Menopause and depression

Menopause, which is defined as the cessation of menses for at least 1 year, begins at an average age of 50 to 51 years.[34] A direct link between menopause and depression has not been substantiated. In fact, epidemiologic studies suggest that the risk of depression decreases in women after age 50. A large 5-year longitudinal prospective study of women between the ages of 45 and 55 years examined the effect of menopause on depression.The study, which controlled for prior depression, menopausal symptoms, and concurrent hormonal treatment, showed that the onset of natural menopause was not associated with an increased risk of depression.


Perimenopause, which typically occurs between the ages of 45 to 50 years, is the transition time between premenopause (the period when women normally have menstrual cycles) and menopause. Several studies and community surveys have reported a peak in the prevalence of MD during perimenopause.[55] For example, Ballinger et al.[55] reported a significant increase in psychiatric morbidity among perimenopausal women ages 45 to 49 years. Similarly, in a longitudinal study, Avis et al.


reported that women who experienced increased menopausal symptoms during a prolonged perimenopausal period (at least 27 months) had a moderately increased risk of developing transitory depression. More recent evidence, based on international Epidemiologic Catchment Area data, also suggested a peak in the onset of depressive illness during the perimenopausal years.[56] Affective changes at the time of menopause may be secondary to the occurrence of vasomotor or other physical symptoms, rather than menopausal status itself.


Environmental events and developmental life stressors, such as changes in family structure, caring for an elderly parent, having children leave or return home, involvement in outside work in addition to running a household, and reappraisal of one’s future role, also have been shown to affect mental health during this life stage.


These psychosocial factors may contribute more to such common menopausal symptoms as fatigue, anxiety, and sadness than the physiologic changes of menopause.[55,57] Women with a previous history of PPD, premenstrual syndrome, or prior depressive episodes are at increased risk for developing a depressive illness at menopause.[58] In a longitudinal study by Avis et al.,[54] prior depression was the variable most predictive of subsequent depression in postmenopausal women.

Risk factors in depression treatment

MD is a multifactorial disorder that is influenced by several risk factor domains. Table 1 lists possible risk factors for MD in women. Epidemiologic data indicate that gender and age are two independent risk factors for the development of MD. Lifetime episodes of MD have high heritability, and MD is 1.5 to 3 times more common among first-degree biological relatives of people with this disorder than in the general population.


Ethnicity, urbanicity, and geographic region may also influence the lifetime prevalence of depression.[1] Socioeconomic status (e.g., income and education) is a risk factor that predicts both lifetime and 12-month prevalence of MD.[1,12] The prevalence of MD usually declines with higher socioeconomic status. Marital status also affects mental health. Single mothers report higher lifetime and 1-year prevalence rates of depression than do married mothers.[20] Single mothers, whether never married, separated, or divorced, are almost three times more likely than married mothers to have experienced a major depressive episode.


They are also significantly more likely than married women to have experienced a larger number of childhood adversities, which increases their risk for early onset depression. Interestingly, married women who are relatively free of childhood adversities are more likely either to report no depressive episodes or to have a later onset of depression.[20] Mirowsky[21] supports the idea that the gender gap in the prevalence of depression is a direct result of the development of unequal adult status, such as marital and employment statuses. The author found that depression was higher among women who kept house, worked part-time, had constricting jobs, had difficulty affording or arranging child care while at work, or received little help with housework and child care.


Kessler et al.[11] also noted that adult gender-role stresses contribute to the greater risk of adult-onset depression in women. Childhood sexual abuse is an important early stressor that may predispose individuals, especially women, to adult-onset depression. A clear relationship between childhood sexual abuse and adult-onset depression has been shown, and this risk factor is considerably more common in women, with the ratio of female-to-male victims estimated to be as high as 12 to 1.


Dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in hypersecretion of corticotropin-releasing hormone, is thought to play a major role in linking this trauma with depression.[22] Other types of childhood trauma, such as parental loss, poor parenting, parental drinking, mental illness, and family violence, may also contribute to the development of adult-onset depression.[22] An integrated, longitudinal model in a population-based sample found recent stressful events to be the single most powerful risk factor for 1-year prevalence of MD, followed by genetic factors, previous history of MD, and temperament.

Psychotherapy Makes a Comeback as a Treatment for Depression

Antidepressants have been the hot ticket in psychiatry, making it seem like psychotherapy’s time was up. But the 50-minute-hour may be coming back into fashion. A growing body of research is showing that combining antidepressants and psychotherapy is significantly better at driving away despair than either treatment alone. “Psychiatry’s discovery that depression could be attacked by drugs that alter the distribution of brain chemicals is an extraordinary achievement, ” says Martin B. Keller, MD, chairman of psychiatry at Brown University Medical School. But in the pursuit of biological causes to explain mental illness, he adds, “Our profession may have fallen behind in its efforts to test the value of new psychotherapies.”


