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Li J, Liu F, Liu Z, Li M, Wang Y, Shang Y, Li Y. Prevalence and associated factors of depression in postmenopausal women: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:431. [PMID: 38858633 PMCID: PMC11165857 DOI: 10.1186/s12888-024-05875-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Depression is a prevalent mental health problem in postmenopausal women. Given its significant impact on the quality of life and overall well-being of postmenopausal women, there is need for a comprehensive review and meta-analysis of the existing research globally. This systematic review and meta-analysis evaluated the global prevalence of depression and potential associated factors in postmenopausal women. METHODS The Cochrane Library, PubMed, EMBASE, Web of Science, MEDLINE, and PsycINFO databases were systematically searched from inception to March 22, 2023. The meta-analysis used the random-effects model to calculate the prevalence of depression rates and associated factors. In addition, subgroup analysis and sensitivity analysis were performed. Publication bias was assessed using funnel plots, Egger's test, and nonparametric trim-and-fill tests. RESULTS The meta-analysis included 50 studies that involved 385,092 postmenopausal women. The prevalence of depression in postmenopausal women was 28.00% (95% CI, 25.80-30.10). Among the factors relevant to depression among postmenopausal women, marital status (OR: 2.03, 95%CI: 1.33-3.11), history of mental illness (OR: 2.31, 95%CI: 1.50-3.57), chronic disease (OR: 3.13, 95%CI: 2.20-4.44), menstrual cycle (OR: 1.42, 95%CI: 1.17-1.72), abortion numbers (OR: 1.59, 95%CI: 1.40-1.80), menopausal symptoms (OR: 2.10, 95%CI: 1.52-2.90), and hormone replacement therapy (OR: 1.76, 95%CI: 1.31-2.35) were risk factors, while physical activity (OR: 0.56, 95%CI: 0.53-0.59), number of breastfed infants (OR: 0.43, 95%CI: 0.19-0.97), menopause age (OR: 0.44, 95%CI: 0.37-0.51) were preventive factors. CONCLUSIONS This study demonstrated that the prevalence of postmenopausal depression is high, and some risk factors and protective factors associated with it have been identified. It is necessary to improve screening and management and optimize prevention and intervention strategies to reduce the harmful effects of postmenopausal depression.
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Affiliation(s)
- Jiaxin Li
- School of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China
| | - Fangli Liu
- School of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China.
- Institution of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China.
- Xinyang Vocational and Technical College, Xinyang, Henan, P. R. China.
| | - Ziwei Liu
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, P. R. China
| | - Mengjie Li
- School of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China
| | - Yingying Wang
- School of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China
| | - Yameng Shang
- School of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China
| | - Yuege Li
- School of Nursing and Health, Henan University, Kaifeng, Henan, P. R. China
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Moore SE, Davey CH, Morgan M, Webel A. Symptoms, Lifetime Duration of Estrogen Exposure, and Ovarian Reserve Among Women Living With HIV: A Cross-Sectional Observational Study. J Assoc Nurses AIDS Care 2024; 35:264-280. [PMID: 38949903 PMCID: PMC11221577 DOI: 10.1097/jnc.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
ABSTRACT This cross-sectional observational study examined associations among symptom burden, lifetime duration of estrogen exposure, and serum antimüllerian hormone (AMH) levels among women living with HIV (n = 98) using bivariate bias-corrected Pearson correlations and multiple correspondence analyses. The mostly Black (85.6%) sample of women, with a mean age of 50 years (SD 12.6 years), exhibited no significant reproductive history factors and symptom burden interrelationships or significant associations between lifetime duration of estrogen exposure and symptoms. Predictably, serum AMH levels were lower among older women; however, less predictable were its significant relationships with months living with HIV (r = -0.362), months on ART (r = -0.270), and CD4+ T-cell nadir (r = 0.347). Symptom-symptom relationships support a fatigue, pain, sleep, anxiety, and depression symptom cluster. The hypotheses were not supported by cross-sectional observation. Further studies should explore variation in relationships between HIV, estrogen exposure, ovarian reserve, and AMH levels over time.
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Affiliation(s)
- Scott Emory Moore
- Scott Emory Moore, PhD, MSN, RN, AGPCNP-BC, FAAN, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Christine Horvat Davey, PhD, RN, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Michael Morgan, BS, is an Outreach & Recruitment Coordinator in the AIDS Clinical Trials Unit, Case Western Reserve University/University Hospitals, Cleveland, Ohio, USA
- Allison Webel, PhD, RN, FAAN, is the Interim Robert G. and Jean A. Reid Executive Dean, and is the Aljoya Endowed Professor in Aging University of Washington School of Nursing, Seattle, Washington, USA
| | - Christine Horvat Davey
- Scott Emory Moore, PhD, MSN, RN, AGPCNP-BC, FAAN, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Christine Horvat Davey, PhD, RN, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Michael Morgan, BS, is an Outreach & Recruitment Coordinator in the AIDS Clinical Trials Unit, Case Western Reserve University/University Hospitals, Cleveland, Ohio, USA
- Allison Webel, PhD, RN, FAAN, is the Interim Robert G. and Jean A. Reid Executive Dean, and is the Aljoya Endowed Professor in Aging University of Washington School of Nursing, Seattle, Washington, USA
| | - Michael Morgan
- Scott Emory Moore, PhD, MSN, RN, AGPCNP-BC, FAAN, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Christine Horvat Davey, PhD, RN, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Michael Morgan, BS, is an Outreach & Recruitment Coordinator in the AIDS Clinical Trials Unit, Case Western Reserve University/University Hospitals, Cleveland, Ohio, USA
- Allison Webel, PhD, RN, FAAN, is the Interim Robert G. and Jean A. Reid Executive Dean, and is the Aljoya Endowed Professor in Aging University of Washington School of Nursing, Seattle, Washington, USA
| | - Allison Webel
- Scott Emory Moore, PhD, MSN, RN, AGPCNP-BC, FAAN, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Christine Horvat Davey, PhD, RN, is an Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Michael Morgan, BS, is an Outreach & Recruitment Coordinator in the AIDS Clinical Trials Unit, Case Western Reserve University/University Hospitals, Cleveland, Ohio, USA
- Allison Webel, PhD, RN, FAAN, is the Interim Robert G. and Jean A. Reid Executive Dean, and is the Aljoya Endowed Professor in Aging University of Washington School of Nursing, Seattle, Washington, USA
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Brown L, Hunter MS, Chen R, Crandall CJ, Gordon JL, Mishra GD, Rother V, Joffe H, Hickey M. Promoting good mental health over the menopause transition. Lancet 2024; 403:969-983. [PMID: 38458216 DOI: 10.1016/s0140-6736(23)02801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/01/2023] [Accepted: 12/11/2023] [Indexed: 03/10/2024]
Abstract
The potential risk for mental health conditions over the menopause transition shapes women's expectations and informs putative physiological mechanisms regulating women's mental health. We review evidence from prospective studies reporting on associations between mental health conditions and the menopause transition. Major depressive disorder and the more prevalent subthreshold depressive symptoms are the most common conditions studied. We reviewed 12 prospective studies reporting depressive symptoms, major depressive disorder, or both over the menopause transition and found no compelling evidence for a universal increased risk for either condition. However, specific subgroups of participants, primarily defined by menopause-related risk factors (ie, vasomotor symptoms that are severe or disturb sleep, a long duration of the transition, or reproductive hormone dynamics) and psychosocial risk factors (eg, stressful life events), were vulnerable to depressive symptoms. The increased risk of major depressive disorder over the menopause transition appears predominantly in individuals with previous major depressive disorder. Greater focus on recognising risk factors in primary care is warranted. On the basis of scarce data, we found no compelling evidence that risk of anxiety, bipolar disorder, or psychosis is universally elevated over the menopause transition. Potential misattribution of psychological distress and psychiatric disorders to menopause could harm women by delaying accurate diagnosis and the initiation of effective psychotropic treatments, and by creating negative expectations for people approaching menopause. A paradigm shift is needed. We conclude with recommendations for the detection and treatment of depressive symptoms or major depressive disorder and strategies to promote good mental health over the menopause transition, while responsibly preparing and supporting those at risk.
