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Letters to the Editor
March 2001

Depression During the Perimenopause

Arch Gen Psychiatry. 2001;58(3):306. doi:

Harlow et al1 recently published data from a study describing prevalence and predictors of depression in older premenopausal women. The study describes a significant rate (22.4%) of current depressive symptoms (defined as Center for Epidemiologic Studies Depression Scale [CES-D]2 score >16) in a cross-sectional population-based study. It also describes a significant association between past or current depression and a higher risk for depressive symptoms and premenstrual complaints, particularly among women with significant premenstrual functioning impairment.

In a recent study,3,4 we noted a high prevalence (49.5%) of psychiatric morbidity (Self-Rating Questionnaire score [SRQ-20]5 >7) among 101 endocrinologically confirmed perimenopausal women attending a menopause clinic (age, 40-58 years; menstrual irregularity, >6 months; amenorrhea, <1 year; follicle-stimulating hormone levels, >20 IU/L). In addition, all women experiencing significant psychiatric symptoms were further assessed with the Mood Module from the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire6 to investigate depressive disorders according to DSM-IV7 criteria. Nearly one third (28.7%) met criteria for a depressive disorder (14.8% for major depressive disorder and 13.9% for minor depression or dysthymia). As in the sample described by Harlow et al,1 we observed a robust association between depressive symptoms (as measured by the Montgomery-Åsberg Depression Rating Scale8) and premenstrual complaints (as assessed by Steiner's Premenstrual Tension Scale9) (Spearman correlation coefficient, 0.75; P<.001). The finding of a significant association between depression and premenstrual complaints in both community and clinic-based studies is noteworthy. The prevalence of major depression in our study was high (14.8%), but this rate could be a product of selection bias since women who are seen at menopause clinics report more depressive symptoms than those recruited from the community.10 However, as Harlow and colleagues noted in their discussion of the CES-D, approximately 65% of patients with scores greater than 16 meet criteria for major depression. Hence, the prevalence of major depression observed in their community-based study is remarkably similar to that observed in our sample.

Finally, our finding with respect to the overall prevalence of depressive disorders during perimenopause is slightly greater than that noted by Harlow et al1 in a younger population of premenopausal women. These findings highlight the controversial question regarding the extent to which the transition to the perimenopause constitutes a period of increased risk for depression. As the cohort described by Harlow and colleagues proceeds through the perimenopausal transition (with repeated clinical and hormonal assessments), the hypothesis that the perimenopause is a period of increased psychiatric vulnerability for mood disorders can be examined prospectively.

References
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Harlow  BLCohen  LSOtto  MWSpiegelman  DCramer  DW Prevalence and predictors of depressive symptoms n older premenopausal women.  Arch Gen Psychiatry. 1999;56418- 424Google ScholarCrossref
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Steiner  MHaskett  RFCarroll  BJ Premenstrual tension syndrome: the development of research diagnostic criteria and new rating scales.  Acta Psychiatr Scand. 1980;62177- 190Google ScholarCrossref
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Schmidt  PJRoca  CABloch  MRubinow  DR The perimenopause and affective disorders.  Sem Reprod Endocrinol. 1997;1591- 100Google ScholarCrossref
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