Depression and Menopause: Current Knowledge and Clinical Recommendations for a Critical Window

Exploring the Intersection of Depression, Anxiety, and Sexual Health in Perimenopausal Women

Purpose

The perimenopausal period is marked by hormonal fluctuations that trigger a complex interplay between estrogen levels and neurotransmitters' function, contributing to increased susceptibility to depression and anxiety in women. Concurrently, hormonal changes, coupled with alterations in vaginal tissue, lead to sexual dysfunction during this transitional phase. This study aimed at evaluating the association between menopausal symptoms and sexual dysfunction among perimenopausal women and identifying the mediating effects of depression and anxiety on this association.

Patients and Methods

Data for the present cross-sectional study were collected from participants via Arabic versions of three questionnaires; the modified Menopausal Rating Scale (MRS), the Female Sexual Functioning Index (FSFI) and the Hospital Anxiety and Depression scale (HADS).

Results

Our study was conducted on 149 females with age ranged from 45 to 55 years. On studying the relation between modified MRS and HADS, the menopausal symptoms were significantly high among female with high anxiety scores. Regarding the relationship between MRS and FSFI, women with anxiety and physical and mental exhaustion had significantly lower FSFI scores than women without such symptoms (19.2 [2-31.4] vs 21.7 [3.8-30.9], p = 0.04, respectively). Furthermore, there were statistically significant negative correlations between depression scores and sexual desire (r = -0.32, p < 0.001), arousal (r = -0.25, p = 0.003), and total FSFI scores (r = -0.27, p = 0.04).

Conclusion

Perimenopausal women experience a confluence of challenges related to depression, anxiety, and sexual dysfunction. Understanding the interconnectedness of hormonal and psychosocial factors is essential for tailored interventions aimed at improving mental health and sexual well-being during this transitional phase.

Investigating the Role of 17β-Estradiol on the Serotonergic System, Targeting Soy Isoflavones as a Strategy to Reduce Menopausal Depression: A Mechanistic Review

Low serotonin is one factor implicated in the development of depression. 17β-estradiol (E2) has been shown to modulate gene expression regulating the neurotransmission of serotonin. Sex hormone levels fluctuate dramatically during the menopausal transition, coinciding with a 14-fold increased risk of depression. This review aimed to examine the effect of soy isoflavones to support decreased and variable E2 levels before and after menopause, linked to an investigation of the pathophysiological mechanisms underlying the protective influence of E2 on the serotonin pathway. The overall aim of this review is to assess the potential of soy isoflavones to reduce depression in middle-aged women. A systematic literature search was performed in three stages. 1,421 papers were screened for relevance to the research aims and objectives. 63 papers were selected based on pre-defined inclusion/exclusion criteria (13 reviews, 24 mechanistic and 26 intervention studies) and critically appraised. Available research supported the hypotheses that E2 increases serotonin synthesis and availability through stimulation of tryptophan hydroxylase-2 (TPH-2) and decreased degradation by monoamine oxidase-A (MAO-A). There was less scientific agreement on the effects of E2 on serotonin transporter (SERT) and serotonin receptors 1 A and 2 A. Studies varied widely on the effectiveness of soy isoflavones in reducing depressive symptoms in (peri)menopausal women. Animal and human studies acknowledge women's increased risk of depression linked to fluctuating E2 rather than absolute levels. However, mechanisms linking E2 variability with depression remain an underrepresented area of research. Study limitations and heterogeneity may contribute to varying results for soy isoflavones and some effects of E2 on the serotonin pathway.

The association between postpartum depression and perimenopausal depression: A nationwide register-based cohort study

OBJECTIVES

The purpose of the study was to investigate whether postpartum depression is associated with a risk of depression during perimenopause.

STUDY DESIGN

This is a Danish nationwide register-based cohort study of 270,613 individuals who were born in 1960-1968, who gave birth to a liveborn child recorded in the Medical Birth Register before the age of 40, and who lived in Denmark when turning 47 years old. The association between postpartum depression and depression during perimenopause was analyzed using a Cox Proportional Hazards model adjusted for education level, marital status, and age at first delivery.

MAIN OUTCOME MEASURES

Depression during perimenopause was identified by a diagnosis of depression during nine years of follow-up registered in the Danish National Patient Registry.

RESULTS

A total of 7694 (2.9 %) study participants were diagnosed with depression during perimenopause. Postpartum depression was associated with 12.82 [95 % confidence interval (CI): 8.93;18.41] times higher hazard of depression during perimenopause, while depression prior to study baseline was associated with 11.91 [95 % CI: 11.14;12.73] times higher hazard compared with individuals with no history of depression. There was no difference in the association between postpartum depression and depression prior to study baseline for depression during perimenopause.

CONCLUSION

Prior depression, no matter the timing, is associated with markedly higher risk of depression during perimenopause. Thus, individuals who have experienced postpartum depression do not experience a greater risk of depression during perimenopause compared with individuals who have experienced depression unrelated to periods of hormonal changes during their fertile life.

Does childhood maltreatment or current stress contribute to increased risk for major depression during the menopause transition?

BACKGROUND

The menopausal transition (MT) poses an increased risk for major depression (MD), but not for all women. Current and past stress are toxic risk factors for depression throughout life. The MT may be a time of increased sensitivity to stress, especially among women with a lifetime history of major depressive disorder (MDD). We evaluated whether women who experienced childhood maltreatment (CM) or current stressful events or ongoing problems were at increased risk for MD during the MT.

METHODS

At the Pittsburgh site of the Study of Women's Health Across the Nation, 333 midlife women were interviewed approximately annually over 15 years with the Structured Clinical Interview for the Diagnosis of DSM-IV Axis I Disorders and provided health and psychosocial data including the Childhood Trauma Questionnaire. Repeated measures logistic regression analyses were conducted separately for women with and without lifetime MDD at study entry.

RESULTS

Among women with lifetime MDD, CM, but not current stress, interacted with menopausal status to increase the risk for MD during postmenopause (ORs ranged from 2.71 to 8.04). All stressors were associated with increased odds of MD. Among women without lifetime MDD, current stress was related to risk for MD, but the effect did not vary by menopausal status.

CONCLUSIONS

Women with MDD prior to midlife and who experienced CM were at greatest risk for MD after the MT. Women without prior MDD were at increased risk for MD during peri- and postmenopause. Healthcare providers should monitor women at risk for MD even after the MT.

[Temporal trend and contributing factors of depressive symptoms in Chinese menopausal women: analysis based on CHARLS panel data]

OBJECTIVE

To understand the temporal trend of and the factors affecting depressive symptoms in Chinese menopausal women to provide evidence for the development of prevention and treatment strategies.

METHODS

CHARLS data were used to select menopausal women aged 45-60 years. Complete values of the key variables were screened and missing values were removed to obtain the cross-sectional data of the years 2011 (n=4318), 2013 (n=4200), 2015 (n=3930), and 2018 (n= 4147). The panel data were matched by the cross-sectional data, and a total of 5040 cases with complete record of the follow-up data were obtained for the 4 years to constitute a balanced short panel dataset with n=1260 and T=4. The prevalence and temporal trend of depressive symptoms in the menopausal women were analyzed based on the panel data. The random-effects Logit model with a panel dichotomous choice model was used to explore the factors affecting depressive symptoms in the menopausal women.