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Affiliation(s)
- Lydia Brown
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; Academic Research Collaborative in Health, La Trobe University, Bundoora, VIC, Australia; Healthscope Hospitals, Melbourne, VIC, Australia.
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rong Chen
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Carolyn J Crandall
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | | | - Gita D Mishra
- NHMRC Centre for Research Excellence in Women and NCDs, School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Viktoria Rother
- Inner West Area Mental Health Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Hadine Joffe
- Connors Center for Women's Health and Gender Biology and Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha Hickey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia
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Lewis Johnson T, Rowland LM, Ashraf MS, Clark CT, Dotson VM, Livinski AA, Simon M. Key Findings from Mental Health Research During the Menopause Transition for Racially and Ethnically Minoritized Women Living in the United States: A Scoping Review. J Womens Health (Larchmt) 2024; 33:113-131. [PMID: 38079223 PMCID: PMC10880275 DOI: 10.1089/jwh.2023.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
Background: Racially and ethnically minoritized (REM) women experience social and structural factors that may affect their response to mental health treatment and menopausal symptoms during the menopause transition (MT). This scoping review on mental health during the MT for REM women in the United States was conducted to characterize factors associated with mental health challenges. Materials and Methods: Five databases were searched. Articles were included if focused on MT in REM women in the United States and its territories with specific mental illnesses and published in English from 2005 to 2021. Titles and abstracts and full text were screened. Screening and data collection were completed in duplicate by two reviewers in Covidence. Results: Sixty-five articles were included and indicate that REM women experience a disproportionate burden of depressive symptoms during the MT. Less evidence is reported about anxiety, Post-Traumatic Stress Disorder, psychosis, schizophrenia, and other mental illnesses. The risk factors associated with mental illness during MT are social, structural, and biological. Treatment response to therapeutic interventions is often underpowered to explain REM differences. Conclusion: Depression during the MT is associated with negative outcomes that may impact REM women differentially. Incorporating theoretical frameworks (e.g., intersectionality, weathering) into mental health research will reduce the likelihood that scientists mislabel race as the cause of these inequities, when racism and intersecting systems of oppression are the root causes of differential expression of mental illness among REM women during the MT. There is a need for interdisciplinary research to advance the mental health of REM women.
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Affiliation(s)
- Tamara Lewis Johnson
- Women's Mental Health Research Program, Office of Disparities Research and Workforce Diversity, National Institute of Mental Health, NIH, Rockville, Maryland, USA
| | - Laura M. Rowland
- Neuroscience of Mental Disorders and Aging Program, Division of Translational Research, National Institute of Mental Health, NIH, Rockville, Maryland, USA
| | - Mahela S. Ashraf
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Crystal T. Clark
- Department of Psychiatry, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Vonetta M. Dotson
- Department of Psychology and Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
| | - Alicia A. Livinski
- National Institutes of Health Library, Office of Research Services, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Melissa Simon
- Department of Obstetrics and Gynecology, Institute for Public Health, and Medicine (IPHAM)—Center for Health Equity Transformation, Northwestern University, Chicago, Illinois, USA
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Venborg E, Osler M, Jørgensen TSH. The association between postpartum depression and perimenopausal depression: A nationwide register-based cohort study. Maturitas 2023; 169:10-15. [PMID: 36621208 DOI: 10.1016/j.maturitas.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Emilie Venborg
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark.
| | - Merete Osler
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark; Center of Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Ndr. Fasanvej 57, 1st floor, building 14, 2000 Frederiksberg, Denmark.
| | - Terese Sara Høj Jørgensen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark; Center of Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Ndr. Fasanvej 57, 1st floor, building 14, 2000 Frederiksberg, Denmark.
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Luo Y, Yang P, Wan Z, Kang Y, Dong X, Li Y, Wang Y, Xie J, Duan Y. Dietary diversity, physical activity and depressive symptoms among middle-aged women: A cross-sectional study of 48,637 women in China. J Affect Disord 2023; 321:147-152. [PMID: 36330900 DOI: 10.1016/j.jad.2022.10.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Depression is the leading cause of mental health-related disease burden. This study aimed to investigate the relationship among dietary diversity, physical activity and depressive symptoms in middle-aged women. METHOD Based on the WHO guidelines on physical activity, subjects who meet moderate-intensity aerobic physical exercise of 150-300 min per week were qualified or otherwise unqualified. The dietary diversity scores (DDS) were developed according to the balanced diet pagoda and assessed the consumption of nine food groups. The total scores ranged from 0 to 9 and could divide into three levels: insufficient [DDS-1] (score of 1-5), moderate [DDS-2] (score of 6-7), and sufficient [DDS-3] (score of 8-9). RESULTS An age at menarche ≥12 years old (OR = 0.94; 95 % CI: 0.89-1.00; p < 0.05), a higher dietary diversity score [DDS-3] (OR = 0.59; 95 % CI: 0.55-0.63; p < 0.001), drinking coffee (OR = 0.88; 95 % CI: 0.84-0.92; p < 0.001), and qualified physical activity (OR = 0.69; 95 % CI: 0.66-0.72; p < 0.001) were protective factors for depressive symptoms, while an age at first birth ≤20 years old (OR = 1.23; 95 % CI: 1.12-1.36; p < 0.001) or ≥30 years old (OR = 1.18; 95 % CI: 1.11-1.26; p < 0.001), eating late-night snacks (OR = 1.44; 95 % CI: 1.36-1.52; p < 0.001), drinking sugar-sweetened beverages (OR = 1.15; 95 % CI: 1.06-1.24; p < 0.001), and overeating (OR = 2.30; 95 % CI: 2.069-2.56; p < 0.001) were risk factors. CONCLUSION This study suggested that dietary diversity and physical activity are associated with depressive symptoms in middle-aged women. To improve dietary diversity, attention should be given to dietary patterns and dietary habits, instead of simply increasing the amount of food.
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Affiliation(s)
- Yating Luo
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China; Xiangya School of Nursing, Central South University, Changsha, China
| | - Pingting Yang
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ziyu Wan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yue Kang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaoqian Dong
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Ying Li
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yaqin Wang
- Health Management Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jianfei Xie
- Department of Nursing, The Third Xiangya Hospital of Central South University, Changsha, China.
| | - Yinglong Duan
- Department of Nursing, The Third Xiangya Hospital of Central South University, Changsha, China.
