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 Researchers found that women with depressive symptoms were also more
likely to have money worries, caregiving responsibilities or chronic
health conditions, suggesting there are many issues that could
contribute to depression in this age group. Treatment for depression
should therefore address the hormonal problems in this mix that are
modifiable, the study team writes in Menopause.
“Other studies had already shown that when women were perimenopausal
or early postmenopausal that there is an increased vulnerability to
depressive symptoms,” senior study author Susan Davis told Reuters
Health by email.
“We were interested in whether hot flushes were indicative of
heightened vulnerability - and we found this to be the case,” said
Davis, a researcher with the School of Public Health and Preventive
Medicine at Monash University in Melbourne.
Davis and colleagues enrolled more than 1,500 mostly white women
between the ages of 65 and 79 who were randomly selected from
Australian voter rolls.
The women answered questionnaires that asked about life and
financial circumstances, relationships, health problems and
medication use. They also asked about post-menopausal symptoms
including hot flashes, night sweats and pain during intercourse, as
well as about depressive symptoms and recent use of anti-depressant
medications.
One of every three women reported having hot flashes, which also
increased their risk of depressive symptoms by 67 percent compared
to women without hot flashes.
One in four women had used a psychotropic medication such as an
antidepressant in the previous month.
Women with partners were about 40 percent less likely to have
depression symptoms compared to women who were alone. Women who were
employed had less than half the risk of depressive symptoms compared
to women who were unemployed.
While hot flashes, vaginal dryness and pelvic floor dysfunction were
each independently associated with depression risk, the study cannot
prove that these or any other factors examined in the analysis cause
depression.
Davis, however, said loss of estrogen could be a contributor.
“Estrogen has major central effects in the brain and the sudden fall
in estrogen at menopause can cause some women to become profoundly
anxious (or depressed)," she said. "After childbirth the sudden drop
in hormones can have the same effect.”
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Older women with hot flashes, vaginal dryness or pelvic floor
concerns should be evaluated for depression, "particularly if they
have financial housing issues or significant caregiving
responsibilities,” Dr. JoAnn Pinkerton, who wasn’t involved in the
study, told Reuters Health by email.
“Women going through the menopause are four times more likely to
suffer from depression than women who are younger than 45,” said
Pinkerton, an obstetrician-gynecologist in Charlottesville,
Virginia, and executive director of the North American Menopause
Society
Depression is not anxiety, bouts of sadness, low mood or mood swings
but a mental disorder defined by the feeling of extreme sadness
lasting for more than two weeks, often with no specific cause, and
which interferes with everyday life, Pinkerton said.
As far as treatment, evidence doesn't support hormone therapy as a
first treatment of depression, although it is often used along with
counseling or antidepressants, she noted.
“For more severe depression, antidepressant medications can be used
to correct the chemical imbalance and some have been found to
relieve hot flashes. If depression is severe, antidepressant
medication is most effective when used in combination with
counseling or psychotherapy,” she said.
For mild to moderate depression, herbal remedies such as St. John’s
wort, cognitive behavioral therapy and lifestyle changes may be
helpful, such as prioritizing tasks, exercising, engaging in
activities, recognizing the effect of stress on your mood, she said.
Women with a history of perimenopause-related depression that
improves on hormone therapy need to be monitored after hormone
therapy is stopped, as their depressive symptoms may recur,
Pinkerton added.
SOURCE: http://bit.ly/2tMbazm Menopause, June 19, 2017.
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