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.

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 < 7 days) and elevated plasma FSH levels; stage -1: at least two skipped cycles as well as an interval of amenorrhea (≥ 60 days) and elevated plasma FSH levels; and stage +1a: up to one year of amenorrhea and elevated FSH levels. STRAW = Stages of Reproductive Aging Workshop. Between Group Comparisons: a - minor depression versus major depression stage -2 Chi square = 12.3, df = 3, p = 0.006; post-hoc Fisher Exact test, p =.003 The distribution of women with and without hot flushes in each STRAW stage differed significantly (Chi square = 9.3, df = 3, p =.03). Individual uncorrected 2×2 Chi square analyses were significantly different between women with and without hot flushes in several comparisons as follows: first, significantly more women 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 [range]); number of women in stage +1a was significantly greater than number in stages -3 and -2, (Z = 2.7 (both comparisons), p =.008) minor depression - the number of women in stages -1 and -2 was significantly different than numbers in stages -3 and +1a (Z = 2.3–6.3 [range]; p =.02 – <.001 [range]); whereas numbers of women in stages -1 and -2 was not significantly different (p = 0.1) 2) First-onset depression - a significantly greater number of women were in STRAW stage -1 (comparisons with stages -3, -2 (Z = 3.1 and 4.6; p =.002 and <.001; respectively) and +1a (Z = 1.6; p =.12 trend) recurrent depression - the number of women with recurrent depression was greatest in STRAW stage -1 (Z = 3.5–8.0 [range]; all comparisons p <.001) and, although to a lesser extent, greater in STRAW stage -2 (comparisons with -3 (Z = 3.4; p =.008) and +1a (Z = 1.6; p =.11) 3) depression with hot flushes (HF) - greater numbers of women were in STRAW stages -1 (compared to +1a: Z = 3.8; p <.001, to -2: Z = 5.8; p <.001 and -3: Z = 8.7; p <.001), and stage +1a (compared to -3: Z = 3.4; p <.001) depression without hot flushes (HF) - a greater number of women were in STRAW stages -1 (compared to +1a: Z = 3.8; p =.001 and to -3: Z = 8.7; p <.001) and stage -2 (compared to -3: Z = 2.9; p =.004 and to +1a: Z = 2.0; p =.052)