What’s the lowdown on depression, midlife and women? And how does the menopause come into play?
I written previously that depression may affect as many as 20% to 40% of women during menopause. However, gender differences in depression evidently begin well before the menopause and women are 1.5 to 3 times likelier than men to report a lifetime history of depression. Moreover, these distinctions start as early as the teen years and continue until the mid 50s, which researchers say, corresponds to female reproductive. Hence, experts have connected waning and altered hormone levels to high rates of mood and anxiety disorders in women.
Is this hypothesis valid? And, where did it originate?
According to a review in the early online edition of the Journal of Affective Disorders, some research has suggested that premenstrual, post partum and menopausal mood disorders are linked and that women are especially vulnerable during certain time periods. This has led to a proposal that reproductive-related depression have its own classification, and that during midlife in particular, all women should be routinely screened for symptoms. Interestingly enough, however, it has also led some researchers to question if we are “overpathologizing the menopause?” Hallelujah! (If you want to read more on medicalizing the menopause, check out one of my favourite Flashfree posts.)
The key finding?
Although studies demonstrate that significant numbers of women in midlife report depressive symptoms, menopause is only one of a range of factors purported to lead to depression during this timeframe. Others include stress, family life, general health issues and a lack of exercise, as well as a history of some sort of anxiety disorder. What’s more is that how women perceived the effect of menopause on their physical health almost doubled the risk that they would first develop depression at the onset of menopause.
The researchers say that although women might score high on self-reported mood scores, these scales or instruments tend to exaggerate the rate of depression in women in midlife and menopause. They also note that if a score is only taken at one time point that is might indicate temporary distress rather than a long-term problem. They add that during menopause, certain symptoms, such as sleep disturbance and fatigue, may be easily confused with depression even though they have nothing to do with a mood disorder and everything to do with hormones.
The bottom line is that symptom overlap and environmental factors can confuse a diagnosis, and that depression is not necessarily more prevalent during menopause than during other periods in a woman’s life. Consequently, like many things, the studies that are out leave more questions than provide definitive answers. Hence, the call for all women to be screened for depression during menopause may be an example of extreme assumption and not based in true necessity.
Is it possible that depression is just the tipping point in the medicalization of menopause?
What do you think?
Ditto and thanks to both of you for another good discussion. I've suffered from severe depression since (well, actually childhood I believe now) but am also happy to say that it has been successfully treated for years. We "used to be" more forgiving of the natural phases of life, it seems to me. Do you remember Gail Sheehy's book "Passages"? I think we had more acceptance with the ebb and flow of life before the stress of rising costs, the economic downturn, medical costs, etc., started to erode how we live now. In the "5-minute" doctor visit a practitioner may be more likely to prescribe than listen and educate. Unfortunate, but true. So we educate ourselves, listen to our sisters. And both of you are great. Thanks so much, Jody
Thanks Jody. It is true that the current medical paradigm doesn't allow enough listening and personalization; economics drive many health decisions. That is why it is so important for women to take decisions into their own hands and start a new dialogue.
Interesting post, Liz. I looked up the article. Who knew there's a medical journal with so much to say about affective disorders? (I didn't.) My general feeling is that we tend to over-call and over-treat diseases depression, even when it's a sometimes normal human condition. The same goes for menopause. The combo can be a "medicalization" overdose. That said, there's a relatively small number of individuals who suffer from severe depression and/or truly disabling effects of menopause/normal aging who might benefit from medical intervention in either of these circumstances. I agree with the authors' conclusion: "...clinicians should be alert to the possibility of depression in every clinical encounter." So this would apply to men, the elderly, kids out of college...