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David Baxter PhD

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Perimenopause could cause serious first-time depression
May 5, 2004
By Marilyn Elias, USA TODAY

A woman's odds of developing depression for the first time increase greatly during perimenopause, a time of irregular periods and hormonal shifts before menopause, a landmark study reported Wednesday.
Women who have hot flashes are at particularly high risk for depression, according to the first research to follow a large group of women from before they enter perimenopause to menopause and check how menstrual periods correlate with the first experience of depression.

Psychiatrist Lee Cohen, director of the Center for Women's Mental Health at Massachusetts General Hospital, reported his study at the American Psychiatric Association meeting in New York.

The 591 women, most in their 40s, were premenopausal when the study began. As Cohen's team followed them for up to five years, 365 of the women passed into perimenopause. These women were three times more likely than premenopausal women to develop the symptoms of major depression, Cohen says. About a quarter of them became depressed.

If women had bothersome hot flashes, they were six times more likely to be depressed. "This isn't just a little bit of sadness; it's the real McCoy," Cohen says.

Other studies have checked women's hormone levels and found the hormonal roller coaster of perimenopause can spur depression and anxiety. Perimenopause can last four years or more and begins, on average, at the age of 47, Cohen says.

Conventional wisdom until a few years ago held that menopause — when periods have stopped for a year — left women depressed. New research is finding no evidence for that, Cohen says.

Most women sail through the transition without major mood swings. But Cohen says more research is needed to find out how many develop mental-health problems during the shift into menopause, and what might put women at high risk.

Certain groups of women appear to suffer more than others. Those who have trouble making ends meet reported having worse hot flashes than affluent women in the Study for Women's Health Across the Nation (SWAN).

Hot flashes also correlated with worse mental health.

"But depressed women tend to rate lots of things as more bothersome," so it's hard to say if their hot flashes were worse or just seemed that way because of poor mental health, says University of Pittsburgh psychologist Karen Matthews, a SWAN researcher.

Women reported more depressive symptoms in early perimenopause, Matthews says. "By the time 12 months had gone by with no periods, they looked just like they had before."
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