MOOD DISORDERS AND MENOPAUSE - 10/09/11
Résumé |
The lifetime prevalence of depression in women in the United States is consistently double the prevalence in men. The increased prevalence in women is also found across countries134 and is true for major depression and milder chronic depression (dysthymia). The Epidemiologic Catchment Area Study reported lifetime prevalence rates of major depression to be 8% in women versus 3.5% in men; lifetime prevalence rates of dysthymia were 5.4% in women versus 2.6% in men.101 The National Comorbidity Survey reported higher lifetime prevalence rates. Major depression occurred at a rate of 21% in women versus 13% in men and dysthymia at a rate of 8% in women versus 5% in men.64 The rates of seasonal affective disorder are higher in women.90 Although the prevalence rates of bipolar disorder (manic-depressive illness) are equal in women and men, women are more likely to have depressive episodes, mixed manic episodes (with depression), and rapid cycling.70 Female gender is clearly associated with an increased risk for affective disorders, particularly, cyclic affective disorders.70, 90
The importance of gender in the expression of depressive disorders is also suggested by the increased rates of depression during the reproductive years. After puberty, the rate of depression rises rapidly in girls relative to boys.63 The premenstrual phase of the menstrual cycle may be associated with an exacerbation of depressive symptoms, may trigger the onset of a depressive episode, or be a time of increased suicidal ideation and psychiatric hospitalization.28 Women with cyclic premenstrual depressive and anxiety symptoms (premenstrual dysphoric disorder) have elevated lifetime prevalence rates of major depression and postpartum depression.94 Although the postpartum period is not always associated with increased rates of depression, women with a previous depression, history of premenstrual dysphoric disorder, or history of bipolar disorder are at increased risk.11 Although many studies do not report increased rates of depression at menopause, the National Comorbidity Survey did find an increased risk of the recurrence of major depression in women aged 45 to 54 years.63 The rates of depression in women decrease after menopause.
The important role of gonadal hormones is suggested by the increased prevalence of depression during the reproductive years and the potential for depressive episodes to occur at times of changes in these hormones. However, the interaction between the hypothalamic-pituitary-gonadal (HPG) axis and mood variables (biologic measures, clinical symptoms, treatment response) is only recently a major focus of research. The expression of depression is also determined by genetic, developmental, psychosocial, and other biologic factors. The complex interaction of these factors at the time of menopause has been previously reviewed.7, 11, 20, 54, 84, 113 This article discusses the association between depression and menopause, the neurobiologic effects of the sex steroids, and the psychologic effects of the clinical use of sex steroids in hormone replacement therapy (HRT).
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| Address reprint requests to Teri Pearlstein, MD, Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906 |
Vol 26 - N° 2
P. 279-294 - juin 1997 Retour au numéro
Article précédent
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