RESULTS

The prevalence of depressive symptoms in the menopausal women calculated based on the panel data was 35.9%, 33.1%, 36.7% and 43.7% in the 4 years, respectively, showing no statistically significant changes in the temporal trend (APC=3.25%, P=0.183). The results of the random-effects Logit model analysis showed that living in the urban area (OR=0.570, 95%CI: 0.457-0.710), a high education level (OR=0.759, 95%CI: 0.655-0.879), and having a spouse (OR=0.363, 95% CI: 0.236-0.558) were associated with a decreased incidence of depressive symptoms, while poor self-reported health (OR= 2.704, 95% CI: 2.152-3.396), disability (OR=1.457, 95%CI: 1.087-1.954), chronic disease (OR=1.407, 95% CI: 1.179-1.680), falls in the last two years (OR=2.028, 95% CI: 1.613-2.550), abnormal sleep duration (OR=2.249, 95% CI: 1.896-2.664), and dissatisfaction with life (OR=4.803, 95% CI: 3.757-6.140) were associated with an increased incidence of depressive symptoms.

CONCLUSION

The prevalence of depressive symptoms is relatively high in menopausal women in China. Measures should be taken to ensure that the menopausal women living in rural areas, with low education level, without spouse, with a poor self-reported health status, disability, chronic diseases, falls in recent two years, abnormal sleep time and dissatisfaction with life have access to psychological health care services and interventions.

Altered brain rhythms and behaviour in the accelerated ovarian failure mouse model of human menopause

To date, potential mechanisms of menopause-related memory and cognitive deficits have not been elucidated. Therefore, we studied brain oscillations, their phase–amplitude coupling, sleep and vigilance state patterns, running wheel use and other behavioural measures in a translationally valid mouse model of menopause, the 4-vinylcyclohexene-diepoxide-induced accelerated ovarian failure. After accelerated ovarian failure, female mice show significant alterations in brain rhythms, including changes in the frequencies of θ (5–12 Hz) and γ (30–120 Hz) oscillations, a reversed phase–amplitude coupling, altered coupling of hippocampal sharp-wave ripples to medial prefrontal cortical sleep spindles and reduced δ oscillation (0.5–4 Hz) synchrony between the two regions during non-rapid eye movement sleep. In addition, we report on significant circadian variations in the frequencies of θ and γ oscillations, and massive synchronous δ oscillations during wheel running. Our results reveal novel and specific network alterations and feasible signs for diminished brain connectivity in the accelerated ovarian failure mouse model of menopause. Taken together, our results may have identified changes possibly responsible for some of the memory and cognitive deficits previously described in this model. Corresponding future studies in menopausal women could shed light on fundamental mechanisms underlying the neurological and psychiatric comorbidities present during this important transitional phase in women’s lives.

The Relationship between Anxiety and Depression Levels and General Health Status before and 12 Months after SUI Treatment in Postmenopausal Women from the Lower Silesian Population

Menopause is often the cut-off point from which most cases of stress urinary incontinence (SUI) in women begin. This dysfunction affects not only the physical experience of the patient, but is also related to the psychological aspects, leading to a reduced quality of life. Despite the large number of patients with SUI and the frequent use of surgical treatment for this condition, there are few scientific reports evaluating the effectiveness of the procedure in terms of reducing depressive symptoms or improving overall health. The aim of this study was to evaluate the relationship between anxiety and depression and general health status before and 12 months after surgical treatment for SUI in postmenopausal women. Seventy-five patients qualified for the study, but due to the long study duration, both sets of questionnaires were eventually obtained from 60 postmenopausal patients. All patients that qualified for the study had a trans obturator tape (TOT) procedure. All patients enrolled in the project were given the Hospital Anxiety and Depression Scale (hAdS) and King's Health Questionnaire (KHQ). After 12 months of surgery with midurethral slings, symptoms of depression were present in only a small number of subjects, 11.7%, and anxiety was present in 13.3% of the entire group. The study confirms that patients with a general poor health condition may suffer from depression or anxiety, and therefore may also need psychological treatment. Patients with SUI should therefore receive therapeutic care from a multidisciplinary team, in which therapeutic activities are divided between doctors, nurses, physiotherapists and psychologists. As a result of the treatment, after 12 months, we confirmed a significant improvement in patients with depression and anxiety disorders.

Estrogen, the Peripheral Immune System and Major Depression – A Reproductive Lifespan Perspective

Major depression is a significant medical issue impacting millions of individuals worldwide. Identifying factors contributing to its manifestation has been a subject of intense investigation for decades and several targets have emerged including sex hormones and the immune system. Indeed, an extensive body of literature has demonstrated that sex hormones play a critical role in modulating brain function and impacting mental health, especially among female organisms. Emerging findings also indicate an inflammatory etiology of major depression, revealing new opportunities to supplement, or even supersede, currently available pharmacological interventions in some patient populations. Given the established sex differences in immunity and the profound impact of fluctuations of sex hormone levels on the immune system within the female, interrogating how the endocrine, nervous, and immune systems converge to impact women’s mental health is warranted. Here, we review the impacts of endogenous estrogens as well as exogenously administered estrogen-containing therapies on affect and immunity and discuss these observations in the context of distinct reproductive milestones across the female lifespan. A theoretical framework and important considerations for additional study in regards to mental health and major depression are provided.

The Greek translation and validation of the electronic version of the Meno-D rating scale for post-menopausal depression

Menopausal transition and post-menopause constitute windows of increased vulnerability to depression. Recently, the Meno-D was introduced, a novel 12-item, with five distinct subscales. The aim of our study was to translate and validate the electronic version of the Meno-D among Greek post-menopausal women. Translation and back-translation were performed by an expert group, while face validity was assessed by five experts. Along with the Beck Depression Inventory-II, the Meno-D scale was distributed online to 502 post-menopausal women. A confirmatory factor analysis was performed to investigate construct validity and both convergent and discriminant validity were evaluated. The data analysis was performed using Statistical Package for Social Sciences and AMOS. The 5-factor model of Meno-D achieved adequate levels of goodness-of-fit indices, scoring lower values in discriminant validity examined with heterotrait-monotrait ratio and composite reliability. The significant correlation with the Beck Depression Inventory-ΙΙ revealed for all subscales was indicative of good convergent validity. An exploratory factor analysis was additionally performed, suggesting a 12-item tool comprising two subscales: (i) psychological and (ii) biological and achieving good levels of fit. Our data confirmed that the electronic version of Meno-D is a valid tool that can be used for screening and evaluation of depression in Greek post-menopausal women.

Changes in the Oral Cavity in Menopausal Women-A Narrative Review

Oral health awareness during the menopausal period is essential to minimize the inevitable inconveniences which may occur due to hormonal changes. The decrease in estrogen hormone concentration impacts the oral mucosa in a similar way to the vaginal mucosa due to the presence of estrogen receptors in both of these structures. An estrogen deficiency also affects the maturation process of the oral mucosal epithelium and can lead to its thinning and atrophy, making it more susceptible to local mechanical injuries, causing a change in pain tolerance and problems in the use of removable prosthetic restorations. Mucosal epithelium during the menopausal period is more vulnerable to infections, candidiasis, burning mouth syndrome, oral lichen planus (OLP), or idiopathic neuropathy. Moreover, salivary glands are also hormone-dependent which leads to changes in saliva secretion and its consistency. In consequence, it may affect teeth and periodontal tissues, resulting in an increased risk of caries and periodontal disease in menopausal women. Due to the large variety of complaints and symptoms occurring in the oral cavity, menopausal women constitute a significant group of patients who should receive special preventive and therapeutic care from doctors and dentists in this particular period.