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Antonelli A, Giannini A, Chedraui P, Monteleone P, Caretto M, Genazzani AD, Mannella P, Simoncini T, Genazzani AR. Mood disorders and hormonal status across women's life: a narrative review. Gynecol Endocrinol 2022; 38:1019-1027. [PMID: 36433781 DOI: 10.1080/09513590.2022.2149730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Depressive disorders and anxiety states represent one of the most frequent psychiatric pathologies occurring transiently in vulnerable women throughout their life, from puberty to menopause. It is now known that sex hormones play a key role on the nervous system, interfering with neuronal plasticity and enhancing the processes of learning, memory, cognition, and mood. Numerous mechanisms are at the base of these processes, displaying interactions between estrogen and serotoninergic, dopaminergic, and GABAergic receptors at the central level. Therefore, given the sexual steroids fluctuations throughout the entire female lifespan, and considering the role played by sex hormones at the central level, it is not surprising to observe the onset of mood or neurodegenerative disorders over time. This is especially true for women in hormonal transition phase, such as puberty, postpartum and the menopausal transition. Moreover, all these conditions are characterized by hormone withdrawal, imbalance, or modifications due to menopausal hormone therapies or contraceptives which could prompt to a deterioration of mood and cognition impairment or to an improvement in the quality of life. More studies are needed to better understand the hormone-related effects on the nervous system, and the underlying pathways involved in transitional or chronic mood disorders, to promote new patient-specific therapeutic strategies more effective than the current ones and tailored according to the individual need and women's life period.
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Affiliation(s)
- Alice Antonelli
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
- Facultad de Ciencias de la Salud, Universidad Católica "Nuestra Señora de la Asunción", Asunción, Paraguay
| | - Patrizia Monteleone
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Caretto
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro D Genazzani
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Mannella
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea R Genazzani
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Biopsychosocial risk factors of depression during menopause transition in southeast China. BMC Womens Health 2022; 22:273. [PMID: 35790958 PMCID: PMC9258098 DOI: 10.1186/s12905-022-01710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/11/2022] [Indexed: 12/05/2022] Open
Abstract
Objective More than 2 billion women are experiencing menopause transition in China and some of them suffered from depression; while the risk factors of depression during menopause transition were still unclearin China. We aimed to investigate the risk factors in mid-life women in Southeast China.
Method This study included 1748 Chinese women aged 40–65 years-old who visited gynecology outpatient department of Women’s hospital School of Medicine, Zhejiang University during 2010–2018. Demographic information was collected, and the modified Kupperman Menopausal Index (mKMI) and Hamilton Rating Scale for Depression were assessed. Circulating levels of sex hormones were tested. Ordinal logistic regression analysis was performed to identify risk factors for depression. Results The prevalence of depression symptoms was 47.43%. The majority of women had mild (38.56%) or moderate depressive symptoms (8.00%); only 0.86% had severe depressive symptoms. Compared with perimenopausal women, postmenopausal women had increased risks of more severe depression. The associations between menopausal syndromes and the intensity of depression were strongly positive (OR 6.69, 95% CI 5.39–8.29). Elder age, higher follicle stimulating hormone levels, lower estradiol levels, and fewer parity were positively related with the intensity of depression. Among postmenopausal women, underweight, mKMI > 14, earlier age at menopause, shorter reproductive period, and longer duration after menopause were risk factors for incresed intensity of depression. Conclusions The results demonstrated a high proportion of depression in women complaining of menopause. Menopausal symptoms were strongly related to the intensity of depression. In postmenopausal women, estrogen related events are associated with the intensity of depression. Gynecological endocrinologists in China should consider screening for depression in high-risk women. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01710-4.
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Weyman EA, McDonald IR, Blocker ES, Welt CK, Dwyer AA. Approach to Evaluation and Comprehensive Care for Primary Ovarian Insufficiency. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Song Q, Huang W, Ye W, Yan H, Wang L, Yang Y, Cheng X, Zhang W, Zheng J, He P, He Y, Fang D, Han X. Neuroprotective Effects of Estrogen Through BDNF-Transient Receptor Potential Channels 6 Signaling Pathway in the Hippocampus in a Rat Model of Perimenopausal Depression. Front Aging Neurosci 2022; 14:869274. [PMID: 35875795 PMCID: PMC9305198 DOI: 10.3389/fnagi.2022.869274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/07/2022] [Indexed: 12/18/2022] Open
Abstract
Estradiol (E2) has been proven to be effective in treating perimenopausal depression (PD); however, the downstream signaling pathways have not been fully elucidated. Transient receptor potential channels 6 (TRPC6) plays a vital role in promoting neuronal development and the formation of excitatory synapses. At present, we found that the serum levels of E2 and brain-derived neurotrophic factor (BDNF) declined significantly in the women with PD compared to perimenopausal women, which was accompanied by a clear reduction in TRPC6 levels. To further reveal the effects of TRPC6 on neuronal survival and excitability, the PD-like rat model was established by the total removal of left ovary and 80% removal of right ovary followed by 21 days of the chronic unpredictable mild stress. Intragastric administration of E2 (2 mg/kg), intraperitoneal injection of BDNF/TrB signaling pathway inhibitor (K252a, 100 μg/kg) and TRPC6 agonist (OAG, 0.6 mg/kg), and intracerebroventricular infusion of anti-BDNF antibody for blocking BDNF (0.5 μg/24 μl/rat) daily for 21 days were conducted. The levels of BDNF and TRPC6 in rat serum were lower in PD rats compared to the control rats; the depression-like behavior was induced, the neuronal death rate in the hippocampus increased, and the thickness of postsynaptic density (PSD) and the number of asymmetric synapses decreased significantly in the PD group. E2 treatment greatly upregulated the serum levels of BDNF and TRPC6, the neuronal excitability indicated by an elevation in the PSD thickness and the numbers of asymmetric synapses, and these actions were reversed by K252a; co-administration of TRPC6 agonist and K252a improved neuronal degeneration and increased the neuronal excitability induced in the E2-treated PD rats. K252a or anti-BDNF antibody inhibited the increased neuronal BDNF and TRPC6 expression in E2-treated PD rats; co-treatment of TRPC6 agonist and anti-BDNF antibody reduced neuronal death and increased the BDNF and TRPC6 expression in the hippocampal CA1 neurons in the E2-treated PD rats. These results suggest that the neuroprotective role of E2 in PD is closely related to enhance the activity of BDNF/TRPC6 pathway and is helpful to provide new prevention and strategies.
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Ilic I, Babic G, Dimitrijevic A, Sipetic Grujicic S, Ilic M. Predictors of depressive symptoms before and after diagnostic procedures in women with abnormal Pap smear attending cervical cancer screening programme in Serbia. Eur J Cancer Care (Engl) 2022; 31:e13634. [PMID: 35697508 DOI: 10.1111/ecc.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 04/07/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Receipt of a positive Papanicolaou screening result and subsequent referral for diagnostic tests can cause psychological stress. Still, not enough is known about depression before and after the diagnostic test in these women. The aim of this study was to determine the burden and predictors of depressive symptoms prior to and after diagnostic investigations in women who had received a positive Papanicolaou screening result. METHODS This was a cross-sectional study. Study cohort comprised women who received an abnormal Papanicolaou screening result. Women completed the socio-demographic questionnaire and 'The Center for Epidemiologic Studies Depression, CES-D' questionnaire before and after diagnostic tests (colposcopy/biopsy/endocervical curettage) to assess factors related to depression. RESULTS No significant difference was noted in the frequency of depressive symptoms (CES-D score ≥ 16) before and after diagnostic investigations, but the mean score on CES-D scale showed a significant difference before and after diagnostic investigations (13.98 ± 9.56 and 12.74 ± 9.15, respectively). A significant predictor of depression before diagnostic investigations was spontaneous abortion, whereas family history of other gynaecological cancers was a predictor of depression after diagnostic investigations. CONCLUSIONS Our findings could contribute to improving the rates of cervical cancer screening, by identifying women at risk for depression before and after investigations.