Dr. Keller is the lead author of a breakthrough study published in the New England Journal of Medicine in May, comparing psychotherapy and antidepressants for the treatment of chronic depression. It is the largest study of its kind. “Our profession may have fallen behind in its efforts to test the value of new psychotherapies.” The Chronic Depression study, conducted at 12 sites across the United States, involved 519 patients who had been continuously depressed for at least 2 years.


(Most had battled depression their entire adult lives.) The researchers found that 85% of those treated with both psychotherapy and the antidepressant Serzone for 3 months experienced remission or showed major improvement in their symptoms. Patients who received psychotherapy or medication alone didn’t fare as well: 55% of those in the drug group and 52% in the psychotherapy group recovered or improved significantly. For some of these patients, “It was the first time in 20 years that they felt joy or optimism or woke up in the morning wanting to face the day,” says Dr. Keller.

Discussions on the relation of fibromyalgia and depression

The controversy about whether Fibromyalgia and Chronic Fatigue Syndrome are simply psychological disorders persists despite the fact that an abundance of research has shown otherwise. Last week’s article focused on the distinction between Fibromyalgia Syndrome (FMS) and depression. There is an even greater body of research that compares patients diagnosed with primary depression to those who fit the criteria for Chronic Fatigue Syndrome. According to CFS expert Dr. Anthony Komaroff of Harvard Medical School, studies of CFS patients around the world show evidence of abnormalities in the brain and immune system.


Although we still do not understand the cause of these problems in CFS patients, Komaroff points out that it is not “all in their heads.” Says Komaroff, “There is no evidence of any psychiatric disorder in a sizable number of patients with this illness.” In fact, research has distinguished between depression and CFS on both a biological and psychiatric basis. Studies of brain pathology have revealed abnormalities in patients with CFS that are not characteristic of depression. For example, a 1992 study showed that CFS patients exhibit more alpha electroencephalographic (EEG) activity during non-REM sleep.


This irregularity is not found in patients with major depressive disorders. In addition, a greater number of CFS patients (53%) report difficulty falling asleep, while this number is only 26% for depressed patients. Immunological and neurological findings also differ between CFS and depression. A 1995 study indicated that CFS patients with more severe cognitive problems exhibited more abnormalities in their immune systems. Since the study statistically controlled for depression, this finding indicates that the presence of cognitive dysfunction in CFS sufferers cannot be explained merely by depressive symptoms.

NIMH on Anxiety Disorders

Today, the National Institute of Mental Health (NIMH) launched the Anxiety Disorders Education Program to help people recognize and find treatment for obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, phobias, and generalized anxiety disorder. At a media briefing in Washington, D.C., NIMH Director Steven E. Hyman, M.D., said tremendous advances in the understanding and treatment of these debilitating mental illnesses are emerging from research on brain disorders.


“Anxiety disorders, like other mental illnesses, reflect dysfunctions within the brain. We are beginning to understand the specific circuits in the brain that underlie post-traumatic stress disorder, obsessive-compulsive disorder and perhaps panic disorder. We are on the path to discovering genes that make people vulnerable to anxiety disorders,” Hyman said. “Already, the fruits of research have resulted in the development of effective treatments for millions of Americans living with these illnesses, but the promise for the future is even greater.” According to Hyman, most people with anxiety disorders, depression or other mental illnesses face great difficulty receiving appropriate treatment due to widespread lack of understanding and stigma.


“Anxiety disorders are the most common mental illnesses in America, yet many people who have them are suffering in silence and secrecy, inappropriately ashamed or unaware of the availability of excellent treatments,” Hyman said. “People are hungering for information, as shown by the thousands who attend national anxiety and depression screening days and call NIMH and other groups for information.”


Through education programs such as this one, Hyman said, NIMH can communicate research findings and help the public and their health care professionals recognize that these are real medical illnesses that can be effectively diagnosed and treated. Effective treatments for anxiety disorders include medication, specific forms of psychotherapy (known as behavioral therapy and cognitive-behavioral therapy), or a combination,

A letter to the psychiatry department

According to the abstract and methods, they screened their patients with chronic fatigue syndrome (CFS) to exclude those with depression. Then they examined this group further using a standardized psychiatric interview (Schedule for Affective Disorders and Schizophrenia) in order to “exclude subjects with current psychiatric illness, with a particular emphasis on depression”. The data from the Hamilton Depression Rating scale are difficult to interpret given the number of illness-related items, but the scores did not indicate a significant degree of depression either.


