Menopause and mood

Factors associated with the high susceptibility to depression of women during the perimenopause

OBJECTIVE

This study investigated the factors associated with the high susceptibility of perimenopausal women to depression.

METHODS

A total of 66 perimenopausal women participated in this study. The Zung self-rating depression scale (SDS) was used to evaluate the intensity of depressive symptoms. The modified Kupperman index (KI) was used to assess common perimenopausal symptoms. Psychosocial factors were assessed via the Eysenck Personality Questionnaire, attitudes toward menopause checklist, and metacognition questionnaire (MCQ). Levels of serum estradiol, testosterone, and progesterone were determined.

RESULTS

There were statistically significant associations between SDS standard score and the KI scale score (β = .361, p = .001), years of education (β = -.309, p = .005), and F3 cognitive self-consciousness score of MCQ (β = -.234, p = .032; adjusted R²  = .264, F = 8.759, p < .001).

CONCLUSIONS

High susceptibility to depression of perimenopausal women may be related to lower educational level, more severe perimenopausal symptoms, and altered metacognition.

Head-Out Aquatic Exercise for Generally Healthy Postmenopausal Women: A Systematic Review

BACKGROUND

Aquatic exercise (AE) is a method for exercise and rehabilitation to enhance function for various clients.

OBJECTIVES

Investigate the effects of head-out AE interventions on the physiological and psychological outcomes of healthy postmenopausal women of age 50-70 years.

SEARCH STRATEGIES

Databases searched included Scopus, ScienceDirect, ResearchGate, PubMed/MEDLINE, PEDro, CINAHL, The Cochrane Library, Nursing & Allied Health Collection: Comprehensive, JSTOR, and OTSeeker.com, through January 2015. Search Criteria: Randomized controlled trial and quasi-randomized controlled trial studies.

DATA COLLECTION AND ANALYSIS

Two researchers scanned studies based on inclusion and exclusion criteria. Studies included were critically appraised using the Physiotherapy Evidence Database scale (PEDro scale).

RESULTS

A total of 15 studies including postmenopausal women and head-out AE intervention were reviewed. Considerable variation existed in the interventions and assessments. Outcome measures showed anthropometric measures (body mass index, circumference, skinfolds, and body fat) were inconclusive; upper and lower body strength improved; flexibility improved; all functional movements (short-distance walk, long-distance walk/run, power, agility, balance and falls) improved; bone density improved; biochemical and hormonal variables were inconclusive; and quality of life outcomes improved.

CONCLUSIONS

Head-out AE appears to be an effective training and conditioning method for postmenopausal women to improve strength, flexibility, functional movements, bone density, and quality of life.

Postmenopausal syndrome

Menopause is one of the most significant events in a woman's life and brings in a number of physiological changes that affect the life of a woman permanently. There have been a lot of speculations about the symptoms that appear before, during and after the onset of menopause. These symptoms constitute the postmenopausal syndrome; they are impairing to a great extent to the woman and management of these symptoms has become an important field of research lately. This chapter attempts to understand these symptoms, the underlying pathophysiology and the management options available.

Predictors of first lifetime episodes of major depression in midlife women

BACKGROUND

Little is known about factors that predict first lifetime episodes of major depression in middle-aged women. It is not known whether health-related factors and life stress pose more or less of a risk to the onset of clinical depression than does the menopausal transition.

METHOD

The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was used to assess diagnoses of lifetime, annual and current major depression in a community-based sample of premenopausal or early perimenopausal African American and White women. Menstrual cycle characteristics, psychosocial and health-related factors, and blood samples for assay of reproductive hormones were obtained annually. Two hundred and sixty-six women without a history of major depression at baseline constituted the cohort for the current analyses.

RESULTS

Over 7 years of follow-up, 42 (15.8%) women met criteria for a diagnosis of major depression. Frequent vasomotor symptoms (VMS; hot flashes and/or night sweats) (HR 2.14, p=0.03) were a significant predictor of major depression in univariate analyses. After simultaneous adjustment for multiple predictors in Cox proportional hazards analyses, frequent VMS were no longer significant; lifetime history of an anxiety disorder (HR 2.20, p=0.02) and role limitations due to physical health (HR 1.88, p=0.07) at baseline and a very stressful life event (HR 2.25, p=0.04) prior to depression onset predicted a first episode of major depression.

CONCLUSIONS

Both earlier (e.g. history of anxiety disorders) and more proximal factors (e.g. life stress) may be more important than VMS in contributing to a first episode of major depression during midlife.

Reduced frontal perfusion in depressed postmenopausal women: a SPECT study with WCST

OBJECTIVES

To investigate frontal cerebral blood flow (CBF) in depressed postmenopausal women and its relation to cognitive function and the severity of depressive symptoms.

METHODS

Regional CBF of 20 unmedicated depressed postmenopausal women was measured using Tc-99m HMPAO SPECT, both at rest and during frontal activation using the Wisconsin card sorting test (WCST). Frontal CBF was semi-quantified by comparing the radioactivity in the prefrontal region to the cerebellum (F/C ratio). We measured the severity of the symptoms of depression using the hospital anxiety and depression scale (HADS) and cognitive function using the mini-mental status examination (MMSE).

