Menopause Not Associated With Universal Risk for Depression, Review Shows

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The transition into menopause by itself does not appear to raise the risk of depression in women, according to a review in The Lancet. However, a subset of women with a history of depression and/or certain menopause-related risk factors may be vulnerable to depressive symptoms during this period.

“Clinicians should not assume that psychological symptoms during the menopause transition are always attributable to hormonal changes,” wrote Lydia Brown, Ph.D., M.Psych., of the University of Melbourne and colleagues. “Potential misattribution of psychological distress and psychiatric disorders to menopause could harm women by delaying accurate diagnosis and the initiation of effective psychotropic treatments, and by creating negative expectations for people approaching menopause.”

Brown and colleagues analyzed 12 prospective studies reporting depressive symptoms, major depressive disorder, or both for more than 25,000 women during the menopause transition. Only two of the studies, totaling around 600 women, used structured clinical interviews to diagnose major depressive disorder.

They found that the risk of first lifetime major depressive disorder is not increased during menopause, but individuals with previous major depressive disorder might be at increased risk of recurrence. Additionally, women are not universally at risk of depressive symptoms during menopause.

Vulnerability to depressive symptoms during menopause may be due to menopause-related risk factors including severe vasomotor symptoms such as hot flashes and night sweats, sleep disturbance, a long transition, or significant hormone fluctuations. Psychosocial risk factors such as a depression history, stressful life events, or lack of social support can also increase the risk for depressive symptoms.

Brown and colleagues offered the following recommendations:

• Provide individuals with evidence-based information about menopause, including clear statements that most individuals are not at risk of mental health problems.
• Be aware of who is at risk of experiencing depressive symptoms and major depressive disorder; if present, consider treating modifiable risk factors such as severe hot flashes and night sweats and sleep problems.
• Be cautious about discontinuing treatments for major depressive disorder during the menopause transition due to the possible increased risk of recurrence.

In an editorial accompanying the review, Lancet editors wrote: “We need to send a realistic, balanced message to women and to society: menopause does not herald the start of a period of decay and decline but is a developmental life stage that can be negotiated successfully with access to evidence-based information as well as appropriate social and medical support.”

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