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DEPRESSIONDepression may also result from the estrogen loss that occurs with menopause. Clinically, there is a strong impression that depression and menopause are associated, but there are no definitive studies that effectively evaluate this relationship. In general, the incidence of depression is higher among women than among men.(12) There is no question that some of this increase can be attributed to environmental factors. Menopausal women have arrived at a complex time of life: careers are demanding, children may be leaving home, economic issues may be overwhelming, roles in the family, as well as society, may be changing, and many women are challenged with the burden of caring for aging relatives. Beyond this, however, there is sufficient reason to believe that hormonal fluctuations may be partly responsible for higher rates of depression.In general, the literature evaluating the incidence of depression surrounding menopause shows conflicting incidence rates.(13) However, a recent study adds substantially to evidence for a link between depression and menopause.(14) This study reported current depression scores for 363 women aged 40 to 60 years who attended a women's primary care clinic. Perimenopausal women were twice as likely to have significant depressive symptoms (elevated scores assessed by the Community Epidemiology Scale), as were middle-aged premenopausal women (odds ratio 2.(0), P = 0.(0)37). This difference held when the study was controlled for a history of depression. The percentage of women with depressive symptoms was the same for perimenopausal and postmenopausal women. It is noteworthy that hot flushes were positively correlated with elevated depression scores. The role of estrogen in depression is frequently debated as well. The answer to whether or not estrogen is an antidepressant differs depending on the origin of the study. Some studies of major depressive disorder (generally conducted by psychiatrists) have shown no benefit from estrogen monotherapy.(15) On the other hand, there are perhaps 30 studies from the primary care/women's health setting showing estrogen to be an effective stabilizer of mood that can improve a sense of well-being.(15) What is apparent is that estrogen has multiple neuromodulatory effects, similar to the neuro-pharmacologic actions of antidepressant medications. These effects include:(16)
Because of estrogen's activity in the CNS, it may modulate mood in such a way as to reduce depression.(12) There are also anecdotal clinical observations that suggest an estrogen/antidepressant agent synergy, but confirmatory studies are lacking |
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