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Affiliation(s)
- Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Babic
- Department of Gynaecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandra Dimitrijevic
- Department of Gynaecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | - Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Kalinowski D, Bogus-Nowakowska K, Kozłowska A, Równiak M. Expression of Calbindin, a Marker of Gamma-Aminobutyric Acid Neurons, Is Reduced in the Amygdala of Oestrogen Receptor β-Deficient Female Mice. J Clin Med 2022; 11:jcm11071760. [PMID: 35407369 PMCID: PMC8999607 DOI: 10.3390/jcm11071760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/12/2022] [Accepted: 03/19/2022] [Indexed: 12/15/2022] Open
Abstract
Oestrogen receptor β (ERβ) knock-out female mice display increased anxiety and decreased threshold for synaptic plasticity induction in the basolateral amygdala. This may suggest that the γ-aminobutyric acid (GABA) inhibitory system is altered. Therefore, the immunoreactivity of main GABAergic markers-i.e., calbindin, parvalbumin, calretinin, somatostatin, α1 subunit-containing GABAA receptor and vesicular GABA transporter-were compared in the six subregions (LA, BL, BM, ME, CE and CO) of the amygdala of adult female wild-type and ERβ knock-out mice using immunohistochemistry and quantitative methods. The influence of ERβ knock-out on neuronal loss and glia was also elucidated using pan-neuronal and astrocyte markers. The results show severe neuronal deficits in all main amygdala regions in ERβ knock-out mice accompanied by astroglia overexpression only in the medial, basomedial and cortical nuclei and a decrease in calbindin-expressing neurons (CB+) in the amygdala in ERβ knock-out mice compared with controls, while other markers of the GABAergic system remain unchanged. Concluding, the lack of ERβ led to failure in the structural integrity of the CB+ subpopulation, reducing interneuron firing and resulting in a disinhibitory effect over pyramidal function. This fear-promoting excitatory/inhibitory alteration may lead to the increased anxiety observed in these mice. The impact of neuronal deficits and astroglia overexpression on the amygdala functions remains unknown.
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Affiliation(s)
- Daniel Kalinowski
- Department of Animal Anatomy and Physiology, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (K.B.-N.); (M.R.)
- Correspondence: ; Tel./Fax: +48-89-523-4301
| | - Krystyna Bogus-Nowakowska
- Department of Animal Anatomy and Physiology, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (K.B.-N.); (M.R.)
| | - Anna Kozłowska
- Department of Human Physiology and Pathophysiology, School of Medicine, University of Warmia and Mazury in Olsztyn, 10-082 Olsztyn, Poland;
| | - Maciej Równiak
- Department of Animal Anatomy and Physiology, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (K.B.-N.); (M.R.)
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13
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Menze ET, Ezzat H, Shawky S, Sami M, Selim EH, Ahmed S, Maged N, Nadeem N, Eldash S, Michel HE. Simvastatin mitigates depressive-like behavior in ovariectomized rats: Possible role of NLRP3 inflammasome and estrogen receptors' modulation. Int Immunopharmacol 2021; 95:107582. [PMID: 33774267 DOI: 10.1016/j.intimp.2021.107582] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/01/2021] [Accepted: 03/09/2021] [Indexed: 12/27/2022]
Abstract
It is well known that females are more vulnerable than males to stress-related psychiatric disorders, particularly during perimenopausal and postmenopausal periods. Hormone replacement therapy (HRT) has been widely used for the management of postmenopausal depression. However, HRT could be associated with severe adverse effects, including increased risk for coronary heart disease, breast cancer and endometrial cancer. Thus, there is a pressing demand for novel therapeutic options for postmenopausal depression without sacrificing uterine health. Simvastatin (SIM) was proven to have neuroprotective activities besides its hypocholesterolemic effect, the former can be attributed to its, antioxidant, anti-apoptotic and anti-inflammatory activities. Moreover, many reports highlighted that SIM has estrogenic activity and was able to induce the expression of estrogen receptors in rats. The present study showed that SIM (20 mg/kg, p.o.) markedly attenuated depressive-like behavior in ovariectomized (OVX) rats. Moreover, SIM prohibited hippocampal microglial activation, abrogated P2X7 receptor, TLR2 and TLR4 expression, inhibited NLRP3 inflammasome activation, with subsequent reduction in the levels of pro-inflammatory mediators; IL-1β and IL-18. Furthermore, a marked elevation in hippocampal expression of ERα and ERβ was noted in SIM-treated animals, without any significant effect on uterine relative weight or ERα expression. Taken together, SIM could provide a safer alternative for HRT for the management of postmenopausal depression, without any hyperplastic effect on the uterus.
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Affiliation(s)
- Esther T Menze
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Hager Ezzat
- Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Salma Shawky
- Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Marwa Sami
- Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Eman H Selim
- Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Samar Ahmed
- Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Nouran Maged
- Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Nancy Nadeem
- Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | | | - Haidy E Michel
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
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Depression, hormone therapy, and the menopausal transition among women aged 45 to 64 years using Canadian Longitudinal Study on aging baseline data. ACTA ACUST UNITED AC 2021; 27:763-770. [PMID: 32217892 DOI: 10.1097/gme.0000000000001540] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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15
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Intravenous ketamine for postmenopausal women with treatment-resistant depression: Results from the Canadian Rapid Treatment Center of Excellence. J Psychiatr Res 2021; 136:444-451. [PMID: 32948309 DOI: 10.1016/j.jpsychires.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/03/2020] [Accepted: 08/03/2020] [Indexed: 01/28/2023]
Abstract
Women are disproportionately represented amongst samples of adults with treatment-resistant depression (TRD). Ketamine has demonstrated rapid and robust efficacy in adults with TRD. Herein, we sought to determine whether the effectiveness of intravenous (IV) ketamine was influenced by menopausal status in women with TRD. We defined premenopausal women as those under the age of 45 (n = 52), while postmenopausal women (n = 54) were those over the age of 51. Participants received four IV ketamine infusions over one-to-two weeks at a community-based center for adults with TRD. The primary outcome of interest was the change in depressive symptom severity as measured by the Quick Inventory of Depressive Symptomatology Self-Report 16 (QIDS-SR16) following four infusions, compared to pretreatment. The secondary outcomes were improvements in suicidal ideation (SI; i.e., QIDS-SR16 SI item), anxiety (i.e., Generalized Anxiety Disorder-7 scale), anhedonic severity (i.e., Snaith-Hamilton Pleasure Scale), and workplace and psychosocial function (i.e., Sheehan Disability Scale). Menopausal status did not influence overall treatment response, F (4, 280) = 1.83, p = .123, ηp2 = 0.025. Both premenopausal and postmenopausal participants demonstrated similar response rates (30% and 26%, respectively) and remission rates (both 13%) to IV ketamine treatment following four infusions. Premenopausal women experienced improvements in social function more rapidly than postmenopausal women, F (2, 174) = 1.65, p = .047, ηp2 = 0.019. Postmenopausal women experienced reduction in SI more rapidly than premenopausal women, F (4, 280) = 2.72, p = .030, ηp2 = 0.037. These preliminary post-hoc findings provide the impetus for future studies to investigate the moderational role of menopausal status, as defined by hormone levels, on response to IV ketamine for TRD.
