to uncertainty about the appropriate dose and preparation, and potential safety concerns. Evidence for other symptoms is currently too limited to draw conclusions. While further trials at different menopausal stages are needed, adopting a healthier dietary pattern in accordance with dietary guidelines is likely to help support women's health before, during and after the menopausal transition.

Anti-apoptotic effect of menaquinone-7 protects the brain of ovariectomized rats

Background

Mood and memory deterioration occurs after ovariectomy (OVX) with various degrees and sometimes requires medical intervention. Menaquinone-7 (MK-7) is a potent isoform of vitamin K2 and has many effects on the bone and cardiovascular system. However, the effect of MK-7 on the brain and its mechanisms of action are still unclear. This study was performed to investigate the effect of MK-7 on mood and memory disorders following ovariectomy. Thirty-two female albino rats were divided into four groups (n = 8). Group I (control group) included sham-operated rats with sunflower oil intake. Group II (K2) included sham-operated rats with an intake of MK-7 dissolved in sunflower oil. Group III (K2 OVX) included ovariectomized rats with an intake of MK-7 dissolved in sunflower oil. Group IV(OVX) included ovariectomized rats with sunflower oil intake. Working memory, anxiety, depression, and sociability behaviors were investigated in all groups. Gene expression of BAX, BCL2, and p53 was measured in the hippocampus of all groups by real-time PCR. Besides, BAX/BCL2 ratio was calculated.

Results

Working memory, anxiety, depression, and sociability behaviors in the OVX rats showed a significant change compared to the sham-operated. However, the intake of MK-7 after the OVX resulted in significant improvement. Regarding hydrogen peroxide and MDA activity, they were significantly higher in the OVX group compared to the sham-operated groups, while in the K2OVX group, their activity showed a significant decrease in comparison with the OVX group. However, catalase and total antioxidant capacity were significantly lower in the OVX group compared to the sham-operated group, while in the k2OVX group, their activity showed a significant increase in comparison with the OVX group. The OVX group showed a significant elevation in the BAX, BAX/BCl2 ratio, and P53, but BCL2 was significantly reduced. However, the intake of MK-7 caused a significant improvement.

Conclusions

Our study showed that the OVX group showed significant physiological, biochemical, and molecular changes, which can be prevented by MK-7 intake.

Emotional, inflammatory, and genetic factors of resilience and vulnerability to depression in patients with premenopausal breast cancer: A longitudinal study protocol

BACKGROUND

Psychosocial stress and depressive disorder have been associated with cancer as putative contributors to worse prognosis. On the other hand, cancer diagnosis is a recognised life event that can contribute to distress and depressive states. Humoral and cellular inflammation can promote depressive disorder by means of decreased monoamine synthesis, glutamate neurotoxicity, neurogenesis and neuroplasticity, dysregulated hypothalamic-pituitary-adrenal axis, and glucocorticoid resistance. This protocol objectives are to observe the interactions between psychosocial variables and biochemical and immunological biomarkers in a longitudinal, prospective design; to identify inflammation-related depression endophenotypes in breast cancer patients and to understand if early diagnosed and treated depression in this population will translate in better inflammation status and better global prognosis.

METHODS

Prospective observational cohort, composed by 100 consecutive premenopausal patients, diagnosed with non-distant metastatic breast carcinoma and with no history of major psychopathology or other organic illness. The participants will have an in-person assessment in three different moments, along illness treatment and follow-up, with respect to cytometric, immunologic, and psychosocial parameters and will be tested for depression vulnerability and resilience inflammation-related functional genetic polymorphisms. Additionally, at years 5 and 10 post enrollment, patients`medical records will be assessed. As a control cohort, all patients excluded due to psychiatric history or past psychiatric treatments will have their clinical records assessed at years 5 and 10 after admission. All the data will be managed with the SPSS® software.

DISCUSSION AND CONCLUSION

This study is an original longitudinal cohort of breast cancer premenopausal patients, with a comprehensive approach to psychosocial, clinical, inflammatory, and genetic variables. It expects to provide evidence regarding the links between genetic, cytometric, immunologic, and psychosocial factors, their potential contribution to the pathophysiology of depressive disorder, breast cancer course, progression, and prognosis. It may further contribute with data to better efficacy of the psycho-oncological interventions.

TRIAL REGISTRATION

National Commission of Data Protection (CNPD) 13413/2017; Ethics Committee of IPOP project code CI-IPOP81/2017.