Menopause is more than Hot Flashes: What is Missing in Homeopathic Research? A Narrative Review

BACKGROUND

 Menopausal complaints are frequently treated with homeopathy in daily practice worldwide. Recently, vasomotor symptoms have been understood to have implications as predictors of other important and long-term outcomes, causing increased risk of mortality and/or disability.

METHODS

 A comprehensive search of the literature was conducted to investigate whether homeopathic treatments for menopausal women with vasomotor symptoms have a positive effect on other important health outcomes associated with menopause, such as cardiovascular disease, neurocognitive impairment, metabolic and mood disorders, or osteoporosis.

RESULTS

 Though observational studies have shown encouraging results in reducing the severity and frequency of hot flashes in women treated with homeopathy, few randomized controlled trials have shown positive results. In most of the studies using homeopathy, the primary outcome is reduction in the frequency and severity of hot flashes, and other menopausal complaints are assessed secondarily as a part of the symptoms evaluated in the menopausal scales. Quality of life improves with homeopathic treatments for hot flashes, but there is scarce evidence of the effect of homeopathy on other health outcomes associated with menopause. Limited evidence exists in the case of menopausal women treated with individualized homeopathy for depression and metabolic disorders.

CONCLUSION

 A more comprehensive approach for treating menopause in routine homeopathic practice constitutes a valuable opportunity to increase knowledge and high-quality research in this field. Future homeopathic research for menopause should be focused on well-designed, double-blind, placebo-controlled, randomized trials as well as on pragmatic trials to show whether homeopathic treatments for vasomotor symptoms can also improve outcomes that are well-known to increase the risk of mortality and/or disability.

Depression, hormone therapy, and the menopausal transition among women aged 45 to 64 years using Canadian Longitudinal Study on aging baseline data

OBJECTIVE

To investigate the association between menopausal status, hormone therapy (HT) use and the presence of depressive symptoms among middle-aged women in Canada.

METHODS

Cross-sectional baseline data from 13,216 women aged 45 to 64 years from the Canadian Longitudinal Study on Aging (CLSA) was used. The association between menopausal status (pre- vs postmenopausal) and self-reported symptoms of depression based on a score of 10 or more on the Center for Epidemiologic Studies Short Depression Scale-10 was assessed using logistic regression. Use and duration of use of HT, time since menopause, age at onset of menopause, and socioeconomic status and other contextual variables were explored for the association with depression.

RESULTS

Overall, 18.4% of middle-aged women in the CLSA data were identified as depressed using the Center for Epidemiologic Studies Short Depression Scale-10. Based on the logistic regression models, women reporting premature menopause (before the age of 40 years) and postmenopausal women currently using HT had 1.45 (1.07-1.97) and 1.21 (1.02-1.44) greater odds of having depression. Chi-square analyses showed that women with depressive symptoms were more likely to have low education, low household incomes, live alone, be nulliparous, and have low social support.

CONCLUSIONS

Our findings highlight the association between depression and premature menopause among midlife women. Current HT use may be a proxy for more severe menopausal vasomotor symptoms, a known risk factor for depressive symptoms. Identification of risk factors, including social determinants of health, age at menopause, and menopausal symptoms can help guide clinicians when assessing mental health. : Video Summary:http://links.lww.com/MENO/A576.

Depressive Symptoms and Healthy Behavior Frequency in Polish Postmenopausal Women from Urban and Rural Areas

The objective of this study was to determine whether the severity of depressive symptoms was linked to healthy behaviors in Polish postmenopausal women and whether the strength of the link differed between women living in urban versus rural settings. The study was conducted in 2018 in the Lublin region of Poland and included 396 postmenopausal women (239 living in rural areas and 157 in urban areas). The severity of depressive symptoms was evaluated by the Beck Depression Inventory (BDI) and the frequency of healthy behaviors was assessed using the Inventory of Healthy Behaviors. Postmenopausal women living in rural areas underwent menopause significantly earlier, were more often widowed, more often obese, more often less educated, and less likely to have never married when compared to those living in urban areas. Importantly, rural postmenopausal women endorsed more depressive symptoms (p = 0.049). There was a negative correlation between the severity of depressive symptoms and age in urban postmenopausal women (r = −0.174, p = 0.029), but this was not evident in rural women (r = −0.034, p = 0.600). The frequency of healthy behaviors was significantly lower in rural postmenopausal women, especially with respect to nutritional habits. A positive correlation was found between the frequency of healthy behaviors and the level of education in both sets of women (p = 0.034 and p = 0.045, respectively). To summarize, we found a significant link between healthy behaviors and depressive symptoms in postmenopausal women. We also found that this link was more evident in rural than in urban women.

Validity and reliability of a shorter version of the Geriatric Depression Scale in institutionalized older Portuguese adults

OBJECTIVES

Depressive symptoms are common in older adults in institutional contexts; however, there is a lack of validated measures for these settings. Identifying depressive symptoms can help clinicians to manage them and to prevent or delay their complications. This study aimed to validate the Geriatric Depression Scale (GDS) in an institutionalized sample of older adults.

METHOD

493 institutionalized older people (73% women) aged 60 or over were evaluated through the GDS, the Mini International Neuropsychiatric Interview (MINI) (depression vs. no depression = 11% vs. 89%), the Geriatric Anxiety Inventory (GAI), the Positive Affect (PA) and Negative Affect (NA) Schedule, and the Satisfaction with Life Scale (SWLS). Test-retest reliability was assessed with 57 older adults.

RESULTS

An 8-item version presented a Cronbach's alpha value of .87 with a single factor explaining its variance. The correlations (p < .01) attested the concurrent validity (GAI: r = .76; PA: r = -.22; AN: r = .62; SWLS: r = -.32). Test-retest reliability (6.51 months) was adequate (r = .52). ROC analysis (AUC = .82; sensitivity = 80%; specificity = 77%) and Youden index revealed a cutoff of 5/6 for the diagnosis of depression.

CONCLUSION

Results support the validity and the screening capacity of a short version of GDS in institutional contexts. Short screening instruments for depressive symptoms may facilitate their identification, allowing for timely clinical interventions in institutional settings.

Menopausal symptoms among Chinese peri- and postmenopausal women: a large prospective single-center cohort study

BACKGROUND

The prevalence and intensity of menopausal symptoms differ depending on ethnicity, culture, and country. Epidemiological data from China are scarce.

OBJECTIVE

To compare the prevalence and severity of menopausal symptoms in peri- and postmenopausal Chinese women.