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16
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Treatment-Resistant Depression Revisited: A Glimmer of Hope. J Pers Med 2021; 11:jpm11020155. [PMID: 33672126 PMCID: PMC7927134 DOI: 10.3390/jpm11020155] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 12/20/2022] Open
Abstract
Major Depressive Disorder (MDD) is a highly prevalent psychiatric disorder worldwide. It causes individual suffering, loss of productivity, increased health care costs and high suicide risk. Current pharmacologic interventions fail to produce at least partial response to approximately one third of these patients, and remission is obtained in approximately 30% of patients. This is known as Treatment-Resistant Depression (TRD). The burden of TRD exponentially increases the longer it persists, with a higher risk of impaired functional and social functioning, vast losses in quality of life and significant risk of somatic morbidity and suicidality. Different approaches have been suggested and utilized, but the results have not been encouraging. In this review article, we present new approaches to identify and correct potential causes of TRD, thereby reducing its prevalence and with it the overall burden of this disease entity. We will address potential contributory factors to TRD, most of which can be investigated in many laboratories as routine tests. We discuss endocrinological aberrations, notably, hypothalamic-pituitary-adrenal (HPA) axis dysregulation and thyroid and gonadal dysfunction. We address the role of Vitamin D in contributing to depression. Pharmacogenomic testing is being increasingly used to determine Single Nucleotide Polymorphisms in Cytochrome P450, Serotonin Transporter, COMT, folic acid conversion (MTHFR). As the role of immune system dysregulation is being recognized as potentially a major contributory factor to TRD, the measurement of C-reactive protein (CRP) and select immune biomarkers, where testing is available, can guide combination treatments with anti-inflammatory agents (e.g., selective COX-2 inhibitors) reversing treatment resistance. We focus on established and emerging test procedures, potential biomarkers and non-biologic assessments and interventions to apply personalized medicine to effectively manage treatment resistance in general and TRD specifically.
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17
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Wang G, Li Y, Lei C, Lei X, Zhu X, Yang L, Zhang R. Quercetin exerts antidepressant and cardioprotective effects in estrogen receptor α-deficient female mice via BDNF-AKT/ERK1/2 signaling. J Steroid Biochem Mol Biol 2021; 206:105795. [PMID: 33246157 DOI: 10.1016/j.jsbmb.2020.105795] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/13/2020] [Accepted: 11/17/2020] [Indexed: 12/23/2022]
Abstract
Brain-derived neurotrophic factor (BDNF) is the potential link between depression and cardiovascular disease and estrogen receptor α (ERα), an estrogen-mediated major regulator, plays an important role in protecting against depression and cardiovascular disease. However, the relationship between BDNF and ERα remains obscure. Herein, quercetin (QUE), a kind of plant flavonoids and existed in many vegetables and fruits, was found to simultaneously reverse ERα-/--induced depression-like and cardiac dysfunction by reducing immobility time in the tail suspension test (TST) and forced swimming test (FST), and decreasing systolic blood pressure and activating the apoptosis-related proteins, BDNF, tropomyosin-related kinase B (TrkB), protein kinase B (AKT), and extracellular regulatory protein kinase (ERK1/2) in the hippocampal and cardiac tissues of female mice. These findings suggested that ERα might be involved in the regulation of BDNF activity, thereby regulating depression-like and cardiovascular responses in female mice, and QUE exerted significant antidepressant and cardioprotective effects, at least in part, through BDNF-TrkB-AKT/ERK1/2 to effectively inhibit ERα-/--induced hippocampal and cardiac dysfunction.
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Affiliation(s)
- Guoli Wang
- College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Yunchuan Li
- College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Cong Lei
- College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Xiaotong Lei
- College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Xiaofeng Zhu
- Department of the First Affiliated Hospital, Jinan University, Guangzhou 510632, China; College of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, China
| | - Li Yang
- College of Pharmacy, Jinan University, Guangzhou 510632, China.
| | - Ronghua Zhang
- College of Pharmacy, Jinan University, Guangzhou 510632, China.
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18
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Lambrinoudaki I, Paschou SA, Lumsden MA, Faubion S, Makrakis E, Kalantaridou S, Panay N. Premature ovarian insufficiency: a toolkit for the primary care physician. Climacteric 2021; 24:425-437. [PMID: 33434082 DOI: 10.1080/13697137.2020.1859246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Premature ovarian insufficiency (POI) refers to the loss of ovarian activity before the age of 40 years, which leads to hypoestrogenism and amenorrhea. The diagnosis of POI in a young woman has potentially life-changing physical and emotional consequences for both the patient and her family. Therefore, it is very important that the diagnosis is correct and that it is made in a timely manner. Unfortunately, the diagnosis and therefore the effective treatment of POI are often delayed, which underlines the need for education of the broad medical community on the issue. A panel of menopause experts reviewed and critically appraised the literature, and present: (1) the diagnostic approach to POI, (2) the investigation of the etiology of this condition, (3) the therapeutic strategy regarding both hormone replacement therapy and fertility, and (4) the long-term follow-up and management for ensuring quality of life, as well as urogenital, cardiovascular, bone and mental health. The ultimate goal of this article is to provide a complete toolkit for the primary care physician to have easy access to all the information needed for the optimal management of women with POI, in the context of evidence-based and personalized medicine.HIGHLIGHTSPremature ovarian insufficiency occurs in 1% of the female population of reproductive age, yet the diagnosis is often delayed, with severe physical and emotional consequences for the patient.Primary care physicians should be aware of the possibility of premature ovarian insufficiency in young women presenting with menstrual irregularity.Prompt initiation of hormone replacement therapy ensures quality of life and prevents osteoporosis and cardiovascular disease.Women seeking fertility should be referred to specialists to discuss assisted reproduction options.
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Affiliation(s)
- I Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S A Paschou
- 2nd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M A Lumsden
- Gynaecology and Medical Education, University of Glasgow, Glasgow, UK
| | - S Faubion
- Mayo Clinic Center for Women's Health, Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - E Makrakis
- 3rd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Kalantaridou
- 3rd Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - N Panay
- Queen Charlotte's & Chelsea and Chelsea and Westminster Hospitals, Imperial College, London, UK
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19
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Premature ovarian insufficiency: A toolkit for the primary care physician. Maturitas 2021; 147:53-63. [PMID: 33451805 DOI: 10.1016/j.maturitas.2020.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022]
Abstract
Premature ovarian insufficiency (POI) refers to the loss of ovarian activity before the age of 40 years, which leads to hypoestrogenism and amenorrhoea. The diagnosis of POI in a young woman has potentially life-changing physical and emotional consequences for both the patient and her family. Therefore, it is very important that the diagnosis is correct and that it is made in a timely manner. Unfortunately, the diagnosis and therefore the effective treatment of POI are often delayed, which underlines the need for education of the broad medical community on the issue. A panel of menopause experts reviewed and critically appraised the literature, and present: 1) the diagnostic approach to POI, 2) the investigation of the etiology of this condition, 3) the therapeutic strategy regarding both hormone replacement therapy (HRT) and fertility and 4) the long-term follow-up and management for ensuring quality of life, as well as urogenital, cardiovascular, bone and mental health. The ultimate goal is to provide a complete toolkit for the primary care physician to have easy access to all the information needed for the optimal management of women with POI, in the context of evidence-based and personalized medicine.