RESULTS

At rest, there was no difference in frontal CBF between patients with moderate or severe (HADS> or =11) and patients with mild depressive symptoms (HADS<11). During the WCST, however, the HADS> or =11 group did not score as well as the HADS<11 group (P=0.03). The changes in F/C ratios were inversely correlated with HADS scores (r=-0.43, P=0.05) and positively correlated with MMSE scores (r=0.58, P=0.004). After adjusting for age, F/C ratios were significantly correlated with MMSE (P=0.002), but not with HADS scores.

CONCLUSIONS

Frontal CBF did not increase in postmenopausal women with moderate/severe symptoms of depression during the WCST activation task, and reduced frontal CBF was related to the impairment of cognitive function. The combination of the functional activation test and SPECT imaging powerfully revealed this functional disease, which remains undetectable using more common baseline measurements.

Variations on hormone replacement therapy: an answer to the 'one dose fits all' Women's Health Initiative study

The Women's Health Initiative study worked on the assumption that one dose would fit all asymptomatic postmenopausal women. The investigators therefore often used the wrong dose, of the wrong hormones, on the wrong patients and therefore came to many wrong conclusions. Different combinations of different hormones are necessary for different symptoms and different age groups. Hormone replacement therapy may be commenced in the perimenopausal phase, the early postmenopause, the late postmenopause or after hysterectomy and bilateral salpingo-oophorectomy or a premature menopause. These all require different treatments. Similarly, various indications such as vasomotor symptoms, sexual problems, depression or the treatment/prevention of osteoporosis all need different combinations of estradiol and possibly progestogen and testosterone, according to the specific requirements of the patient.

Relative antidepressant efficacy of bupropion and the selective serotonin reuptake inhibitors in major depressive disorder: gender-age interactions

To determine whether age/gender-based differences in efficacy exist between bupropion and the selective serotonin reuptake inhibitors for major depressive disorder, we pooled the findings of 10 double-blind studies comparing bupropion with a selective serotonin reuptake inhibitor. Men (N=943) and women (N=1179) were divided into three age groups (younger than 40, 40-55, older than 55). Improvement in terms of the 17-item Hamilton Depression Rating Scale, as well as the Bech melancholia, anxiety-somatization, and insomnia factors of the Hamilton Depression Rating Scale was compared between the two treatment groups. Of 64 pair-wise comparisons, only one was statistically significant. Specifically, more women treated with a selective serotonin reuptake inhibitor experienced a 50% or greater decrease in Hamilton Depression Rating Scale Anxiety-Somatization scores (58.8 versus 63.8%, P=0.0394). No difference, however, was seen in the degree of resolution of Hamilton Depression Rating Scale Anxiety-Somatization scores (continuous measure) between women treated with bupropion versus a selective serotonin reuptake inhibitor (P=0.114). Bupropion and the selective serotonin reuptake inhibitors, thus, appear to be equally effective in treating depressive symptoms, as well as anxious/somatic symptoms and insomnia in depression. No gender-related or age-related differences were found except that greater improvement was seen in anxious/somatic symptoms of depression among women during selective serotonin reuptake inhibitor treatment. This finding could, however, not be replicated when improvement in anxious/somatic symptoms was defined as a continuous measure.

Sleep disorders in women: clinical evidence and treatment strategies

Sleep disorders are more prevalent in women than in men. Sex hormones modulate sleep-wake behaviors and mood and may contribute to heightened risk across the life cycle of women. Sleep disorders may have a unique expression in women, emerging throughout their reproductive life cycle. These conditions require careful treatment strategy to manage medical, hormonal, and behavioral contributing factors to poor sleep efficiency and impaired quality of life. This review focuses on clinical evidence for sleep disorders in women and discusses existing evidence of risk factors and treatment options for insomnia and sleep-disordered breathing in women.

Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: a comprehensive review

Many women experience vasomotor symptoms at or around the time of menopause. Hot flushes and night sweats are considered primary menopausal symptoms that may also be associated with sleep and mood disturbances, as well as decreased cognitive function. All of these symptoms may lead to social impairment and work-related difficulties that significantly decrease overall quality of life. Hot flushes have shown a great deal of variability in their frequency and severity in women. In some women, hot flushes persist for several months; in others, they may last for more than 10 years. Traditionally vasomotor symptoms were reported to begin 5 to 10 years prior to the cessation of the final menstrual cycle, corresponding with the initial decline in circulating gonadal hormones; however, night sweats in particular most often begin in perimenopause. The pathogenesis of hot flushes has not yet been fully elucidated, but the circuitry involving estrogen and neurotransmitters, norepinephrine and serotonin specifically, are hypothesized to play a major role in the altered homeostatic thermoregulatory mechanisms underlying these events.

Menopause-associated vasomotor symptoms are associated with significant direct and indirect costs. Overall costs of traditional pharmacotherapy or complementary and alternative medicine modalities, including over-the-counter treatments and dietary supplements, for managing menopause-related vasomotor symptoms are substantial and include initial and follow-up physician visits and telephone calls. Additional costs include laboratory testing, management of adverse events, loss of productivity at work, and personal and miscellaneous costs. Pharmacoeconomic analyses, including those that consider risks identified by the Women's Health Initiative, generally support the cost-effectiveness of hormonal therapy for menopause-associated vasomotor symptoms, which have been the mainstay for the management of these symptoms for more than 50 years. However, because many women now want to avoid hormone therapy, there is a need for additional targeted therapies, validated by results from controlled clinical trials that are safe, efficacious, cost-effective, and well tolerated by symptomatic menopausal women.