depression

Wednesday Bubble: Depression and midlife – “overmedicalizing” the menopause

Posted by Liz on Jun 15, 2011 in depression, menopause | 4 comments

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?

Depression and menopause: can acupuncture help?

Posted by Liz on Jan 21, 2011 in depression | 4 comments

Depression and menopause. It keeps coming up as a topic and so I’m going to continue to write about it until researchers find an effective way to battle depression during menopause, effective meaning that it is an acceptable strategy for women who prefer alternatives to pharmaceutical agents, effective in that it addresses the underlying causes of depression in menopausal women, including fluctuating estrogen levels, sleep disturbances, night sweats, hot flashes and life factors, and effective in that it is affordable. It’s a tall order, isn’t it?

As I’ve noted time and again, depression is an important issue for many but not all menopausal women, affecting approximately 20% to 40% in a some way or another. Just this week, I wrote about use of the SSRI antidepressants as an alternative to HRT for hot flashes and depression, and possibly as a stop-gap measure until practitioners more widely embrace alternative strategies. On the heels of this study comes another in the  Online Edition of Menopause journal, examining data from one of my favourite studies, ACUFLASH. If you don’t feel like clicking on the link and updates about this study, briefly, in ACUFLASH, researchers randomized 399 postmenopausal women (1 year since last menstrual period) regularly experiencing at least 7 hot flashes daily to acupuncture or no treatment. Moxibustion was used at the practitioner’s discretion and sessions could also be extended by two weeks (from 12 weeks), if needed.  Although the practitioners met beforehand to discuss possible diagnoses and recommended treatment points, all treatment was individualized. Both groups of patients also received self care recommendations, which consisted of a one-page information leaflet on care of menopausal symptoms (e.g. soy, herbs, physical activity and relaxation techniques) which they were free to add at their own discretion.

Overall, the mean frequency of hot flashes declined by 48% in women receiving acupuncture compared with 28% of women using self-care methods only. This means that 50% of women receiving acupuncture experienced a 50% or greater reduction in how often their hot flashes occurred, compared to 16% of women using self-care. Significant reductions were also seen in hot flash intensity. Additionally, the acupuncture group reported significant improvements in vasomotor, sleep, and somatic symptoms over the course of the study.

So, what about acupuncture and depression?

In the current study, researchers examined a sample of 72 women who had participated in ACUFLASH and had either received self-care only or self-care plus acupuncture. At the start, almost 31% of these women reported depressive symptoms and of these, about 17% were determined to suffer from moderate to severe depression (based on a scientific method that measures the severity of depressive symptoms). Although these figures are higher than what is normally seen in the general population, severe depression is often seen among women experiencing very frequent hot flashes (7 or more in a 24 hour period for at least 1 week). And while both groups reported significant declines in depressive symptoms during the 12 week study period by as much as 16%, the declines were similar in both groups, indicating the acupuncture,while helpful for lessening the severity of hot flashes, did not have a specific effect on depression.

If acupuncture doesn’t help depression, why did the results indicate such a high level of improvement that under normal circumstances, an individual could forgo drugs for needles?

A key finding of the original and follow up ACUFLASH studies was the feeling of control over symptoms that was imparted by being educated about self-care. However, here’s the rub: even though acupuncture was shown to significantly benefit both the intensity and frequency of hot flashes, it didn’t provide an edge over depressive symptoms compared to self care alone. The researchers say that this leads them to believe that although a domino effect is at-play (i.e. hot flashes lead to sleep issues lead to symptoms of depression) there is something else that also influences the depression part of the equation.

In the interim, it’s frustrating, right? You can deal with your hot flashes but you still feel blue, low, out of sorts. There is clearly a link between the hot flashes and sleep and depression. It simply needs to be teased out a wee bit further. Keep the faith. We’ll get there!

Looking through the window: depression and menopause

Posted by Liz on Dec 27, 2010 in depression | 2 comments

There’s a new term that’s being kicked around in medical circles: ‘windows of vulnerability.’

It appears that a growing body of evidence supports the fact that during times of hormonal flux or reproductive cycle “events,” women become increasingly vulnerable to mood swings, anxiety and depression. And while this is certainly not news for many women, it still requires some attention because among the many windows that women may go through, the menopausal transition is evidently one of the most complex. The reason? This is a time when hormones interact with aging, sexuality, life stressors, self-esteem and general health issues.

The subject of depression and menopause is not new to this blog, nor are statistics suggesting that as many as 20% to 40% of women are believed to suffer major depression or at the very least, depressive symptoms during the peri/postmenopausal years. Moreover, women may have as much as a two- to four-times increased risk of developing depression as they transition from pre- to perimenopausal status. Among the multiple factors at play, estrogen is one of the most important; estrogen has been shown to promote the amount of the mood neurotransmitter serotonin available to the body, thereby providing an important antidepressant effect. However, a recent review suggests that the role that hormones like estrogen play in depression is directly related to their wide fluctuations rather than the fact that they are becoming deficient.

So, why is this important? For one, it highlights that hormone replacement is not the only answer for depression during menopause but rather, that it’s critical to pay attention to timing, i.e. when preventive strategies, including exercise, behavioral therapy and antidepressants might yield the greatest long-term benefits. Yet, it also suggests that estrogen-based therapies may indeed have a role in depression during menopause. And, since estrogen alone therapy has been shown to up the risk for ovarian cancer except for in women who’ve had hysterectomies, it also helps supports the need to explore the role plant-based estrogens in treating menopausal depression; fortunately, S-equol has already shown promise in this regard.

Feeling the window of vulnerability? There’s no time like the present to insure that you aren’t simply looking through the window but actually seeing that there’s hope and help on the other side. There are a lot of resources and strategies available to address depression during this time of life. While depression may be a “menopause-associated risk,” like others, it can be successfully ameliorated.

