Menopause doesn't cause depression--but the misperception persists

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Many physicians and mental health professionals see menopause as the time of life when depression is most likely to occur. But a new review of all studies on the topic has failed to find evidence to support this widespread belief, which could led to inappropriate treatment. Dr. Louise Nicol-Smith, University of Oslo, Norway, confined her computerized search to studies of women who had experienced natural menopause, as opposed to surgical menopause, which can be abrupt and severe (British Medical Journal, 16 November 1996).

In the last three decades' worth of studies published in the English language, 94 explored the relation between natural menopause and depression. "At present there is no substantial evidence that either a natural menopause with its accompanying changes in hormone concentrations or psychosocial factors exclusive to middle age put women at increased risk of depression," Dr. Nichol-Smith concluded. In fact, researchers have demonstrated that depression is most likely to occur in women of childbearing age.

Women suffering depression at menopause should not be treated any differently than other depressed people, wrote Dr. Nicol-Smith. Moreover, the false belief that menopause is the underlying complaint could result in women receiving estrogen for their depression rather than an antidepressant or psychotherapy.

"There is no link between estrogen concentrations and depression," observed Dr. Myra S. Hunter of University College, London, in an editorial that accompanied the new review. "Overall, there is no conclusive evidence that hormone replacement therapy improves depression in women seeking help for menopausal problems over and above placebo effects. There is some evidence of a small improvement in well-being in selected healthy women, particularly when higher doses are used. Again, carefully designed studies are needed to disentangle the effects of placebo relief from vasomotor symptoms [e.g., hot flashes], and the possible psychoactive properties of estrogen. However, even if hormone replacement therapy increases well-being or improves mood, this would not necessarily mean that depression is caused by low levels of estrogen."

Dr. Hunter puts the current medical views of menopause in context. "In the 19th century the menopause was thought to cause insanity, and it was only as recently as 1980 that the diagnosis of involutional melancholia was removed from the third edition of the Diagnostic and Statistical Manual of Mental Disorders."

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