Menopause and depression: keep your eye on the long run.
symptoms and sleep problems in midlife depression continue M ost researchers and experienced clinicians would agree, in this day and age, that the 'jury is no longer out' on the potential effects of reproductive hormones on mood and the extent to which hormone fluctuations/changes may impact overall functioning throughout the female reproductive life cycle. Premenstrual Dysphoric Disorder, for example, has now been officially recognized and incorporated as a new diagnostic category for the DSM 5, representing an acknowledgment by experts and peers of the severe functional impairment that some but not all women experience during the luteal phase of their cycles. There is also little dispute about the wide spectrum of mood and behavioral changes that may occur during the postpartum period ranging from the commonly observed dysphoria or 'baby blues' to the occurrence of postpartum depression or even the rare but severe postnatal psychosis. On the contrary, after many decades of accumulated research, some of the controversy surrounding the existence of a 'menopause associated depression' still persists. As previously discussed, part of the confusion could be attributed to misinformation and insufficient knowledge dissemination on what is already known about the 'window of vulnerability' for depression in midlife years. Methodologic limitations have also contributed contradictory findings, including the heterogeneity of subpopulations studied, the lack of standardized criteria to define menopause staging, or appropriate diagnostic tools to characterize the nature and severity of psychiatric symptoms. Moreover, the presence of comorbid conditions such as anxiety and/or sleep problem has not always been taken into consideration or even documented, despite their impact on the well being of midlife women. Fortunately, the last few decades have also produced welldesigned, well executed population studies, shedding some light on the risk for new and recurrent depression among women approaching menopause and beyond. Prospective cohort studies have unequivocally demonstrated an increased risk for the development of depression during the menopausal transition and helped us to disentangle some of its various components (sociodemographic, clinical, hormonal) We have learned, for example, that past history of depression is one of the strongest predictors for the occurrence of a major depressive episode during midlife years, and that greater within subject variations in gonadal steroids over time (rather than absolute levels at one point in time) could be associated with heightened risk for developing depression. The nature and magnitude of the role played by vasomotor
Menopause