Menopause May Dramatically Up Depression, Mania Risk in BD

Deborah Brauser

May 09, 2014

NEW YORK ― The late menopausal transition (MT) period and early postmenopausal time point may severely increase risk for depression as well as mania, new research suggests.

An observational study of 56 women between the ages of 40 and 60 years with bipolar disorder (BD) showed that the participants in these stages had significantly higher depression and mood elevation scores than those who were in the early MT stage.

"Basically, the risk for depression increased during the time around the final menstrual period, so just before and just after, compared to the years that lead up to that time," lead author Wendy K. Marsh, MD, associate professor in the Department of Psychiatry at the University of Massachusetts Medical School in Worcester, told Medscape Medical News.

She noted that although past research has shown a link between MT and increased risk for depression in women without BD, this is the first prospective study to look at this in women with BD.

"There have been cross-sectional studies but no prospective ones. So this is quite unique," said Dr. Marsh. "For clinicians, I recommend being aware of where a female patient is in her menstrual status."

The findings were presented here at the American Psychiatric Association's 2014 Annual Meeting.

Rapid Hormonal Changes

For women with BD, "the postpartum, a time of rapid reproductive hormonal change and decline, is associated with severe mood episodes," write the researchers.

Dr. Wendy Marsh

"Herein, mood is assessed in association with menopausal stage and reproductive hormones," they explain.

The investigators enrolled 56 women who had been clinically diagnosed with BD and either reported experiencing menopausal symptoms or "were up to 5 years since final menstrual period."

All were put into subgroups based on menopausal stage: the late MT and early postmenopausal joint group (mean age, 50.6 years) or the early MT group (mean age, 45 years).

Evaluation tools used for the participants during a 5-month period included the Montgomery-Åsperg Depression Rating Scale (MADRS) for depression and the Young Mania Rating Scale (YMRS) for mood elevation. The reproductive hormones estradiol and follicule stimulating hormone (FSH) levels were also measured.

All of the assessments occurred during the early follicular phase for participants with predictable menstrual cycles or up to 6 weeks for participants with unpredictable or absent cycles.

Results showed that the participants in the late MT and early postmenopausal group had significantly higher mean depression scores on the MADRS (14.0 ± 9.9) than did those in the early MT group (10.4 ± 7.8; P < .01).

They also had significantly higher mood elevation scores on the YMRS (7.4 ± 5.8 vs 5.6 ± 5.5, respectively; P = .04).

"No consistent association with absolute or variability" in estradiol or FSH levels was found with either depression or mood elevation scores.

Dr. Marsh noted that current treatment for bipolar depression is the same for both sexes and for adults of all ages.

"But these stages are a time of increased risk that we need to be aware of," she said. "And I think it opens a pathway to consider novel treatments for these people."

Fine-Grain Look

"This is a study that is important work," Stephen J. Ferrando, MD, professor of clinical psychiatry and clinical director at the New York–Presbyterian Hospital/Weill Cornell Medical College's Westchester Division, told Medscape Medical News.

Dr. Stephen Ferrando

"The importance is that it takes a finer-grain look at the timing of depressive and manic symptoms during the menopausal transition. And it shows that particularly late as compared to early is a higher-risk category," said Dr. Ferrando, who was not involved with this research.

He added that there are "absolutely" some important take-aways for clinicians.

"I think it's pretty clear that the menopausal transition is high risk really for all women for depression and for women with bipolar for both depression and manic exacerbation."

Dr. Ferrando added that this phase can also affect currently prescribed treatments.

"These women were already stabilized on their medication. But the results suggest that maybe further adjustments are needed or other agents may need to be added to their regimen," he said.

In addition, he noted that patients should be asked whether they are taking any alternative or complementary treatments that could interact with their prescriptions.

"Ask about anything that affects mood, their circadian rhythm, sleep, or their hormonal milieu. They really need to scrutinize what they're taking, which many times can be benign but which could contribute to exacerbation," said Dr. Ferrando.

The study authors and Dr. Ferrando report no relevant financial relationships.

American Psychiatric Association's 2014 Annual Meeting. Abstract NR6-61. Poster presented May 5, 2014.

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