METHODS

This was a prospective two year cohort study that included all eligible women from 31 Chinese provinces attending our 'Menopause Clinic', the first official specialized center in China. Structured questionnaires containing seven domains with 41 items in total were used to assess the following menopausal symptoms using descriptive analysis: negative mood, cognitive symptoms, sleep disorder, vasomotor symptoms (VMS), urogenital symptoms, autonomic nervous disorder, and limb pain/paresthesia.

RESULTS

A total of 4063 women with a mean age of 50.53 ± 6.57 (n = 2107 perimenopausal and 1956 postmenopausal) participated. All menopausal symptoms were more severe in postmenopausal women (p<.05). Independent of menopausal status, urogenital symptoms, often combined with sexual problems, were the most common complaints (in prevalence and severity), followed by sleep disorder, cognitive symptoms (especially hypomnesia), negative mood, autonomic nervous disorder, limb pain/paresthesia and, as the rarest complaint, VMS.

CONCLUSIONS

Urogenital symptoms among midlife Chinese women are common, frequently also in combination with sexual dysfunction, although many do not often complain about these in the first place. Postmenopausal women presented more prevalent and severe menopausal symptoms. In contrast to Western countries, VMS are rare among our population. A multidisciplinary approach and use of hormonal and non-hormonal therapies should be considered for these women.

Taking a fresh look at mood, hormones, and menopause

Depression, with or without concomitant anxiety, is one of the most burdensome medical conditions worldwide. Depression affects women more often than men and may cause significant impairment. Reproductive phase-related windows of vulnerability for depression (new or recurrent) have been recognized, including the menopause transition. Midlife depression is likely influenced by both menopause- and nonmenopause-related factors. Antidepressants and cognitive behavioral therapy remain first-line treatment options for moderate to severe major depressive disorder at any time, with proven efficacy and tolerability in midlife women. Transdermal estradiol can also be part of the treatment armamentarium, but its use as a prophylaxis against midlife depressive symptoms, although promising, warrants further investigation.

Psychosocial factors promoting resilience during the menopausal transition

Despite significant biological, psychological, and social challenges in the perimenopause, most women report an overall positive well-being and appear to be resilient to potentially negative effects of this life phase. The objective of this study was to detect psychosocial variables which contribute to resilience in a sample of perimenopausal women. A total of 135 healthy perimenopausal women aged 40-56 years completed a battery of validated psychosocial questionnaires including variables related to resilience, well-being, and mental health. First, using exploratory factor analysis, we examined which of the assessed variables related to resilience can be assigned to a common factor. Second, linear regression analyses were performed to investigate whether a common resilience factor predicts well-being and mental health in the examined sample of women. Optimism (LOT-R-O), emotional stability (BFI-K-N), emotion regulation (ERQ), self-compassion (SCS-D), and self-esteem (RSES) in perimenopausal women can be allocated to a single resilience-associated factor. Regression analyses revealed that this factor is related to higher life satisfaction (SWLS; β = .39, p < .001, adj. R² = .20), lower perceived stress (PSS-10; β = - .55, p < .001, adj. R² = .30), lower psychological distress (BSI-18; β = - .49, p < .001, adj. R² = .22), better general psychological health (GHQ-12; β = - .49, p < .001, adj. R² = .22), milder menopausal complaints (MRS II; β = - .41, p < .001, adj. R² = .18), and lower depressive symptoms (ADS-L; β = - .32, p < .001, adj. R² = .26). The α levels were adjusted for multiple testing. Our findings confirm that several psychosocial variables (optimism, emotional stability, emotion regulation, self-compassion, and self-esteem) can be allocated to one common resilience-associated factor. This resilience factor is strongly related to women's well-being as well as mental health in perimenopause.

Depressive Symptoms among Middle-Aged Women-Understanding the Cause

Menopause is an important event in a woman’s life associated with hormonal changes that play a substantial role in the functioning of her body. A decline in the level of estrogens contributes to depressive symptoms and mood disorders during this period. The severity of depressive symptoms experienced by middle-aged women depends on many factors, including sociodemographic data (e.g., menopause, employment status, and marital status) and genetic variables (MAO-A and 5-HTT gene polymorphisms). In order to assess their influence on the development of depression in females, we analyzed 1453 healthy Polish women in different stages of menopause. Based on the results, we found that the l/l + l/s inheritance model for the 5-HTT gene polymorphism was more common in women without and with moderate depressive symptoms according to the Beck Depression Inventory (BDI), while the l/s model was more often observed in women with mild depression. Moreover, the overdominant 3/3 + 4/4 genotype of the MAO-A gene polymorphism was more often found in respondents without depressive symptoms, while women with depressive symptoms had more often the overdominant 3/4 genotype.

Prior depression affects the experience of the perimenopause - findings from the Swiss Perimenopause Study

BACKGROUND

There is a prevalence peak of depression in the perimenopause, with this reproductive phase being considered a window of vulnerability due to major biopsychosocial changes. Depression has been associated with physical and psychosocial impairment. Prior depression has been shown to be a risk factor for the development of several somatic and mental diseases. We assume that women with prior depression will exhibit increased burdensome symptoms in the perimenopause compared to women without prior depression.

METHODS

A total of 135 perimenopausal women aged 40-56 years participated in the longitudinal Swiss Perimenopause Study. For the purpose of this investigation, a cross-sectional design was chosen. A wide range of validated psychosocial questionnaires were used to compare women with and without prior depression regarding their experience of the perimenopause. Findings were statistically adjusted for multiple testing.

RESULTS

Women with prior depression showed significantly more depressive symptoms (U = 1215.5, p < .01), more menopausal symptoms (U = 1395.0, p < .01), and more sleep disturbances (U = 1583.5, p < .05) than women without prior depression. Moreover, women with a history of depression reported lower subjective mental health (U = 1573.0, p <  05) and felt more isolated (U = 1524.0, p < .05) than those without prior depression.

LIMITATIONS

Self-report data may affect the results. Furthermore, due to the cross-sectional design, causality cannot be inferred.

CONCLUSIONS

Prior depression affects women's experience of the perimenopause. Women with prior depression exhibit significantly more negative health outcomes in the perimenopause than those without prior depression.

Symptoms assessed in studies on perimenopausal depression: A narrative review

The menopausal transition constitutes a phase of major biopsychosocial changes associated with an elevated risk for the development of depression. Perimenopausal depression is highly prevalent and usually characterized by core symptoms of a major depressive disorder combined with menopausal complaints such as vasomotor symptoms or other physical complaints. However, a distinct definition of the condition is lacking. The aim of this review is to portray the symptoms assessed in studies on perimenopausal depression in order to provide relevant information on the current understanding of this condition. A literature search was conducted using the databases PubMed, Cochrane Library, and PsycINFO. A total of 37 studies were included. Various assessment tools have been used to measure symptoms related to perimenopausal depression. Fifteen symptoms were identified. Depressed mood was assessed across all studies. Low energy or sleep disturbances, as acknowledged symptoms of a major depressive disorder, were surveyed in most studies. However, the assessment of menopausal complaints was rather heterogeneous. While vasomotor symptoms were often measured, other menopausal symptoms such as mood swings or pain were investigated less frequently. Sexual problems were only rarely assessed. Studies on perimenopausal depression regularly include the assessment of core symptoms of a major depressive disorder, but the assessment of menopausal complaints is inconsistent. While certain symptoms are commonly measured, others are not assessed. Such inconsistencies underline an ambiguous understanding of perimenopausal depression, which in turn affects the evaluation and treatment of the condition. Thus, the use of the existing guidelines on perimenopausal depression is recommended.

