Does Depression Affect Menopausal Symptoms?
Sandra R. Leiblum, PhD
Published: 08/06/2009
Medscape

Summary

Reed SD, Ludman EJ, Newton KM, et al. Depressive symptoms and menopausal burden in the midlife. Maturitas 2009;62:306-310. Abstract copyright ? 2009 Elsevier. All rights reserved. Used with permission.

Objective: The goal of this study was to assess whether menopausal symptoms were more common and/or more severe among women with depressive symptoms.
Methods: A cross-sectional survey of 1358 women, ages 45-70, at two large integrated health plans (Seattle; Boston) was performed. Information on demographics, medical and reproductive history, medication use, menopausal experience and depressive symptoms (PHQ-8) were collected. Women taking HT were excluded. Logistic regression models adjusted for age and body mass index tested the associations between menopausal symptoms (hot flushes, night sweats, vaginal dryness and dyspareunia) and presence of moderate/severe depressive symptoms.

Results: 770 women were included; 98 (12.7%) had moderate/severe depressive symptoms and 672 (87.3%) had no/mild depressive symptoms. Women with moderate/severe depressive symptoms were almost twice as likely to report recent vasomotor symptoms (hot flashes and or night sweats) vs. women with no/mild depressive symptoms (adjusted odds ratio (aOR) 1.67, 95%CI 1.04-2.68), and to report them as severe (aOR 1.63, 95%CI 0.95-2.83). A higher symptom burden was observed despite the fact that 20% of women with moderate/severe depressive symptoms (vs. 4.6% no/mild depressive symptoms) were using an SSRI or SNRI, medications known to improve vasomotor symptoms. The percentage of women with menopausal symptoms, and the percentage with severe vasomotor symptoms were linearly associated with the depressive symptom score.

Conclusions: Depressive symptoms "amplified" the menopausal experience, or alternatively, severe vasomotor symptoms worsened depressive symptoms.

Commentary by Sandra R. Leiblum, PhD

The findings of this large-scale survey are not unexpected but are relevant?namely that depression seems to "amplify" both the experience and intensity of vasomotor symptoms associated with menopause. The study was well done and controlled for confounding variables such as age and body mass index, but still found that women with moderate/severe depression were almost twice as likely to report recent hot flashes, night sweats, or both than women with no or mild depressive symptoms.

The authors acknowledge the correlational nature of their findings and note that severe vasomotor symptoms might worsen depressive symptoms. Certainly, if the sleep interruptions associated with night sweats interfere with refreshing sleep, depressive symptoms will be exacerbated?feelings of fatigue, irritability, and lack of energy. Sleep disruption is already a hallmark of depression. Nevertheless, the authors make the reasonable argument that depression may be associated with greater severity of bodily symptoms and/or may result in poorer self-care regimens such as diet or exercise, which will exacerbate vasomotor symptoms.

Notwithstanding the likely bidirectional nature of the findings, the authors suggest that their study has clinical implications?namely that identification and treatment of depression in midlife women may ameliorate the experience or severity of menopausal complaints. Although the severely depressed sample of women in this research were already on SSRIs or SNRIs, the authors pose three possible explanations: "(1) their antidepressant therapy was suboptimal, (2) they might have benefited from HT, or (3) even in the face of optimal management of depressive and vasomotor symptoms, these women's symptoms would remain refractory to therapy."

Clearly, this study raises as many questions as it answers, although it points to the importance of conducting well-controlled prospective longitudinal research on depressed women compared to nondepressed women as they undergo the menopause transition.