Women over age 65 dealing with hot flashes and other treatable symptoms of low estrogen are more likely to also have moderate or severe depression, according to a large study in Australia.
Researchers found that women with depressive symptoms were also more likely to have money worries, care giving responsibilities or chronic health conditions, suggesting there are many issues that could contribute to depression in this age group. Treatment for depression should therefore address the hormonal problems in this mix that are modifiable, the study team writes in Menopause.
“Other studies had already shown that when women were perimenopausal or early postmenopausal that there is an increased vulnerability to depressive symptoms,” senior study author Susan Davis said.
“We were interested in whether hot flushes were indicative of heightened vulnerability - and we found this to be the case,” said Davis, a researcher with the School of Public Health and Preventive Medicine at Monash University in Melbourne.
Davis and colleagues enrolled more than 1,500 mostly white women between the ages of 65 and 79 who were randomly selected from Australian voter rolls.
The women answered questionnaires that asked about life and financial circumstances, relationships, health problems and medication use. They also asked about post-menopausal symptoms including hot flashes, night sweats and pain during intercourse, as well as about depressive symptoms and recent use of anti-depressant medications.
One of every three women reported having hot flashes, which also increased their risk of depressive symptoms by 67 percent compared to women without hot flashes.
One in four women had used a psychotropic medication such as an antidepressant in the previous month.
Women with partners were about 40 percent less likely to have depression symptoms compared to women who were alone. Women who were employed had less than half the risk of depressive symptoms compared to women who were unemployed.
While hot flashes, vaginal dryness and pelvic floor dysfunction were each independently associated with depression risk, the study cannot prove that these or any other factors examined in the analysis cause depression.
Davis, however, said loss of estrogen could be a contributor. “Estrogen has major central effects in the brain and the sudden fall in estrogen at menopause can cause some women to become profoundly anxious (or depressed)," she said. "After childbirth the sudden drop in hormones can have the same effect.”
Older women with hot flashes, vaginal dryness or pelvic floor concerns should be evaluated for depression, "particularly if they have financial housing issues or significant caregiving responsibilities,” Dr. JoAnn Pinkerton, who wasn’t involved in the study, told Reuters Health by email.
“Women going through the menopause are four times more likely to suffer from depression than women who are younger than 45,” said Pinkerton, an obstetrician-gynecologist in Charlottesville, Virginia, and executive director of the North American Menopause Society
Depression is not anxiety, bouts of sadness, low mood or mood swings but a mental disorder defined by the feeling of extreme sadness lasting for more than two weeks, often with no specific cause, and which interferes with everyday life, Pinkerton said.
As far as treatment, evidence doesn't support hormone therapy as a first treatment of depression, although it is often used along with counseling or antidepressants, she noted.
“For more severe depression, antidepressant medications can be used to correct the chemical imbalance and some have been found to relieve hot flashes. If depression is severe, antidepressant medication is most effective when used in combination with counseling or psychotherapy,” she said.
For mild to moderate depression, herbal remedies such as St. John’s wort, cognitive behavioral therapy and lifestyle changes may be helpful, such as prioritizing tasks, exercising, engaging in activities, recognizing the effect of stress on your mood, she said.
Women with a history of perimenopause-related depression that improves on hormone therapy need to be monitored after hormone therapy is stopped, as their depressive symptoms may recur, Pinkerton added.