Menopause and multiple sclerosis: Influence on prognosis and role of disease-modifying drugs and hormonal replacement therapy

Background:

Sex hormones play a role in both the risk and the prognosis of multiple sclerosis (MS). Considering all stages of women’s reproductive life, data regarding the influence of menopause on MS and vice versa are scarce.

Objective:

The aim of this study was to review the evidence addressing the relationship between menopause and MS.

Methods:

A literature search through PubMed was conducted, selecting studies that assessed (1) the influence of menopause in the MS course, (2) the influence of MS and disease-modifying drugs (DMD) on the development of menopause and (3) the effect of hormone replacement therapy (HRT) on symptoms of menopausal MS patients.

Results:

(1) Most studies suggest menopause may transitorily aggravate MS symptoms. Two studies found an inflexion point on the Expanding Disability Status Scale (EDSS) with clinical worsening during the menopausal transition. Another study considering full EDSS trajectories from clinically isolated syndrome to postmenopause did not find such an EDSS inflection; (2) MS and DMD do not seem to alter the age of menopause onset; and (3) HRT in menopausal MS patients has not shown consistent benefits.

Conclusion:

Menopause seems to be associated with transient symptom worsening, but the existence of an inflection in disability progression is still controversial. Properly designed studies are necessary to achieve conclusive results.

The Swiss Perimenopause Study - study protocol of a longitudinal prospective study in perimenopausal women

BACKGROUND

The perimenopause is associated with considerable biopsychosocial changes. The majority of women manage to adjust to these changes and cope well with the shift from reproductive to non-reproductive life. However, some women develop burdensome physical and psychological symptoms during the perimenopause. A strong link between menopausal complaints and depressed mood has been shown in this regard. To date, the decisive factors determining whether a woman will successfully achieve a healthy transition remain unclear. Thus, the purpose of this study is to investigate a range of theory-based markers related to health in perimenopausal women.

METHODS

The Swiss Perimenopause Study comprises a sample of 135 healthy perimenopausal women aged 40-56. A variety of health-related genetic, epigenetic, endocrinological, physiological, and psychosocial markers associated with the menopausal transition are investigated over a period of 13 months.

DISCUSSION

The Swiss Perimenopause Study will contribute to a better understanding of the biopsychosocial processes associated with the perimenopause, which should help to improve the clinical care of women undergoing the menopausal transition.

The Effect of Whole Blood Lead (Pb-B) Levels on Changes in Peripheral Blood Morphology and Selected Biochemical Parameters, and the Severity of Depression in Peri-Menopausal Women at Risk of Metabolic Syndrome or with Metabolic Syndrome

The aim of our study was to assess the impact of whole blood lead (Pb-B) levels on changes in peripheral blood morphology and selected biochemical parameters, and the severity of depression in peri-menopausal women at risk of metabolic syndrome (pre-MetS) or with metabolic syndrome (MetS). The study involved 233 women from the general population of the West Pomeranian Province (Poland) aged 44–65 years. The intensity of menopausal symptoms and the severity of depression was examined using the Blatt–Kupperman Index (KI) and the Beck Depression Inventory (BDI). C-reactive protein (CRP), insulin, glucose, glycated hemoglobin (HbA1C), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglyceride levels (TG), cortisol, morphology of blood cells and homeostasis model assessment for insulin resistance (HOMA-IR) and Pb-B was measured. Women with MetS had higher levels of glucose, HbA1C, HDL, LDL, TG, cortisol, insulin and higher HOMA-IR. No significant differences in Pb-B were observed between pre-MetS and the control group, and between pre-MetS and the MetS group. A significant correlation was noticed between Pb-B vs. the percentage of monocytes in blood, and blood cortisol levels in women with MetS; Pb-B vs. lymphocyte count and HbA1C in the pre-MetS group, as well as in the BDI scores between the MetS and pre-MetS group. We cannot clearly state that exposure to Pb is an environmental factor that can be considered as a risk factor for MetS in this studied group.

Smoking Across the Menopausal Transition in a 10-Year Longitudinal Sample: The Role of Sex Hormones and Depressive Symptoms

INTRODUCTION

Current cigarette smoking rates among older women remain problematic, especially given that this population experiences increased smoking-related health consequences. Despite these increased health concerns, little research to date has explored smoking patterns across the menopausal transition (pre-, early-peri-, late-peri-, and postmenopausal) or the effect of unique factors such as sex hormones and depression during this transition.

METHODS

This study used 10 yearly waves of data from the Study of Women's Health Across the Nation, a longitudinal dataset. Data included 1397 women endorsing ever smoking regularly at baseline. Random-effects logistic regression models were used to examine smoking transitions.

RESULTS

Although there were no associations between menopausal transition stage and smoking behavior, increased estradiol was associated with an increased likelihood of quitting regular smoking (eg, transitioning from regular smoking to non-regular or no smoking; odds ratio [OR] = 1.28), whereas increased testosterone was associated with an increased likelihood of relapsing to regular smoking (eg, transitioning from former or nonregular smoking to regular smoking OR = 2.56). Depression was associated with increased likelihood of continued smoking (OR = 0.97) and relapse (OR = 1.03).

CONCLUSIONS

The results emphasize the need to develop interventions to target initiated or continued smoking among women across the menopausal transition and specifically highlight the importance of developing treatments that target depressive symptoms in this population. In addition, although singular hormone measures were associated with smoking behavior, there is a need for future study of dynamic changes in hormones, as well as the impact of progesterone on smoking behaviors across the menopausal transition.

IMPLICATIONS

To date, no studies have examined smoking behaviors across the menopausal transition. In this study, although menopausal transition status was not significantly related to transitions in smoking behavior, important relationships between sex hormones and depression were observed. Increased estradiol was associated with an increased likelihood of quitting regular smoking, whereas increased testosterone was associated with an increased likelihood of relapsing to regular smoking behavior. Higher depression scores were related to continued smoking and relapse to regular smoking behavior. These results highlight the need to develop interventions to target smoking cessation among women across the menopausal transition.

Antidepressants during and after Menopausal Transition: A Systematic Review and Meta-Analysis

To assess the therapeutic benefits of antidepressants in depressive women during and after menopausal transition, PubMed, Cochrane Library, EMBASE and Science Direct were systematically searched from inception to February 1, 2020 for randomized controlled trials examining antidepressants compared to placebo. Primary outcome was change in depressive symptom severity, while secondary outcomes were rates of response/remission rates and dropout/discontinuation due to adverse events. Seven trials involving 1,676 participants (mean age = 52.6 years) showed significant improvement in depressive symptoms (k = 7, Hedges’ g = 0.44, 95% confidence interval (CI) = 0.32 to 0.57, p < 0.001) relative to that in controls. Furthermore, response (k = 3, odds ratio (OR) = 2.53, 95% CI = 1.24 to 5.15, p = 0.01) and remission (k = 3, OR = 1.84, 95% CI = 1.32 to 2.57, p < 0.001) rates were significantly higher in antidepressant-treated groups compared to those with controls. Although dropout rates did not differ between antidepressant and control groups (k = 6, OR = 0.93, 95% CI = 0.70 to 1.26, p = 0.68), the rate of discontinuation due to adverse events was significantly higher in antidepressant-treated groups (k = 6, OR = 0.55, 95% CI = 0.35 to 0.86, p = 0.01). Subgroup analysis indicated that antidepressants were also efficacious for depressive symptoms in those without diagnosis of MDD. The results demonstrated that antidepressants were efficacious for women with depressive syndromes during and after menopausal transition but associated with a higher risk of discontinuation due to adverse events.