[Complex therapy of psychosomatic disorders associated with the female reproductive cycle]

Psychosomatic disorders make a great contribution to the structure of reproductive health disorders in women. The purpose of this review was to analyze the available data on effective methods of therapy for psychosomatic disorders associated with the reproductive cycle of women - psychopharmacological, psychotherapeutic, non-drug biological, hormonal. The review summarizes the evidence in relation to the treatment of disorders such as: stress-related menstrual irregularities; premenstrual dysphoric disorder; perinatal affective disorders (especially depression); psychosomatic disorders of the involutionary period. General recommendations on the complex therapy of psychosomatic disorders associated with the menstrual cycle within the framework of an interdisciplinary team have been formed.

Nocturnal Hot Flashes, but Not Serum Hormone Concentrations, as a Predictor of Insomnia in Menopausal Women: Results from the Midlife Women's Health Study

Background: Sleep disruptions are among the most common symptoms experienced during menopause and can be associated with depression, hot flashes, and fluctuating hormones. However, few studies have examined how such risk factors influence sleep in midlife women in a network-based approach that will establish the complex relationship between variables. Materials and Methods: We used a Bayesian network (BN) to examine the relationship between multiple factors known to influence sleep and depression in midlife women, including hormone concentrations, hot flashes, and menopause status among participants of the longitudinal Midlife Women's Health Study. In year 1, 762 women (45-54 years of age) answered questions regarding the frequency of insomnia, hot flashes, and depression; 389 of the same women answered similar questions at year 4. We measured serum hormones and calculated free estradiol index, free testosterone index, and ratios of estradiol:progesterone, and estradiol:testosterone. For our model, we calculated the change in frequency of insomnia, depression, and covariates (body mass index, menopause status, hot flashes at night, and present quality of life) from year 1 to 4. Results: Using a BN, we found that self-reported hot flashes at night, and no other factors, were direct predictors of self-reported insomnia in year 1. Surprisingly, we did not identify an association between hormone concentrations and self-reported insomnia. Frequency of insomnia in year 4 was only predicted by frequency of insomnia in year 1, whereas frequency of depression in year 4 was predicted by year 4 insomnia and frequency of depression in year 1. No other factors were direct predictors of insomnia or depression in our model. Conclusions: Therefore, hot flashes at night, previous insomnia, and depression are stronger predictors of how women will self-report frequency of sleep disruptions and treatment may reduce menopausal sleep complaints.

Neuroendocrine pathogenesis of perimenopausal depression

With the development of social economics and the increase of working pressure, more and more women are suffering from long-term serious stress and showing symptoms of perimenopausal depression (PMD). The incidence rate of PMD is increasing, and the physical and mental health are seriously affected. However, due to the lack of accurate knowledge of pathophysiology, its diagnosis and treatment cannot be accurately executed. By consulting the relevant literature in recent years, this paper elaborates the neuroendocrine mechanism of perimenopausal depression from the aspects of epigenetic changes, monoamine neurotransmitter and receptor hypothesis, glial cell-induced neuroinflammation, estrogen receptor, interaction between HPA axis and HPG axis, and micro-organism-brain gut axis. The purpose is to probe into new ways of treatment of PMD by providing new knowledge about the neuroendocrine mechanism and treatment of PMD.

Risk Assessment of Depression amongst Women during Menopause before and during the COVID-19 Pandemic

During menopause, the risk of depression is 2-5 times greater than pre- or post-menopause. To assess the risk of depression amongst menopausal women in 2006, compared with 2021 (i.e., during the COVID-19 pandemic), we recruited female volunteers at least 40 years old to complete the menopause rating scale (MRS), the Blatt-Kupperman menopausal index (BKMI), and the Beck depression inventory. Compared with 2006, in 2021, the number of participants who experienced mild, moderate, and severe menopausal symptoms rose by 8%, 1.9%, and 3.2%, respectively. Moreover, the frequency of using hormone replacement therapy rose by 5.1%, feelings of mistrust by 16%, feelings of guilt by 11%, disposition to cry by 25%, mood swings by 12%, and suicidal ideation by 9%, whilst the average body weight and body mass index fell by 5.1 kg and 2.3%, respectively. In 2006 and 2021, 46.3% and 59.3% of participants experienced moderate depression, whereas 3.0% and 5.2% experienced severe depression. The number of participants who denied needing support during menopause decreased by 14.6%, whereas the demand for support from husbands and friends increased by 18.3% and 9.8%, respectively. In 2021, the number of participants who experienced menopausal symptoms, a loss of trust, self-blame, a tendency to cry, mood swings, suicidal ideation, and anxiety also increased compared with 2006, whilst the number of participants without depressive symptoms decreased, but with suspected mild or severe depression increased. Last, menopausal complaints caused an increase in depressive mood in 2021, as evaluated using the BKMI and MRS.