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20
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Kim K. Identifying the Factors That Affect Depressive Symptoms in Middle-Aged Menopausal Women: A Nationwide Study in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8505. [PMID: 33212823 PMCID: PMC7698336 DOI: 10.3390/ijerph17228505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022]
Abstract
Depressive symptoms do not persistently negatively affect functioning throughout the life span, but they may affect quality of life (QOL), especially in middle-aged women. Therefore, this study aimed to investigate the factors associated with depressive symptoms in premenopausal and postmenopausal women. This descriptive study was a secondary analysis of the data from the seventh Korea National Health and Nutrition Examination Survey that was conducted in 2016. Of the 8150 participants, the analysis included 644 premenopausal women and 459 postmenopausal women aged 40-60 years. The factors associated with depressive symptoms in the participants were examined using multivariate regression analysis. It was found that the depressive symptoms of postmenopausal middle-aged women were greater than those of premenopausal women. While a high perceived stress status and high pain-related discomfort were factors that influenced depressive symptoms among the premenopausal group, a high level of discomfort due to anxiety/depression, a poor perceived health status, shortened weekend sleep time, and smoking were associated with depressive symptoms in the postmenopausal group. Thus, it is necessary to develop an intervention to decrease depressive symptoms in postmenopausal women that considers their QOL, which is associated with depression, their subjective health status, sleep time, and smoking cessation.
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Affiliation(s)
- Kisook Kim
- Department of Nursing, Chung-Ang University, Seoul 06974, Korea
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21
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Jiao-Tai-Wan Ameliorates Depressive-Like Behavior through the A 1R Pathway in Ovariectomized Mice after Unpredictable Chronic Stress. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1507561. [PMID: 33015153 PMCID: PMC7519999 DOI: 10.1155/2020/1507561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022]
Abstract
Objective This study was aimed at observing the effect Jiao-Tai-Wan in menopausal depression. Methods In this paper, we used ovariectomized mice subjected to chronic unpredictable stress as a menopausal depression model. After the chronic stress, mice were administrated with JTW (3.3 and 6.6mg/kg) and imipramine (10 mg/kg) for 14 days. On the 14th day, mice were subjected to the behavior test like the forced swim test, tail suspension test, and locomotor activity or were sacrificed to assess the protein changes in different brain regions. Results The administration of JTW at doses of 3.3 and 6.6mg/kg (p.o.) significantly shortened the duration of immobility in forced swim and tail suspension tests. There was no obvious difference in locomotor activity among all the groups. The western blot analysis data indicated that treatment with JTW (3.3 and 6.6 mg/kg, p.o.) prominently increased the A1R protein and the downstream protein ERK1/2 levels in the prefrontal cortex and hippocampus. However, the administration of JTW did not influence c-Fos protein in either the prefrontal cortex or hippocampus. Conclusion Our findings suggest that JTW plays a vital role in ameliorating menopausal depression symptoms in the A1R-ERK1/2 pathway in the prefrontal cortex and hippocampus.
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22
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Bailey SC, Andrews EN, Halton CC, Wolf MS. Evaluation of a Discussion Guide to Promote Patient Understanding of Menopause and Informed Treatment Decision-Making. J Womens Health (Larchmt) 2020; 30:445-451. [PMID: 32857643 DOI: 10.1089/jwh.2020.8436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Patient-provider communication surrounding menopause symptoms and treatment is often limited. We developed and evaluated a health literacy-appropriate discussion guide to support patient education. Materials and Methods: A cross-sectional randomized study was conducted among 100 English-speaking women, aged 45-60 years, in Chicago, IL, and Durham, NC. Participants were randomly assigned to review either the discussion guide or a standard education material (n = 50 per arm) and to complete an open book knowledge questionnaire; they then rated the appearance and quality of both materials. Bivariate analyses examined knowledge and satisfaction by study arm and across sociodemographic characteristics. Multivariable models tested the effectiveness of the discussion guide to improve knowledge compared with the standard material. Results: Women receiving the discussion guide demonstrated significantly higher knowledge scores compared with those who reviewed the standard material (mean [M] = 20.0, standard deviation [SD] = 2.7, vs. M = 18.1, SD = 2.6; p < 0.001); 82.0% of those exposed to the discussion guide correctly answered ≥85% of knowledge items compared with only 48.0% of those reviewing the standard material (p < 0.001). In multivariable analyses, participants receiving the discussion guide displayed significantly greater knowledge in comparison with those receiving the standard material regardless of whether knowledge was examined as a score (∝ = 1.9, 95% confidence interval [CI]: 0.9-2.9, p < 0.001) or 85% threshold (odds ratio: 5.7, 95% CI: 2.0-16.2, p < 0.001). More than two-thirds of women (68%) preferred the discussion guide; it was rated highly in terms of appearance and content. Conclusions: The discussion guide improved understanding of menopause symptoms and treatment options in comparison with a current standard and was well received by a diverse audience.
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Affiliation(s)
- Stacy Cooper Bailey
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emma N Andrews
- U.S./Global Medical Affairs, Pfizer, Inc., New York, New York, USA
| | - Candida C Halton
- School of Social Sciences, University of Westminster, London, United Kingdom.,Consultant at Studio Health, London, United Kingdom
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Bartz D, Chitnis T, Kaiser UB, Rich-Edwards JW, Rexrode KM, Pennell PB, Goldstein JM, O'Neal MA, LeBoff M, Behn M, Seely EW, Joffe H, Manson JE. Clinical Advances in Sex- and Gender-Informed Medicine to Improve the Health of All: A Review. JAMA Intern Med 2020; 180:574-583. [PMID: 32040165 DOI: 10.1001/jamainternmed.2019.7194] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Biological sex and sociocultural gender represent major sources of diversity among patients, and recent research has shown the association of sex and gender with health. A growing body of literature describes widespread associations of sex and gender with cells, organs, and the manner in which individual patients interact with health care systems. Sex- and gender-informed medicine is a young paradigm of clinical practice and medical research founded on this literature that considers the association of sex and gender with each element of the disease process from risk, to presentation, to response to therapy. OBSERVATIONS Characteristics that underlie sex and gender involve both endogenous and exogenous factors that change throughout the life course. This review details clinical examples with broad applicability that highlight sex and gender differences in the key domains of genetics, epigenomic modifiers, hormonal milieu, immune function, neurocognitive aging process, vascular health, response to therapeutics, and interaction with health care systems. These domains interact with one another in multidimensional associations, contributing to the diversity of the sex and gender spectra. Novel research has identified differences of clinical relevance with the potential to improve care for all patients. CONCLUSIONS AND RELEVANCE Clinicians should consider incorporating sex and gender in their decision-making to practice precision medicine that integrates fundamental components of patient individuality. Recognizing the biological and environmental factors that affect the disease course is imperative to optimizing care for each patient. Research highlights the myriad ways sex and gender play a role in health and disease. However, these clinically relevant insights have yet to be systematically incorporated into care. The framework described in this review serves as a guide to help clinicians consider sex and gender as they practice precision medicine.