Ovariectomy-induced depressive-like behavior and brain glucose metabolism changes in female rats are not affected by chronic mild stress

The increased incidence of depression in women going through peri-menopause suggests that fluctuations in estrogen levels may increase the risk of developing depression. Nonetheless, this psychiatric disorder is likely to be multifactorial and consequently an additional trigger may be needed to induce depression in this population. Stress could be such a trigger. We therefore investigated the effect of ovarian estrogen depletion and chronic mild stress (CMS) on depressive-like behavior and brain metabolism in female rats. Approximately 2 and 9 weeks after estrogen depletion by ovariectomy, behavioral changes were assessed in the open-field test and the forced swim test, and brain metabolism was measured with [¹⁸F]FDG PET imaging. A subset of animals was subjected to a 6-weeks CMS protocol starting 17 days after ovariectomy. Short-term estrogen depletion had a significant effect on brain metabolism in subcortical areas, but not on behavior. Differences in depressive-like behavior were only found after prolonged estrogen depletion, leading to an increased immobility time in the forced swim test. Prolonged estrogen depletion also resulted in an increase in glucose metabolism in frontal cortical areas and hippocampus, whereas a decrease glucose metabolism was found in temporal cortical areas, hypothalamus and brainstem. Neither short-term nor prolonged estrogen depletion caused anxiety-like behavior. Changes in body weight, behavior and brain glucose metabolism were not significantly affected by CMS. In conclusion, ovarian estrogen depletion resulted in changes in brain metabolism and depressive-like behavior, but these changes were not enhanced by CMS.

Linguistic translation and validation of the Menopause-specific Quality of Life (MENQOL) questionnaire in Greek menopausal women

OBJECTIVE

The objective of this study was to translate the Menopause-specific Quality of Life (MENQOL) questionnaire in Greek and validate it for usage in the Greek population both in written and electronic form.

METHODS

The original English questionnaire MENQOL with 1-month recall period was translated by our team. According to instructions by Mapi Research Trust, the questionnaire was forward and back-translated, followed by patient testing and proofreading. Then it was transcripted electronically. Validation was performed with the following tests: internal consistency (reliability), stability (test-retest reliability) with Cronbach's alpha correlations, independent and paired t tests, and Pearson's correlation coefficients.

RESULTS

A total of 105 women, the majority recently menopausal, participated in the study. Internal consistency using the Cronbach's alpha showed high reliability ranging between 0.833 (physical domain) and 0.896 (vasomotor domain) for the written, and 0.720 (physical domain) and 0.868 (vasomotor domain) for the online form. Test-retest reliability was also high for both forms. The sexual domain of MENQOL had the higher mean, indicating the highest impact on quality of life (3.80 ± 2.35).

CONCLUSIONS

The Greek version of MENQOL is a reliable instrument for evaluating menopausal women. Availability of an online form will allow wider dissemination of the questionnaire. Further use of the questionnaire in Greece may lead to better understanding of the bothersome symptoms of menopause; a prerequisite to develop intervention studies for amelioration of quality of life.

Dietary creatine intake and depression risk among U.S. adults

Creatine monohydrate is actively being researched for its antidepressant effects, yet little is known about the link between dietary creatine and depression risk. This study examines the association between dietary creatine and depression in U.S. adults, using data from the 2005 to 2012 National Health and Nutrition Examination Survey (NHANES). Patient health questionnaire, dietary creatine intake and covariates were obtained on 22,692 NHANES participants ≥20 years of age. Depression prevalence was calculated within quartiles of dietary creatine intake. Adjusted logistic regression models were formulated to determine the relationship between dietary creatine intake and depression risk. Additional covariates included income to poverty ratio, race/ethnicity, sex, age, education level, body mass index, healthcare access, smoking status, physical activity, and antidepressant/anxiolytic medication use. Models were further stratified by sex, age group, and antidepressant/anxiolytic medication use. Depression prevalence was 10.23/100 persons (95% CI: 8.64-11.83) among NHANES participants in the lowest quartile of dietary creatine intake compared with 5.98/100 persons (95% CI: 4.97-6.98) among participants in the highest quartile (p < 0.001). An inverse association was measured between dietary creatine and depression (adjusted odds ratio (AOR) = 0.68, 95% CI: 0.52-0.88). Dietary creatine's negative association with depression was strongest in females (AOR = 0.62, 95% CI: 0.40-0.98), participants aged 20-39 years (AOR = 0.52, 95% CI: 0.34-0.79) and participants not taking antidepressant/anxiolytic medication (AOR = 0.58, 95% CI: 0.43-0.77). Study results indicate a significant negative relationship between dietary creatine and depression in a nationally representative adult cohort. Further research is warranted to investigate the role creatine plays in depression, particularly among women and across the lifespan.

Depression during perimenopause: the role of the obstetrician-gynecologist

Depression in women is more common during perimenopause (the transition to menopause) than at other times in the life cycle. Symptoms of depression may be different in perimenopausal women compared to younger or older women, and are often dismissed as part of normal menopause. This is an expert narrative review. There are several evidence-based screening modalities which can be integrated into routine women's health visits, and can facilitate distinguishing between depression and normal perimenopausal symptoms. There is emerging evidence regarding the effect of hormonal changes on the development of perimenopausal depression and its optimal treatment, though critical research gaps remain. Obstetrician-gynecologists and other primary care providers play a vital role in the detection and management of depression in women. Providers caring for women during perimenopause have a unique opportunity to diagnose depression in their patients and identify appropriate treatment options.

Psychobiological indicators of the subjectively experienced health status - findings from the Women 40+ Healthy Aging Study

BACKGROUND

Healthy aging is particularly important in women, as their life-span is generally longer than men's, leaving women at higher risk for age-related diseases. Understanding determinants of women's healthy aging is therefore a major public health interest. Clinical utility of previous research is limited, through its focus on either single psychosocial or biological predictors. The present study investigated psychobiological predictors of women's healthy aging, for the first time including positive psychological traits and biomarkers of healthy aging.

METHODS

Totally, 121 generally healthy women aged 40 to 75 were investigated cross-sectionally. Healthy aging was operationalized via self-rated health (SRH). To gain a nuanced view of the particularities at the upper end of the illness-wellness continuum, women with excellent SRH and those with good SRH were analyzed as distinct groups. Socioeconomic and sociodemographic variables, health behavior, resilience, optimism, and self-worth as well as menopausal symptoms, and levels of steroid hormones and gonadotropins were considered as predictors of SRH. Binary logistic regression analyses using the forward conditional method were performed with the two health status groups as dependent variable.