Impact of Menopausal Symptoms on Work: Findings from Women in the Health and Employment after Fifty (HEAF) Study

Women make up a growing proportion of the workforce and therefore many women experience menopause while in paid employment. We explored the prevalence of menopausal symptoms, the relationship between symptoms and coping with work and the risk factors associated with struggling at work during the menopause. The Health and Employment After Fifty (HEAF) community-based cohort of people aged 50-64 years was incepted 2013-2014 to study health and work. In 2019, female participants were asked to complete a questionnaire about their menopausal symptoms, and effect of those symptoms on their ability to cope at work. 409 women were eligible for inclusion. The commonest symptoms were vasomotor (91.7%); trouble sleeping (68.2%); psychological (63.6%) and urinary (49.1%). The prevalence of reporting symptoms was similar no matter which type of occupation women were performing at the time. Around one-third of women reported moderate/severe difficulties coping at work because of menopausal symptoms. Risk factors for difficulties coping at work included: financial deprivation, poorer self-rated health, depression, and adverse psychosocial occupational factors but not physical demands. More awareness is needed amongst employers in all sectors but women with financial difficulties and those with jobs in which they feel insecure, unappreciated, or dissatisfied are at greatest risk.

Female reproductive factors are associated with the risk of newly diagnosed bipolar disorder in postmenopausal women

Changes in the levels of female sex hormones are associated with mood disorders in middle-aged women. This study investigated the association between female reproductive factors and the development of newly diagnosed bipolar disorder (BD). We used a South Korean nationwide medical records database. Postmenopausal women aged 40 or older who underwent health examinations were identified and followed for the occurrence of BD. We identified female reproductive factors including the age at menarche and menopause, parity, history of breastfeeding, oral contraceptive (OC) use, and hormone therapy (HT), and investigated their association with the occurrence of newly diagnosed BD. During an average of 8.32 years (SD 0.83) of follow-up, the incidence of BD was 0.50 per 1000 person-years in postmenopausal women. Compared to women with menopause at an age of 40 years or younger, those with menopause at an age of 45 years or older showed decreased risks of BD. Compared to women who had never breastfed, those who had breastfed for more than 12 months showed a decreased risk of BD. Compared to women who never received HT, those who received HT showed an increased risk of BD in a time-dependent manner. Among postmenopausal women, later menopause and breastfeeding for more than one year were associated with a decreased risk of BD occurrence, and receiving HT was associated with an increased risk.

Sex hormone fluctuation and increased female risk for depression and anxiety disorders: From clinical evidence to molecular mechanisms

Women are at twice the risk for anxiety and depression disorders as men are, although the underlying biological factors and mechanisms are largely unknown. In this review, we address this sex disparity at both the etiological and mechanistic level. We dissect the role of fluctuating sex hormones as a critical biological factor contributing to the increased depression and anxiety risk in women. We provide parallel evidence in humans and rodents that brain structure and function vary with naturally-cycling ovarian hormones. This female-unique brain plasticity and associated vulnerability are primarily driven by estrogen level changes. For the first time, we provide a sex hormone-driven molecular mechanism, namely chromatin organizational changes, that regulates neuronal gene expression and brain plasticity but may also prime the (epi)genome for psychopathology. Finally, we map out future directions including experimental and clinical studies that will facilitate novel sex- and gender-informed approaches to treat depression and anxiety disorders.

Menopausal Hormone Therapy and the Mind: The Role of Hormone Replacement in the Prevention and Treatment of Cognitive Decline, Dementia, and Cognitive Dysfunction of Depression

LEARNING OBJECTIVES

After participating in this activity, learners should be better able to:• Outline the clinical recommendations for menopausal hormone treatment related to cognitive concerns• Debate and discuss the various research pieces on the use of menopausal hormone therapy cognitive decline, dysfunction, and dementia.

ABSTRACT

Menopause has been associated with subjective cognitive dysfunction and elevated rates of depression. While menopausal hormone therapy (MHT) is Food and Drug Administration-approved for the treatment of vasomotor symptoms related to menopause, a potential role for MHT in treating and preventing cognitive decline, dysfunction, and dementia has remained unclear and a topic of continued interest and debate across decades of research. Increasing numbers of patients are seeking help for subjective cognitive decline, and those with poorer mental health are substantially more likely to perceive themselves to be at high risk of developing dementia; thus, mental health professionals are likely to encounter such patients and may be asked to provide advice concerning MHT, cognition, and indications for MHT use. Here, we synthesize the neurobiological effects of MHT, make recommendations for its use in current clinical practice in the contexts of cognitive dysfunction associated with major depressive disorder, cognitive decline, and Alzheimer's disease, and discuss the frontiers being explored by ongoing research on this topic. We conclude that MHT to improve cognitive functioning has only a few scenarios where it would be recommended and that particular caution may be warranted for carriers of the APOE ε4 allele.