Thank you to Dr. Claudio Soares from McMaster University for an excellent review of depression in menopause and the inspiring, succinct “windows of vulnerability” terminology.

Omega-3s and depression

Posted by Liz on Nov 12, 2010 in depression | 4 comments

According to recent estimates, more than 20% of women undergoing menopause have major depressive disorder. In fact, mood disorders and depression affect a disproportionate amount of women in the peri- and postmenopausal stages compared to women in pre-menopause. Moreover, these mood disorders tend to occur in conjunction with hot flashes.

While researchers have yet to discover the cause of the depression/mood surge during menopause, they continue to explore therapeutic strategies that might help to take the edge off. And surprisingly, numerous studies actually point to the value of omega-3 fatty acids — eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — for alleviating depression. Besides wellbeing, one of the reasons this is so important is that research has linked depression with other serious conditions including heart disease and stroke. The one thing that all these conditions have in common is that they are believed to be caused, at least in part, by an inflammatory response by the body. One particular action of omega-3 fatty acids is that they have been shown to lower inflammation, which makes them potentially useful in treating disease.

So, can omega-3s help stave off depression in menopausal women? In a very small study published in the online edition of Menopause, peri- or postmenopausal taking daily omega-3 fatty acids  (Lovaza, 2 g daily) for 8 weeks had significant declines in depression scores, number of daily hot flashes and hot flash interference scores.  During the course of the study, 70% of women responded, and those whose depressive symptoms declined also experienced declines in hot flashes, indicating both a connection between the two and a possible role for omega-3s in menopause.

However, this study was very small, enrolling only 20 women and more evidence is needed with larger numbers of women before omega-3s can be recommended as a treatment for mood and hot flashes during menopause. Moreover, it’s essential to note that a thorough analysis of scientifically sound studies has recently pointed to the EPA component as driving as much as a 56% reduction in depressive symptoms, that is, if the supplements used contain more than 50% of standardized EPA or pure EPA. Therefore, when it comes to fish oils, the ratio of EPA to DHA may play an important role.

I’m excited because this study brings us another step closer towards demonstrating that menopausal symptoms can indeed, be effectively alleviated without hormonal therapy.

Little Girl Blue

Posted by Liz on Apr 26, 2010 in depression | 0 comments

[youtube=http://www.youtube.com/watch?v=FVpDOIPx_sY]

Depression in the perimenopause and postmenopausal years is no joke. I’ve written about it several times on this blog and will continue to do so until experts figure out an effective, acceptable strategy for combating the blues.

As I’ve noted before, researchers are not quite sure of the exact reasons for the depression surge during the transition,  (e.g. dramatic surge and declines in hormones, vasomotor issues, sleep issues, life stress and prior history). However, they do acknowledge that many women tend to suffer the blues during this time.

In the latest bit of research, published in the online edition of the journal Menopause, researchers found that over 40% of women studied (out of a pool of 685) suffered from symptoms of depression. What was more interesting, however, is that depression was almost twice as likely to develop in the peri/post menopausal stages than before menopause. (Note that other studies have found this likelihood to be as high as 4 times during the perimenopause). Moreover:

• Women who reported having had experienced some sort of negative event in their were 3.6 times likelier than those who hadn’t to develop depression
• Weight appeared to play a role, with obese women twice as likely as those of normal weight to develop depressive symptoms

Although I’ve discussed some potentially effective strategies for combatting the menopausal blues (e.g., exercise, chamomile, antidepressants, red clover, St. John’s Wort, soy isoflavones), none are a quick fix or a ‘one size fits all.’

Personally, I’ve noticed that fluctuating hormones coupled with elevated stress tends to heighten depression at specific times, while at other times, it’s easier to deal with. Pile it on and well, I become a pile of mush. My strategy entails an insane amount of physical activity, deep breathing, therapy and admittedly, some medication. Still, I’ve found that while I can usually keep the blues at bay, they do tend to crop up at the most inopportune moments.

What do you do to chase the blues away? Have they gotten worse or stayed the same during your transition? What advice do you have to offer for other readers? I’d love to hear!

Chamo chamo chamomile-on

Posted by Liz on Apr 16, 2010 in anxiety, depression, herbal medicine | 2 comments

[youtube=http://www.youtube.com/watch?v=JmcA9LIIXWw]

Is chamomile the ultimate chameleon, good for both anxiety in depression?

Back in February, I posted information about a small study that showed that a daily chamomile tablets (containing 220 mg of pharmaceutical grade extract) significant reduced anxiety and improved well-being among postmenopausal women. Thanks to a fellow reporter and Twitter colleague Miriam Tucker, I learned that the researchers of this study presented findings at a recent Anxiety Disorders of American meeting that might be of equal interest, i.e. that benefits of chamomile might extend to depression as well.

In a second part of this study, the researchers looked at the effect of chamomile on the same women who currently suffered from anxiety and depression, who had a past history of depression or who had never had depressive symptoms. Although the results were not as striking as in the first study, they did see what they characterized as meaningful reductions in depression ratings among women who had both anxiety and depression. Across all the groups, the researchers observed significant declines in depressed mood, guilt and thoughts of suicide).

Women entering perimenopause have twice the risk for developing depressive symptoms than during other phases of their lives. Researchers have also shown that attitude towards menopause can also increase the risk. While various interventions including antidepressants, exercise and maybe even moderate intake of red wine may help, it’s wonderful to know that scientists are seriously looking into the role of chamomile and studying it under controlled conditions to prove or disprove its power over our moods.

Is chamomile the ultimate panacea when it comes to mood swings and the blues? Perhaps not. But it may provide a wonderful option to women and men alike, who are seeking solutions out of the medicine cabinet.