RESULTS

Women with a lower body mass index (BMI; OR = .59, 95% CI = .33-1.03), higher intensive physical activity (OR = 2.27, 95% CI = 1.06-4.86), and higher resilience (OR = 2.37, 95% CI = 1.34-4.18) were more likely to rate their health as excellent compared to good. No clinically significant differences could be found regarding endocrine levels.

CONCLUSION

Psychobiological indicators (lower BMI, intensive physical activity, higher resilience) discriminated SRH at the top level of the health spectrum. In healthy women, the predictive value of endocrine markers seems to be secondary. Interventions targeting these indicators could promote women's healthy aging.

Estradiol administration differentially affects the response to experimental psychosocial stress in post-menopausal women with or without a history of major depression

BACKGROUND:

The effects of estradiol on the brain regions involved in the response to stress and emotional processes may be particularly important in women who have alterations in these systems that make them vulnerable to Major Depressive Disorder (MDD). This study examined whether the effect of estradiol administration on the subjective distress and mood response to a laboratory-based psychosocial stress task differs in women with and without a history of MDD.

METHODS:

Participants were 65 euthymic postmenopausal women, with and without a history of MDD. They received either 3 months of open-label oral estradiol or did not receive estradiol. After 3 months, participants completed the Montreal Stress Imaging Task (MIST) and subjective distress and mood ratings.

RESULTS:

The effect of estradiol on subjective distress following the MIST differed based on MDD history. In women without a history of MDD, estradiol administration was associated with greater subjective distress than no estradiol. However, in women with a history of MDD, estradiol administration was associated with less subjective distress compared to no estradiol.

LIMITATIONS:

This study included open-label administration of estradiol and participants were not blinded to administration. Interpretation of result should include consideration of the relatively small group sizes and that results may not generalize to currently depressed individuals.

CONCLUSIONS:

In euthymic women with a history of MDD, estradiol may benefit the affective response to psychosocial stress while having comparatively little benefit in women with no MDD history. Further work should explore whether estradiol administration reduces the risk of depression recurrence in post-menopausal women with past MDD.

Fatty Acid Profile of Postmenopausal Women Receiving, and Not Receiving, Hormone Replacement Therapy

Menopause, the permanent cessation of the menstrual cycle, marks the end of a woman's reproductive lifespan. Menopausal hormonal therapy (MHT) can potentially skew the fatty acid profile increasing the risk for developing metabolic diseases and disorders of skeletal, gastrointestinal, and nervous systems. The aim of this study was to investigate the fatty acid profile of postmenopausal women receiving, and not receiving, hormone replacement therapy. A total of 156 healthy women with a mean age of 60 participated in this cross-sectional study. Gas chromatography with an Agilent Technologies 7890A GC system was used to determine fatty acid content. Statistical analysis was conducted using R software, version 3.4.1. Women receiving MHT had significantly higher (p < 0.05) concentrations of C14:0 and C16:0. MHT was found to be associated with a tendency (p = 0.053) to diminish concentrations of C18:1n-9, C20:4, and all unsaturated fatty acids (p < 0.05). The longer MHT was used, the higher the concentration of C24:1 (p = 0.04) and the lower the concentration of C18:2n-6 (p = 0.03).

Antidepressive Effects of Kamishoyosan through 5-HT1AReceptor and PKA-CREB-BDNF Signaling in the Hippocampus in Postmenopausal Depression-Model Mice

Females are well known to suffer disproportionately more than males from stress-related neuropsychiatric disorders, especially during perimenopausal and postmenopausal periods. In addition to a decline in serum estradiol levels, environmental stress and social stress likely contribute to the development of neuropsychiatric symptoms in perimenopausal and postmenopausal women. Kamishoyosan (KSS) is a traditional Japanese Kampo medicine, composed of a specified mixture of 10 crude compounds derived from plant sources, widely used for various neuropsychiatric symptoms in perimenopausal and postmenopausal women. However, the molecular mechanisms underlying KSS-mediated attenuation of neuropsychological symptoms and stress-response behaviors in perimenopausal and postmenopausal women remain unknown. In the present study, we first established a mouse model for postmenopausal depression-like signs using chronic water-immersion and restraint-stressed ovariectomized (OVX) mice to investigate the underlying molecular mechanism of KSS. We found that continuous administration of KSS to these mice normalized the activation of the hypothalamic-pituitary-adrenal (HPA) axis, ameliorated stress-induced depressive behavior, and prevented a decrease of neurogenesis in the hippocampus. As previous studies have implicated dysfunction of the hippocampal 5-HT1A receptor (5-HT1AR) in depressive disorders, we also evaluated the effect of KSS on 5-HT1AR expression and the protein kinase A- (PKA-) cAMP response element-binding- (CREB-) brain-derived neurotrophic factor (BDNF) signaling pathway in the hippocampus in this model. The level of 5-HT1AR in the hippocampus decreased in chronic stress-exposed OVX mice, while KSS treatment normalized the stress-induced decrease in 5-HT1AR expression in the hippocampus of chronic stress-exposed OVX mice. Furthermore, we found that KSS treatment upregulated the expression levels of phosphorylated PKA (p-PKA), phosphorylated CREB (p-CREB), and BDNF in the hippocampus in chronic stress-exposed OVX mice. These results suggest that KSS improves neuropsychiatric symptoms through 5-HT1AR and PKA-CREB-BDNF signaling in the hippocampus in postmenopausal women.

Association between HIV status and psychological symptoms in perimenopausal women

OBJECTIVE

HIV-infected women are burdened by depression and anxiety, which may impact adherence to antiretroviral therapy and overall quality of life. Yet, little is known about the scope of psychological symptoms in the growing number of HIV-infected women reaching menopause, when affective symptoms are more prevalent in the general population. We conducted a longitudinal study to compare affective symptoms between perimenopausal HIV-infected and non-HIV-infected women.

METHODS

The Center for Epidemiologic Studies Depression Scale (CES-D), and the Generalized Anxiety Disorder scale (GAD-7) were completed at baseline and 12 months among 33 HIV-infected and 33 non-HIV-infected perimenopausal women matched by race, age, menstrual patterns, and BMI. Linear regression models estimated the relationship of baseline GAD-7 and CES-D scores with clinical factors.

RESULTS

All women were perimenopausal at baseline, and the vast majority remained perimenopausal throughout follow-up. HIV status was associated with higher baseline CES-D scores (median [interquartile range] 21 [12, 29] vs 10 [5, 14]; P = 0.03) and GAD-7 scores (7 [5, 15] vs 2 [1, 7]; P = 0.01), controlling for smoking, substance use, and antidepressant use. Depressive symptoms and anxiety remained significantly higher in the HIV-infected women at 12 months (P ≤ 0.01). Significant relationships of depressive symptoms (P = 0.048) and anxiety (P = 0.02) with hot flash severity were also observed.

CONCLUSIONS

Perimenopausal HIV-infected women experienced a disproportionately high level of affective symptom burden over a 12-month observation period. Given the potential for these factors to influence adherence to HIV clinical care and quality of life, careful assessment and referral for treatment of these symptoms is essential.