Acupuncture combined with SSRIs in the treatment of perimenopausal depressive disorder: A protocol for systematic review and meta-analysis

BACKGROUND

Perimenopausal depressive disorder (PDD) is an affective disorder involving endocrine, neurological, immune, which seriously endangers the physical and mental health of human. Selective serotonin reuptake inhibitors (SSRIs) are the current first-line clinical treatment, have limited efficacy and serious side effects. Acupuncture combined with SSRIs therapy has been widely used clinically because it increases efficacy and reduces side effects. There is a lack of high-quality evidence to assess its efficacy and safety. This study evaluated the effectiveness and safety of acupuncture combined with SSRIs in the treatment of PDD by meta-analysis.

METHODS

All randomized controlled trials articles about acupuncture combined with SSRIs treatment of PDD will be searched in databases, such as PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang, Wei Pu from the construction of the library to December 16, 2021. According to Cochrane 5.1 Handbook criteria, two researchers independently screened the literature, extracted data, and evaluated the quality of included studies. Meta-analysis was performed by using RevMan 5.4 and STATA 16.0 software.

RESULTS

This study will summarize the current evidence to evaluate the effectiveness and safety of acupuncture combined with SSRIs for the treatment of PDD.

CONCLUSION

The results of this study will provide clinicians with new treatment ideas and bring benefits to most patients.

REGISTRATION NUMBER

INPLASY2021120080 (DOI number: 10.37766/inplasy2021.12.0080).

Prevalence of post-menopausal depression and associated factors: A web-based cross-sectional study in Greece

OBJECTIVES

The impact of depression on post-menopausal women is an important public health issue but remains largely unknown. The purpose of this study was to identify the prevalence of post-menopausal depression in Greece and outline the profile of the women it affects.

STUDY DESIGN

A sample of post-menopausal women completed an anonymous, self-administered, web-based survey which included the Beck Depression Inventory-ΙΙ (BDI-II) and questions regarding socio-demographic data.

MAIN OUTCOME MEASURES

The dependent variable of interest was a BDI-II score ≥ 20 (the cut-off for moderate depression according to the BDI).

RESULTS

Overall, 502 post-menopausal women participated in the study. The median BDI-II score was 13 (range 0-50); 136 (27.1%) of the women scored ≥ 20 and were considered screen-positive for depression. According to the multivariate logistic regression model, age< 55 years (OR: 1.621; 95% CI: 1.036-2.535), not working (OR: 1.580; 95% CI: 1.013-2.465), smoking (OR: 1.656; 95% CI: 1.081-2.536) and history of depression (OR: 1.650; 95% CI: 1.045-2.604) were independently associated with post-menopausal depression. Subgroup analyses revealed that current smokers (OR: 2.514; 95% CI: 1.485-4.256) had higher odds of moderate depression, while obesity (OR: 2.455; 95% CI: 1.206-4.996), absence of healthcare insurance (OR: 4.413; 95% CI: 1.970-9.887) and a history of depression (OR: 2.253; 95% CI: 1.212-4.190) were identified as independent risk factors for severe post-menopausal depression.

CONCLUSIONS

More than one out of four post-menopausal women were screen-positive for symptoms indicative of depression, while a personal history of depression, age < 55 years, smoking and current working status were independent predictors of its emergence.

Event-Related Potentials in Women on the Pill: Neural Correlates of Positive and Erotic Stimulus Processing in Oral Contraceptive Users

Background/Aims: Exposure toward positive emotional cues with - and without - reproductive significance plays a crucial role in daily life and regarding well-being as well as mental health. While possible adverse effects of oral contraceptive (OC) use on female mental and sexual health are widely discussed, neural processing of positive emotional stimuli has not been systematically investigated in association with OC use. Considering reported effects on mood, well-being and sexual function, and proposed associations with depression, it was hypothesized that OC users showed reduced neural reactivity toward positive and erotic emotional stimuli during early as well as later stages of emotional processing and also rated these stimuli as less pleasant and less arousing compared to naturally cycling (NC) women. Method: Sixty-two female subjects (29 NC and 33 OC) were assessed at three time points across the natural menstrual cycle and corresponding time points of the OC regimen. Early (early posterior negativity, EPN) and late (late positive potential, LPP) event-related potentials in reaction to positive, erotic and neutral stimuli were collected during an Emotional Picture Stroop Paradigm (EPSP). At each appointment, subjects provided saliva samples for analysis of gonadal steroid concentration. Valence and arousal ratings were collected at the last appointment. Results: Oral contraceptive users had significantly lower endogenous estradiol and progesterone concentrations compared to NC women. No significant group differences in either subjective stimulus evaluations or neural reactivity toward positive and erotic emotional stimuli were observed. For the OC group, LPP amplitudes in reaction to erotic vs. neutral pictures differed significantly between measurement times across the OC regimen. Discussion: In this study, no evidence regarding alterations of neural reactivity toward positive and erotic stimuli in OC users compared to NC was found. Possible confounding factors and lines for future research are elaborated and discussed.