So, having excluded “subjects with depression or anxiety”, why did the authors claim in their discussion that “the main limitation of the present study is that our CFS subjects had high levels of depression”? If this is correct, why was their depression not picked up by the three measures? Why were these patients not excluded from the research as stated by the authors, or funds permitting, used as a comparison group (cf. Costa et al 1995, Fischler et al 1998)?


How depressed were the ten patients on antidepressants and if these were not effective, could their suboptimal treatment have contributed to their ongoing fatigue? I was also baffled by the authors’ suggestion that the thalamic hyperperfusion may reflect “increased attention to motor and cognitive tasks”. What were the patients doing? The abstract states that the scans were conducted at rest.


If the subjects had just completed a battery of cognitive tests, why did the authors not check to see if the data available supported their hypothesis (cf. Fischler et al)? If this paper was subjected to peer review, why did no one challenge the obvious inconsistencies? Why did no one query the selective discussion of the findings and the misrepresentation of the literature on CFS and psychopathology? Does British Psychiatry no longer value scientific objectivity and attention to detail?

Studies on chronic fatigue syndrome and depression

Thirty ambulant subjects with CFS were recruited from a local infectious diseases unit (17 subjects) and a local self-help group (13 subjects). We screened a further seven people from the infectious diseases unit and 63 from the self-help group — the majority of the latter were excluded as they did not meet CFS criteria and/or were not interested in the study; most of the exclusions from the former group were due to scoring above case threshold on the Hospital Anxiety and Depression Scale (HAD).


All participants had a thorough clinical evaluation, including physical examination and laboratory screening tests as recommended by the International CFS Study Group (Fukuda et al, 1994). The HAD questionnaire (Zigmond & Snaith, 1983) and a standardised psychiatric interview (Schedule for Affective Disorders and Schizophrenia: SADS) (Endicott & Spitzer, 1978) were used to exclude subjects with current psychiatric illness, with a particular emphasis on depression. Subjects with depression or anxiety disorders were excluded, but the one with somatisation disorder was included. The Hamilton Depression Rating Scale (HDRS) was used as a measure of severity of any depressive symptoms (Hamilton, 1960).


The mean duration of illness was 68 months (range 6-240). Sixteen subjects were medication-free at the time of imaging; the remaining 14 had been prescribed either antidepressants (10), minor tranquillisers (4), and/or endocrine replacement (two on thyroxine, one on oral contraceptive). Of the 10 patients prescribed antidepressants, five had a previous diagnosis of depression, of whom three were still receiving full antidepressant doses. The remaining five patients were prescribed antidepressant medication for symptomatic relief, generally 25-50 mg of a tricyclic antidepressant (or its equivalent).


Patients were excluded if there had been any changes in their medication in the preceding 3 weeks. Current fatigue levels on the day of testing were rated using the fatigue scale of the health scale (Befindlichkeitsskala) of von Zerssen et al (1974). Subjects within the CFS and healthy volunteer groups also completed the Likert-Chalder Fatigue Scale (Chalder et al, 1993), which rates levels of fatigue over the preceding month.

Paxil has ruined my life…

Paxil has basically ruined my life. I have terrible tinnitus and have had to deal with that and now am still dealing with it. The nauseusness and tinnitus was so overwhelming I have had to take a leave of absence from work and today I submitted my resignatiiion because I still feel like shit, and to get better is going to take 1 to 2 years according to the nuero-otologist for my ears. I have been thru the ringer with doctors, sinus surgery, predisone, diuritecs, because my ears were popping like a microwave popcorn bag.


They are full of pressure. My head felt so bad on the paxil and ears, I felt like if you could stick a knife in them and pop them, I could feel better. I was having terrible night sweats drenching, restless legs, which the psychologist blamed on perimenopause- wrong, it’s all gone now, now that I am off that crap. I am still left with the nauseau and dehabilitating tinnitus and no dr. knew, not even psychiatrist that tinnitus is a frequent side effect of Paxil unitl I called the manufacturer and found out. I was also having weird vivid dreams, mood swings, and never got undepressed til I got off that stuff. It wasn’t working for my depression, so they just kept upping the dosage.


What idiot drs. The withdrawal was so bad, I wanted to die. My kids will never be drug addicts, I can guarantee that of what they saw me go thru. I have had tubes put in my ears to help the tinnitus, to no avail. Paxil has ruined my health, my finances, my marriage, and has taken a year of me away from my children. I now have to spend the next 1 to 2 years rehabilatitaing myself. I am tired of the nausea- it should be gone by now but is not. I cannot believe I haven’t had a heart attack with what I have gone thru. Someone should have known this stuff. I have reported to FDA and so has manufacturer. I am sick of drs. who know nothing. I am tryiing chiropracty , homeopathy, but decided Ineed to see a gastrointestinaologist due to nausea-paxil has messed up my insides. And you all know what a pain it is with the HMO and getting referrals, etc.


