Major depression during and after the menopausal transition: Study of Women's Health Across the Nation (SWAN)

TLDR

The risk of major depression during the menopausal transition versus pre-menopause is uncertain. The study aimed to determine whether peri- or post-menopausal women have higher odds of major depression than pre-menopausal women, controlling for prior depression and hormone levels. 221 pre-menopausal women aged 42–52 were followed annually with structured clinical interviews for depression and yearly hormone assays. Peri- and early post-menopausal women were two to four times more likely to develop major depression, an effect independent of hormone levels and other confounders, and prior depression strongly predicted future episodes.

Abstract

Background It is unclear whether risk for major depression during the menopausal transition or immediately thereafter is increased relative to pre-menopause. We aimed to examine whether the odds of experiencing major depression were greater when women were peri- or post-menopausal compared to when they were pre-menopausal, independent of a history of major depression at study entry and annual measures of vasomotor symptoms (VMS), serum levels of, or changes in, estradiol (E2), follicular stimulating hormone (FSH) or testosterone (T) and relevant confounders. Method Participants included the 221 African American and Caucasian women, aged 42–52 years, who were pre-menopausal at entry into the Pittsburgh site of a community-based study of menopause, the Study of Women's Health Across the Nation (SWAN). We conducted the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) to assess diagnoses of lifetime, annual and current major depression at baseline and at annual follow-ups. Psychosocial and health factors, and blood samples for assay of reproductive hormones, were obtained annually. Results Women were two to four times more likely to experience a major depressive episode (MDE) when they were peri-menopausal or early post-menopausal. Repeated-measures logistic regression analyses showed that the effect of menopausal status was independent of history of major depression and annually measured upsetting life events, psychotropic medication use, VMS and serum levels of or changes in reproductive hormones. History of major depression was a strong predictor of major depression throughout the study. Conclusions The risk of major depression is greater for women during and immediately after the menopausal transition than when they are pre-menopausal.