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Affiliation(s)
- Deborah Bartz
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tanuja Chitnis
- Harvard Medical School, Boston, Massachusetts.,Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ursula B Kaiser
- Harvard Medical School, Boston, Massachusetts.,Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Janet W Rich-Edwards
- Harvard Medical School, Boston, Massachusetts.,Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kathryn M Rexrode
- Harvard Medical School, Boston, Massachusetts.,Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Page B Pennell
- Harvard Medical School, Boston, Massachusetts.,Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jill M Goldstein
- Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary Angela O'Neal
- Harvard Medical School, Boston, Massachusetts.,Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Meryl LeBoff
- Harvard Medical School, Boston, Massachusetts.,Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Maya Behn
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ellen W Seely
- Harvard Medical School, Boston, Massachusetts.,Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hadine Joffe
- Harvard Medical School, Boston, Massachusetts.,Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - JoAnn E Manson
- Harvard Medical School, Boston, Massachusetts.,Mary Horrigan Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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25
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Raglan GB, Schulkin J, Micks E. Depression during perimenopause: the role of the obstetrician-gynecologist. Arch Womens Ment Health 2020; 23:1-10. [PMID: 30758732 DOI: 10.1007/s00737-019-0950-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/31/2019] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Greta B Raglan
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jay Schulkin
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE Pacific St., Box 356460, Seattle, WA, 98195-6460, USA
| | - Elizabeth Micks
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE Pacific St., Box 356460, Seattle, WA, 98195-6460, USA.
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26
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Cao LH, Qiao JY, Huang HY, Fang XY, Zhang R, Miao MS, Li XM. PI3K-AKT Signaling Activation and Icariin: The Potential Effects on the Perimenopausal Depression-Like Rat Model. Molecules 2019; 24:E3700. [PMID: 31618892 PMCID: PMC6832648 DOI: 10.3390/molecules24203700] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 12/17/2022] Open
Abstract
Icariin is a prenylated flavonol glycoside isolated from Epimedium herb, and has been shown to be its main bioactive component. Recently, the antidepressant-like mechanism of icariin has been increasingly evaluated and demonstrated. However, there are few studies that have focused on the involvement of the phosphatidylinositol 3-kinase (PI3K)/serine-threonine protein kinase (AKT) signaling in mediating the perimenopausal depression effects of icariin. Perimenopausal depression is a chronic recurrent disease that leads to an increased risk of suicide, and poses a significant risk to public health. The aim of the present study was to explore the effect of icariin on the expression of the PI3K-AKT pathway related to proteins in a rat model of perimenopausal depression. Eighty percent of the left ovary and the entire right ovary were removed from the model rats. A perimenopausal depression model was created through 18 days of chronic unpredictable stimulation, followed by the gavage administration of target drugs for 30 consecutive days. We found that icariin administered at various doses significantly improved the apparent symptoms in the model rats, increased the organ indices of the uterus, spleen, and thymus, and improved the pathological changes in the ovaries. Moreover, icariin administration elevated the serum levels of female hormone estradiol (E2), testosterone (T), and interleukin (IL)-2, decreased those of follicle stimulating hormone (FSH) and luteotropic hormone (LH), promoted the expression levels of estrogen receptor (ER) and ERα in the hypothalamus, and increased those of serotonin (5-HT), dopamine (DA), and noradrenaline (NA) in the brain homogenate. Furthermore, icariin elevated the expression levels of AKT, phosphorylation-akt (p-AKT), PI3K (110 kDa), PI3K (85 kDa), and B-cell lymphoma 2 (Bcl-2) in the ovaries, and inhibited those of Bax. These results show that icariin administration rebalanced the disordered sex hormones in perimenopausal depression rats, regulated the secretion of neurotransmitters in the brain, boosted immune function, and improved the perimenopausal syndrome. The mechanism of action may be related to the regulation of the expression of PI3K-AKT pathway-related proteins.
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Affiliation(s)
- Li-Hua Cao
- International TCM Immunopharmacology Research Center, Henan University of Chinese Medicine, Zhengzhou 450046, China.
| | - Jing-Yi Qiao
- International TCM Immunopharmacology Research Center, Henan University of Chinese Medicine, Zhengzhou 450046, China.
- Department of Pharmacology, Henan University of Chinese Medicine, Zhengzhou 450046, China.
| | - Hui-Yuan Huang
- Department of Pharmacology, Henan University of Chinese Medicine, Zhengzhou 450046, China.
| | - Xiao-Yan Fang
- Department of Pharmacology, Henan University of Chinese Medicine, Zhengzhou 450046, China.
| | - Rui Zhang
- Department of Pharmacology, Henan University of Chinese Medicine, Zhengzhou 450046, China.
| | - Ming-San Miao
- International TCM Immunopharmacology Research Center, Henan University of Chinese Medicine, Zhengzhou 450046, China.
- Department of Pharmacology, Henan University of Chinese Medicine, Zhengzhou 450046, China.
| | - Xiu-Min Li
- Microbiology and Immunology Department, New York Medical College, Valhalla, NY 10595, USA.
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27
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Garay RP, Charpeaud T, Logan S, Hannaert P, Garay RG, Llorca PM, Shorey S. Pharmacotherapeutic approaches to treating depression during the perimenopause. Expert Opin Pharmacother 2019; 20:1837-1845. [PMID: 31355688 DOI: 10.1080/14656566.2019.1645122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Introduction: Although postnatal depression is now well recognized, there is also a risk of depressive symptoms during perimenopause. The mechanisms underlying perimenopausal depression are still poorly understood; however, there are available treatment options. Areas covered: This review describes: the current pharmacotherapeutic approaches for perimenopausal depression, their strengths and weakness, and provides recommendations on how current treatment can be improved in the future. An electronic search identified specific guidelines for the treatment of perimenopausal depression released in 2018, as well as recent clinical studies on the subject. Expert opinion: The 2018 guidelines recommend selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) as front-line medications for perimenopausal depression, but SSRIs and SNRIs are not always effective. The efficacy of estrogen in perimenopausal depression is well documented, but estrogen is not FDA-approved to treat mood disturbances in perimenopausal women. Clinical practice guidelines currently recommend to restrict hormone therapy to the symptomatic treatment of menopause (not for the prevention of chronic diseases). Research with new estrogenic compounds is under way to improve their benefit/risk ratio in perimenopausal depression.
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Affiliation(s)
- Ricardo P Garay
- Department of Pharmacology and Therapeutics , Craven , France.,CNRS, National Centre of Scientific Research , Paris , France
| | | | - Susan Logan
- Department of Obstetrics & Gynecology, National University Hospital , Singapore , Singapore
| | | | | | | | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore , Singapore , Singapore
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Abstract
Hormones impact on cognition, emotions, and behaviour. Given that mental disorders are defined by abnormalities in these very same domains, clinical psychologists may benefit from learning more about alterations in endocrine systems, how they can contribute to symptoms commonly experienced by patients, and how such knowledge may be put to use in clinical practice.
The aim of the present scientific update was to provide a brief overview of endocrine research relevant to the aetiology, diagnostics, and treatment of mental disorders, including some of the latest studies in this area.
Hormones appear to be intrinsic to the development and maintenance of mental disorders. Oxytocin is involved in social cognition and behaviour and as such may be relevant to mental disorders characterised by social deficits (e.g., autism spectrum disorder and schizophrenia). Stress and sex steroids exert demonstrable effects on mood and cognition. In patients with depression and anxiety disorders, initial attempts to lower/enhance such hormones have thus been undertaken within conventional therapies in order to improve outcomes. Finally, hunger and satiety hormones may be involved in the vicious circle of dysfunctional eating behaviours and weight loss/gain in anorexia or bulimia nervosa.