I found out from an urgent care dr. that Paxil can be very bad, she saw a story on ABC news about it , some lady on it, I didn’t find out from my primary care who prescribed it in the first place or the psychiatrist who just kept saying try this, try this, and the stupid psychologist who was supposed to be in touch with the psychiatrist who i kept telling about my ears.


I also had extreme sleepiness, and when i went to psychiatrist, he said that is side effect, bring you down slowly, but talked about my ears, sinus surgery, he never connected the tinnitus.. – And guess what, its side effects are long lasting. They just handed it out like water. Insane. Did anyone else see the judgement on the Today Show- family won $8million judgment against makers of Paxil. We need to start a class action lawsuit. Any takers? I have name of lawyer friend here.

Lack of treatment for depression

The Global Alliance of Mental Illness Advocacy Networks (GAMIAN) is conducting a worldwide survey this summer to identify the predominant attitudes and behaviors that prevent people suffering anxiety and depressive illnesses from receiving proper medical treatment. The mail survey will be sent to members of advocacy organizations in Europe, South Africa, Latin America and North America that currently belong to GAMIAN.


The vast majority of persons suffering from all types of anxiety and depression including bipolar (manic) depression, major depression, persistent anxiety, panic, phobia and obsessive-compulsive disorder are not receiving proper health care treatment for their illness or are receiving no treatment at all. “The undertreatment of anxiety and depression is a health care crisis of major proportion,” says Mary Guardino, co-chair of GAMIAN. “These illnesses severely impair not only the lives of the individuals with the symptoms, but their families as well.


It is absolutely essential that we address this very serious problem right now.” The World Health Organization (WHO) reports that neuro-psychiatric disorders, particularly anxiety and depression, will be the major cause of disability-adjusted life years (DALY) in the economically developed countries early in the next century. The cost of anxiety and depression in the United States in 1990 was more than $90 billion, and 75% of that cost was due to absenteeism and reduced productivity in the work force and suicides.

Anger can cause depression

The “greatness” that I refer to is immutable. I only attribute it to the fact that I have done NOTHING to cause or deserve this, and I have done EVERYTHING in my best judgement to make it better. That includes my lack of interest in suicide, and the restraint against homicide. I cannot be greater, I cannot be lessor. The limit of my greatness is where my anger is able to feed my depression. That was the problem in the first place. In the advent of my depression I realized that I had problems, but I had other responsibilities, so I had a damn-the-torpedos attitude, and set aside my problems.


I tried to be greater a greater man; greater than my emotions. I’m afraid it is not that easy. I can’t just hose down my anger and extinguish it. I guess I don’t have an analogy for what I is necessary, but it is a very large and complicated ambition. Suffice to say, I intend to make this OH-SO well respected therapist face his shame. I’m paying for someone else’s crime, and that has to change. At the level that I’m specifying it is. I am so intensely angry and vengeful that I have burnt my mind. I have always felt like mine is the only depressive case with that cause. It seems that maybe you also went through this, but it is difficult for me to tell at this point. Now PAY ATTENTION everyone cause THIS IS MY THESIS QUESTION: Is there anyone else out there whose mind has been filled with such intense anger that it caused something pathological like depression? The kind of anger drives others to suicide or homicide? >parents growing up and was the neighborhood “patsy” for years. A gang of >older kids used to pound me weekly for sport.


I was in constant fear of [snip] {‘hope you don’t mind} Yes I see. You seem to have gone through the same thing I did, in that we both have been dealt a grave injustice when we were young and vulnerable, by those who are much more powerful than we were, and in some cases, were charged with protecting and nurturing us. One point where we differ (I suspect) are the intricacies of the shame that I’ve had to live with. (And the very simple shame that he has escaped.) Yes, we deserve medals for our endurance. Unfortunately such suffering goes largely unnoticed (at least until the likes of Oprah notices) but the minute we would act on it and commit a crime we’d get a LOT of notice, and it would not give much credit for the crime that we are already paying for.


That is a major technical problem with such a need. There are plenty of ways in which I could return the evil, but most of those ways would only breed more problems. Speaking of not being a psycho, most of my psychiatrists have expected psychotic episodes from me by now, because it is expected in such long-term depression. I guess this is just another one of those things that makes my case unique.