A cross-sectional evaluation of perimenopausal depression

Abstract

Objective: Overall, the clinical spectrum of depression during the perimenopause is not well characterized. This cross-sectional study examined the following: (1) clinical characteristics of women who presented to the National Institute of Mental Health midlife mood disorders clinic (between March 1990 and January 2004) with peri-menopausal major and minor depressions and (2) the impact on these characteristics of either a prior episode of depression or the presence of hot flushes.

Method: Historical variables, reproductive status, symptom ratings, and plasma hormone measures were examined in 116 women between the ages of 40 and 55 years who met research criteria for perimenopause-related depression (a current episode of major or minor depression according to the Structured Clinical Interview for DSM-IV or Primary Care Evaluation of Mental Disorders supplemented with a past history form).

Results: Clinical characteristics did not differ in those women with first-onset (39%) versus recurrent depressions or in those with (57%) and without hot flushes. Depressive episodes clustered in the later stages of the menopause transition and the first year postmenopause. Seven women (6%) reported a past postpartum major depression, and 55% of women reported a history of premenstrual dysphoria (PMD).

Conclusions: We found no evidence that either hot flushes or a previous episode of depression conveys a distinct clinical profile in these women. The clustering of onsets of depression suggests the hormone events that characterize the late menopause transition may be relevant to the onset of this form of depression. Finally, although we observed a high rate of PMD, neither postpartum depression nor PMD are consistent accompaniments of perimenopausal depression.

Figures

Figure I

Numbers of depressed perimenopausal women in each STRAW stage were compared across three groups: (1) women with major versus minor depression, (2) first onset versus recurrent depression, and (3) women with and without hot flushes Criteria for STRAW Stages: Stage -3: regular menstrual cycles and one elevated (> 2 SD) FSH level; stage -2: regular menstrual cycles, but with variable cycle lengths (> or without hot flushes were in STRAW stage -2; second, significantly more women with hot flushes were in STRAW stages -1 and +1a. However, none of the comparisons remained significant when p values were adjusted for six comparisons. Otherwise all comparisons p = NS Within Group Comparisons (multinomial): 1) major depression - the number of women in stage -1 was significantly greater than numbers in stages +1a -2, -3 (Z = 4.3–6.1 [range]; p =.003 – <.001 number of women in stage was significantly greater than stages and comparisons p=".008)" minor depression the different numbers whereas not first-onset a were straw with respectively trend recurrent greatest all although to lesser extent hot flushes z="3.8;" without>