Three conclusions can be drawn from this review: First, endocrine research should be considered when patients and clinicians are developing multidimensional illness models together. Second, endocrine markers can complement conventional assessments to provide a more comprehensive account of a patient’s current state. Third, endocrine testing may guide treatment choices and inform the development of novel treatments.
Hormones are intrinsic to the development and maintenance of mental disorders
Endocrine research should be incorporated into multidimensional illness models
Endocrine markers can complement conventional diagnostic assessments
Endocrine testing may guide treatment choices and inform the development of new treatments
Hormones are intrinsic to the development and maintenance of mental disorders
Endocrine research should be incorporated into multidimensional illness models
Endocrine markers can complement conventional diagnostic assessments
Endocrine testing may guide treatment choices and inform the development of new treatments
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Thériault RK, Perreault ML. Hormonal regulation of circuit function: sex, systems and depression. Biol Sex Differ 2019; 10:12. [PMID: 30819248 PMCID: PMC6394099 DOI: 10.1186/s13293-019-0226-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/18/2019] [Indexed: 01/10/2023] Open
Abstract
Major depressive disorder (MDD) is a debilitating chronic illness that is two times more prevalent in women than in men. The mechanisms associated with the increased female susceptibility to depression remain poorly characterized. Aberrant neuronal oscillatory activity within the putative depression network is an emerging mechanism underlying MDD. However, innate sex differences in network activity and its contribution to depression vulnerability have not been well described. In this review, current evidence of sex differences in neuronal oscillatory activity, including the influence of sex hormones and female cycling, will first be described followed by evidence of disrupted neuronal circuit function in MDD and the effects of antidepressant treatment. Lastly, current knowledge of sex differences in MDD-associated aberrant circuit function and oscillatory activity will be highlighted, with an emphasis on the role of sex steroids and female cycling. Collectively, it is clear that there are significant gaps in the literature regarding innate and pathologically associated sex differences in network activity and that the elucidation of these differences is invaluable to our understanding of sex-specific vulnerabilities and therapies for MDD.
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Affiliation(s)
- Rachel-Karson Thériault
- Department of Molecular and Cellular Biology, University of Guelph (ON), 50 Stone Rd. E, Guelph, Ontario N1G 2W1 Canada
- Collaborative Neuroscience Program, University of Guelph (ON), Guelph, Canada
| | - Melissa L. Perreault
- Department of Molecular and Cellular Biology, University of Guelph (ON), 50 Stone Rd. E, Guelph, Ontario N1G 2W1 Canada
- Collaborative Neuroscience Program, University of Guelph (ON), Guelph, Canada
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30
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Bromberger JT, Epperson CN. Depression During and After the Perimenopause: Impact of Hormones, Genetics, and Environmental Determinants of Disease. Obstet Gynecol Clin North Am 2018; 45:663-678. [PMID: 30401549 PMCID: PMC6226029 DOI: 10.1016/j.ogc.2018.07.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vulnerability to depression is increased across the menopause transition and in the early years after the final menstrual period. Clinicians should systematically screen women in this age group; if depressive symptoms or disorder are present, treatment of depression should be initiated. Potential treatments include antidepressants for moderate to severe symptoms, psychotherapy to target psychological and interpersonal factors, and hormone therapy for women with first-onset major depressive disorder or elevated depressive symptoms and at low risk for adverse effects. Behavioral interventions can improve physical activity and sleep patterns.
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Affiliation(s)
- Joyce T Bromberger
- Department of Epidemiology, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA; Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Cynthia Neill Epperson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA; Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA; Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
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31
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Fang YY, Zeng P, Qu N, Ning LN, Chu J, Zhang T, Zhou XW, Tian Q. Evidence of altered depression and dementia-related proteins in the brains of young rats after ovariectomy. J Neurochem 2018; 146:703-721. [DOI: 10.1111/jnc.14537] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/01/2018] [Accepted: 06/19/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Ying-Yan Fang
- Department of Pathology and Pathophysiology; School of Basic Medicine; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Institute for Brain Research; Huazhong University of Science and Technology; Wuhan China
| | - Peng Zeng
- Department of Pathology and Pathophysiology; School of Basic Medicine; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Institute for Brain Research; Huazhong University of Science and Technology; Wuhan China
| | - Na Qu
- Institute for Brain Research; Huazhong University of Science and Technology; Wuhan China
- Affiliated Mental Health Center; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Lin-Na Ning
- Department of Pathology and Pathophysiology; School of Basic Medicine; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Institute for Brain Research; Huazhong University of Science and Technology; Wuhan China
| | - Jiang Chu
- Department of Pathology and Pathophysiology; School of Basic Medicine; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Institute for Brain Research; Huazhong University of Science and Technology; Wuhan China
| | - Teng Zhang
- Department of Pathology and Pathophysiology; School of Basic Medicine; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Institute for Brain Research; Huazhong University of Science and Technology; Wuhan China
| | - Xin-Wen Zhou
- Department of Pathology and Pathophysiology; School of Basic Medicine; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Institute for Brain Research; Huazhong University of Science and Technology; Wuhan China
| | - Qing Tian
- Department of Pathology and Pathophysiology; School of Basic Medicine; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Institute for Brain Research; Huazhong University of Science and Technology; Wuhan China
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32
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Grochans E, Szkup M, Kotwas A, Kopeć J, Karakiewicz B, Jurczak A. Analysis of Sociodemographic, Psychological, and Genetic Factors Contributing to Depressive symptoms in Pre-, Peri- and Postmenopausal Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040712. [PMID: 29642625 PMCID: PMC5923754 DOI: 10.3390/ijerph15040712] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/05/2018] [Accepted: 04/07/2018] [Indexed: 12/13/2022]
Abstract
Depressive symptoms that are faced by women in the pre-, peri-, and postmenopausal periods are determined by a wide array of sociodemographic, psychological, and biological variables. The aim of our study was to identify factors that contribute to depressive problems at this stage of life. The study included 815 healthy Polish women aged 45–60 years. The survey part was conducted using the Beck Depression Inventory (BDI), the State–Trait Anxiety Inventory (STAI), the Neuroticism–Extroversion–Openness Five Factor Inventory (NEO-FFI), and a self-developed questionnaire. Genetic analysis was also performed. Depressive symptoms were observed in 25.5% of participants. 70% of the women were postmenopausal. No statistically significant differences in the severity of depressive symptoms were demonstrated with regard to genetic variables (p > 0.05). Reproductive capacity (p < 0.001), employment (p < 0.001), and being married (p < 0.018) were found to reduce the incidence of depressive symptoms. The contribution of personality and anxiety as a trait to depressive symptoms varied. Conclusions: The factors predisposing pre-, peri-, and postmenopausal women to depressive symptoms include lower education, lack of a life partner, unemployment, high anxiety, and neurotic personality. No evidence was found for the contribution of genetic factors to depressive symptoms in the examined women.
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Affiliation(s)
- Elżbieta Grochans
- Department of Nursing, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland.
| | - Małgorzata Szkup
- Department of Nursing, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland.
| | - Artur Kotwas
- Department of Public Health, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland.
| | - Jacek Kopeć
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, 2206 East Mall Vancouver, BC V6T 1Z3, Canada.
| | - Beata Karakiewicz
- Department of Public Health, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland.
| | - Anna Jurczak
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland.
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33
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