Steroid secretion in healthy aging

Nowadays, people spend a considerable amount of their lives as older adults, but this longer lifespan is often accompanied by an increase in chronic conditions and disease, resulting in reduced quality of life and unprecedented societal and economic burden. Healthy aging is therefore increasingly recognized as a healthcare priority. Physical and mental adaptations to changes over the life course, and the maintenance of well-being, represent pivotal challenges in healthy aging. To capture the complexity of healthy aging, we propose a specific phenotype based on body composition, cognition, mood, and sexual function as indicators of different dimensions of healthy aging. With increasing age, sex hormones as well as glucocorticoids undergo significant alterations, and different patterns emerge for women and men. This review describes age-related patterns of change for women and men, and sheds light on the underlying mechanisms. Furthermore, an overview is provided of the challenges for healthy aging resulting from these age-related steroid alterations. While clinical practice guidelines recommend hormonal treatment only in the case of consistently low hormone levels and symptoms of hormone deficiency, physical exercise and a healthy lifestyle emerge as preventive strategies which can counter age-related hormonal changes and at best prevent chronic conditions.

Reversal effect of Riparin IV in depression and anxiety caused by corticosterone chronic administration in mice

Mental disorders have a multifactorial etiology and stress presents as one of the causal factors. In depression, it is suggested that high cortisol concentration contributes directly to the pathology of this disease. Based on that, the study aims to evaluate the potential antidepressant effect of Riparin IV (Rip IV) in mice submitted to chronic stress model by repeated corticosterone administration. Female Swiss mice were selected into four groups: control (Ctrl), corticosterone (Cort), Riparin IV (Cort + Rip IV) and fluvoxamine (Cort + Flu). Three groups were administrated subcutaneously (SC) with corticosterone (20 mg/kg) during twenty-one days, while the control group received only vehicle. After the fourteenth day, groups were administrated tested drugs: Riparin IV, fluvoxamine or distilled water, by gavage, 1 h after subcutaneous injections. After the final treatment, animals were exposed to behavioral models such as forced swimming test (FST), tail suspension test (TST), open field test (OFT), elevated plus maze (EPM) and sucrose preference test (SPT). The hippocampus was also removed for the determination of BDNF levels. Corticosterone treatment altered all parameters in behavioral tests, leading to a depressive- and anxious-like behavior. Riparin IV and fluvoxamine exhibit antidepressant effect in FST, TST and SPT. In EPM and OFT, treatment displayed anxiolytic effect without alteration of locomotor activity. Corticosterone administration decreased BDNF levels and Riparin IV could reestablish them, indicating that its antidepressant effect may be related to ability to ameliorate hippocampal neurogenesis. These findings suggest that Riparin IV improves the depressive and anxious symptoms after chronic stress and could be a new alternative treatment for patients with depression.

Effect of Aromatherapy on the Treatment of Psychological Symptoms in Postmenopausal and Elderly Women: A Systematic Review and Meta-analysis

Objectives

To critically assess the effect of aromatherapy on the psychological symptoms as noted in the postmenopausal and elderly women.

Methods

Three following databases were systematically searched: MEDLINE, Scopus and Cochrane Library (Cochrane Central Register of Controlled Trials) from inception to January 2018. The search keywords included ‘menopause’ AND (aromatherapy), without language restrictions.

Results

In this study, 4 trials were included which fit into our systematic review. The findings demonstrated that the aromatherapy massage have significantly improved psychological symptoms in menopausal and elderly women as compared to the control group (standardized mean difference [SMD] = −1.24; 95% confidence interval, −0.188 to −0.606; P < 0.001 random effect model; 3 trials, moderate to high heterogeneity, I² = 0.76; P = 0.028). According to 1 of the trials, the aromatherapy oil massage was no more effective than the untreated group regarding their experience of symptoms such as nervousness.

Conclusions

The aromatherapy may be beneficial in attenuating the psychological symptoms that these women may experience, such as anxiety and depression, but it is not considered as an effective treatment to manage nervousness symptom among menopausal women. This finding should be observed in light of study limitations.

Depression and Quality of Life among Postmenopausal Women in Bangladesh: A Cross-sectional Study

OBJECTIVES

The aims of the research are to examine the problems of abnormal menopausal women: the relationship between depression and menopausal-specific quality of life (MENQOL)-symptoms among postmenopausal women; the association of MENQOL-symptoms between pre- and postmenopausal female society in Bangladeshi real community.

METHODS

This cross sectional study was conducted on 435 women of Tangail, aged (≥ 17) years, using a structured questionnaire where is inaacluded the information of MENQOL and one of the main outcomes "depression" is measured by beck depression inventory.

RESULTS

Menopausal status and MENQOL symptoms (except pain) are significantly (P < 0.05) associated. By using post-hoc analysis, the proportion of menopausal women, classified as having a depressive mood of early menopause is significantly higher than natural-menopause. Among postmenopausal women, there is a significant correlation between "concentration problem" and "depression". Here mean depression score (29.40 ± 6.42) of menopausal women who have any difficulty in concentrating is higher than mean depression score (20.89 ± 6.64) of menopausal women who have no difficulty in concentrating. Another six factors (osteoporosis, heart-beating, fatigue, pressure, tingling, headaches) of MENQOL-symptoms were significantly correlated with depression and P-values are 0.000, 0.000, 0.000, 0.033, 0.006, and 0.002, respectively. Finally the presence of "difficulty in concentrating" and "fatigue" are strongly associated factors with depression score (P < 0.001).

CONCLUSIONS

The early postmenopausal women have to face more psychological problems (e.g., depression) compare to others. Among postmenopausal women, there is no significant relation between depression and vasomotor symptom (e.g., hot-flashes) perspective to menopausal female society of Bangladesh.

Study of Sex Differences in Duloxetine Efficacy for Depression in Transgenic Mouse Models

Clinical evidences show sex differences in risk of developing depressive disorders as well as effect of antidepressants in depression treatment. However, whether such a sex-dependent risk of depression and efficacy of antidepressants is dependent on endogenous estrogen level remain elusive. The aim of this study is to explore the molecular mechanisms of sex differences in antidepressant duloxetine. In the present study, we used genetic knockout or overexpression estrogen-synthesizing enzyme aromatase (Ar) gene as models for endogenous estrogen deficiency and elevation endogenous estrogen, respectively, to examine the anti-depressive efficacy of duloxetine in males and females by force swimming test (FST). We also measured the sex-specific effect of duloxetine on dopamine and serotonin (5-HT) metabolisms in frontal cortex and hippocampus (HPC). Elevation of brain endogenous estrogen in male and female mice showed a reduction of immobility time in FST compared to control mice. Estrogen deficiency in females showed poor response to duloxetine treatment compared to sex-matched wildtype (WT) or aromatase transgenic mice. In contrast, male mice with estrogen deficiency showed same anti-depressive response to duloxetine treatments as aromatase transgenic mice. Our data showed that the sex different effect of endogenous estrogen on duloxetine-induced anti-depressive behavioral change is associated with brain region-specific changes of dopamine (DA) and 5-HT system. Endogenous estrogen exerts antidepressant effects in both males and females. Lacking of endogenous estrogen reduced antidepressive effect of duloxetine in females only. The endogenous estrogen level alters 5-HT system in female mainly, while both DA and 5-HT metabolisms were regulated by endogenous estrogen levels after duloxetine administration.