Symptom profiles of women at risk of mood disorders: A latent class analysis

BACKGROUND

Depression is the leading cause of disease burden among women worldwide. However, an understanding of symptom profiles among women at risk of mood disorders is limited. We determined distinct profiles of affective symptoms among high risk women, along with their distinguishing characteristics.

METHODS

Women were recruited from 17 clinical sites affiliated with the National Network of Depression Centers. They completed measures of depression (Patient Health Questionnaire - 9) and anxiety (Generalized Anxiety Disorder - 7) as well as questions regarding demographics, reproductive status, behavioral/mental health history, and life stress/adversity. Latent class analysis and multinomial logistic regression were used to identify and characterize symptom profiles.

RESULTS

5792 women participated, ages 18 to 90 (M = 38). Three latent classes were identified: generally asymptomatic (48%), elevated symptoms of comorbid anxiety and depression (16%), and somatic symptoms (36%). Financial security and greater social support were protective factors that distinguished asymptomatic women. The profile of the class with elevated anxiety/depressive symptoms constituted a complex mix of adverse social determinants and potentially heritable clinical features, including a diagnosis of Bipolar Disorder. Women in the 3rd latent class were characterized by menstrual irregularity and a stronger expression of neurovegetative symptoms, especially sleep disturbance and fatigue.

LIMITATIONS

Limitations included less than optimal racial diversity of our sample and reliance on self-report.

CONCLUSIONS

Different symptom profiles may reflect distinct subtypes of women at risk of mood disorders. Understanding the etiology and mechanisms underlying clinical and psychosocial features of these profiles can inform more precisely targeted interventions to address women's diverse needs.

In search of sex-related mediators of affective illness

Sex differences in the rates of affective disorders have been recognized for decades. Studies of physiologic sex-related differences in animals and humans, however, have generally yielded little in terms of explaining these differences. Furthermore, the significance of these findings is difficult to interpret given the dynamic, integrative, and highly context-dependent nature of human physiology. In this article, we provide an overview of the current literature on sex differences as they relate to mood disorders, organizing existing findings into five levels at which sex differences conceivably influence physiology relevant to affective states. These levels include the following: brain structure, network connectivity, signal transduction, transcription/translation, and epigenesis. We then evaluate the importance and limitations of this body of work, as well as offer perspectives on the future of research into sex differences. In creating this overview, we attempt to bring perspective to a body of research that is complex, poorly synthesized, and far from complete, as well as provide a theoretical framework for thinking about the role that sex differences ultimately play in affective regulation. Despite the overall gaps regarding both the underlying pathogenesis of affective illness and the role of sex-related factors in the development of affective disorders, it is evident that sex should be considered as an important contributor to alterations in neural function giving rise to susceptibility to and expression of depression.

Benefits of Adding an Aquatic Resistance Interval Training to a Nutritional Education on Body Composition, Body Image Perception and Adherence to the Mediterranean Diet in Older Women

The human population is increasing due to lengthening life expectancy, but the quality of life and health of people is moving in the opposite direction. The purpose of this study is to evaluate how aquatic resistance interval training can influence body composition, body image perception and adherence to the Mediterranean diet (MD) in older women participants in a nutrition education program and to study the relation between these variables. Thirty-four participants aged 69 ± 4 years were randomly assigned into two groups: experimental (aquatic resistance interval training plus nutritional intervention) and control (nutritional intervention). The intervention consisted of resistance training in an aquatic environment carried out for 14 weeks (three sessions per week; 60 min each). Body composition, body image perception and adherence to MD diet were evaluated at baseline and 14 weeks. No significant differences were found between groups regarding body image perception and adherence to the MD. There was a significant increase in muscle mass (kg) (p < 0.001) and a significant decrease in fat mass (kg) (p < 0.001) in the intervention group when compared to the control group. The addition of aquatic resistance interval training to a nutritional intervention was not sufficient to change body image perception and adherence to MD but produced improvement in body composition (through an increase in muscle mass and decrease on fat mass) in older women.