LAKE BUENA VISTA, FLA. — Men-opausal status and use of hormone therapy can influence the presentation and treatment of major depression, according to Dr. Susan G. Kornstein, professor of psychiatry and obstetrics-gynecology at Virginia Commonwealth University, Richmond.
Dr. Kornstein and her associates evaluated differences in depression by menopausal status using data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, sponsored by the National Institute of Mental Health. “We looked at whether major depressive disorder presents differently in the pre-, peri-, and postmenopausal period,” said Dr. Kornstein, also executive director of the Institute for Women's Health and the Mood Disorders Institute at VCU Medical Center.
The study included 948 premenopausal, 376 perimenopausal, and 566 postmenopausal participants. Women taking hormone therapy were excluded.
Postmenopausal women were less likely to have a family history of depression and more likely to experience an older age of depression onset and more medical comorbidity.
“Depression presenting in postmenopausal women may be more related to general medical comorbidity or hormonal factors or aging as opposed to a lifelong depressive disorder,” she said.
Dr. Kornstein and her colleagues also compared 177 women taking hormone therapy with 566 women not taking hormone therapy. “Women taking hormone therapy were more likely to have recurrent depression and greater general medical comorbidity. But more interaction with health care providers may have led to more opportunities to be prescribed hormone therapy.”
Participants taking hormone therapy reported better physical health and were less likely to report sympathetic arousal or melancholic features of depression. “This can point to some benefit of hormone therapy on depressive symptoms, although estrogen is not a treatment for depression in postmenopausal women,” Dr. Kornstein said. “But we can say that hormone therapy does not seem to worsen depressive symptoms.”
In perimenopausal women, estrogen has been shown to be an effective treatment for depression, when used either alone or in combination with antidepressants; however, risks and benefits of estrogen use must be weighed (Arch. Gen. Psychiatry 2001;58:529–34; Expert Rev. Neurother. 2007;10:1285–93). In contrast, estrogen alone has been shown to be ineffective in postmenopausal depression (Psychiatry 2004;55:406–12).
“The literature suggests psychotherapy is as effective as medication for mild to moderate depression, and the combination may be superior to either alone” (N. Engl. J. Med. 2000;342:1462–70; Psychiatr. Ann. 2002;32:465–76). Psychotherapy may also have a “long-term benefit in preventing relapse of depression,” Dr. Kornstein said (Am. J. Psychiatry 2004;161:1872–6).