Yakup AKPİNAR, Buket Belkiz GUNGOR, Almila Ikra AKGUL, Rustem ASKİN, Hakan DEMİRCİ, Ibrahim TAYMUR, Mahmut GUNGOR

The Effect of Perimenopausal Estrogen Levels on Depression and Anxiety: A Pilot Study

Objectives. Among women in the perimenopausal period, rapid hormonal changes can be seen. In the present study, we aimed to investigate the relationship between depression, anxiety and changing estrogen hormone levels at menopause. Materials and Methods. The research group was composed of 30 perimenopausal women who had FSH levels higher than 20 IU and irregular menses. Anxiety and depression status was assessed with the Hospital Anxiety and Depression Scale. Patients with or without depression or serious anxiety were compared in terms of age, body mass index (BMI), hot flushes, smoking, premenstrual syndrome (PMS) and estrogen levels. Results. There were no statistically significant differences in terms of hot flushes, BMI, smoking, age, and PMS in patients with or without depression/anxiety. Estrogen levels were statistically significantly lower in the group with depression compared to the group without depression (p=0.026). Conclusion. We believe that falling levels of estrogen in the perimenopausal period can be considered to be a risk factor for depression. The possible role of estrogen replacement in the treatment of depression and anxiety should be investigated in further studies.

PDF

___

[1] Rasgon N, Shelton S, Halbreich U. Perimenopausal mental disorders: epidemiology and phenomenology. CNS Spectr. 2005;10(6):471-8.
[2] Fritz MA, Speroff L. Clinical gynecologic endocrinology and infertility. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011.
[3] Schmidt PJ, Rubinow DR. Reproductive ageing, sex steroids and depression. J Br Menopause Soc. 2006;12(4):178-85.
[4] Freeman EW, Sammel MD, Liu L, Gracia CR, Nelson DB, Hollander L. Hormones and menopausal status as predictors of depression in women in transition to menopause. Arch Gen Psychiatry. 2004;61(1):62-70.
[5] Schmidt PJ, Haq N, Rubinow DR. A longitudinal evaluation of the relationship between reproductive status and mood in perimenopausal women. Am J Psychiatry. 2004;161(12):2238-44.[6]
Khan SA, Pace JE, Cox ML, Gau DW, Cox SA, Hodkinson HM. Climacteric symptoms in healthy middle-aged women. Br J Clin Pract. 1994;48(5):240-2.
[6] Khan SA, Pace JE, Cox ML, Gau DW, Cox SA, Hodkinson HM. Climacteric symptoms in healthy middle-aged women. Br J Clin Pract. 1994;48(5):240-2.
[7] Aloysi A, Van Dyk K, Sano M. Women's cognitive and affective health and neuropsychiatry. Mt Sinai J Med. 2006;73(7):967-75.
[8 ] McEwen BS. Invited review: Estrogens effects on the brain: multiple sites and molecular mechanisms. J Appl Physiol (1985). 2001;91(6):2785-801.
[9] Kruijver FP, Balesar R, Espila AM, Unmehopa UA, Swaab DF. Estrogen-receptor-beta distribution in the human hypothalamus: similarities and differences with ER alpha distribution. J Comp Neurol. 2003;466(2):251-77.
[10] Sherwin BB. Hormones, mood, and cognitive functioning in postmenopausal women. Obstet Gynecol. 1996;87(2 Suppl):20S- 6S.
[11] Kessler RC, McGonagle KA, Swartz M, Blazer DG, Nelson CB. Sex and depression in the National Comorbidity Survey. I: Lifetime prevalence, chronicity and recurrence. J Affect Disord. 1993;29(2-3):85-96.
[12 ] Weissman MM, Leaf PJ, Holzer CE, 3rd, Myers JK, Tischler GL. The epidemiology of depression. An update on sex differences in rates. J Affect Disord. 1984;7(3-4):179-88.
[13] Joffe H, Cohen LS. Estrogen, serotonin, and mood disturbance: where is the
therapeutic bridge? Biol Psychiatry. 1998;44(9):798- 811. [14] Studd J, Panay N. Are oestrogens useful for the treatment of depression in women? Best Pract Res Clin Obstet Gynaecol. 2009;23(1):63-71.
[15] Polat A. PrementrÃ¼el sendrom. 3P Psikiyatri Psikoloji Psikofarmakoloji Dergisi, 2001; 9: 631-8.
[16] Backstrom CT, Boyle H, Baird DT. Persistence of symptoms of premenstrual tension in hysterectomized women. Br J Obstet Gynaecol. 1981;88(5):530-6.
[17] Smith RN, Studd JW, Zamblera D, Holland EF. A randomised comparison over 8 months of 100 micrograms and 200 micrograms twice weekly doses of transdermal oestradiol in the treatment of severe premenstrual syndrome. Br J Obstet Gynaecol. 1995;102(6):475-84.
[18] Baksu A, Ayas B, Citak S, Kalan A, Baksu B, Goker N. Efficacy of tibolone and transdermal estrogen therapy on psychological symptoms in women following surgical menopause. Int J Gynaecol Obstet. 2005;91(1):58-62.
[19] Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70.
Aydemir Ö, Güvenir T, Küey L, Kültür S. Hastane Anksiyete ve Depresyon Ölçeði Türkçe Geçerlilik ve Güvenirliði. Türk Psikiyatri Dergisi 1997; 8: 280-7.
[21] Avis NE, Brambilla D, McKinlay SM, Vass K. A longitudinal analysis of the association between menopause and depression. Results from the Massachusetts Women's Health Study. Ann Epidemiol. 1994;4(3):214-20.
[22] Almeida OP, Lautenschlager N, Vasikaram S, Leedman P, Flicker L. Association between physiological serum concentration of estrogen and the mental health of community-dwelling postmenopausal women age 70 years and over. Am J Geriatr Psychiatry. 2005;13(2):142-9.
[23] Alpay N, Kývanç ZE, Ulasoðlu C. The relationship between hormonal profile and depressive symptoms in menopausal women. Düþünen Adam The Journal of Psychiatry and Neurological Sciences 2013;26:171-6.
[24] Sherwin BB. Affective changes with estrogen and androgen replacement therapy in surgically menopausal women. J Affect Disord. 1988;14(2):177-87.
[25] Avis NE, Crawford S, Stellato R, Longcope C. Longitudinal study of hormone levels and depression among women transitioning through menopause. Climacteric. 2001;4(3):243-9.
[26] Stearns V, Loprinzi CL. New therapeutic approaches for hot flashes in women. J Support Oncol. 2003;1(1):11-21; discussion 14- 5, 9-21.
[27] Kronenberg F. Hot flashes: epidemiology and physiology. Ann N Y Acad Sci. 1990;592:52-86; discussion 123-33.
[28] Weissman MM, Leaf PJ, Holzer CE 3rd, Myers JK, Tischler GL. The epidemiology of depression: an update on sex differences in rates. J Affect Disord. 1984;7(3-4):179-88.
[29] Moe KE. Hot ï¬ashes and sleep in women. Sleep Med Rev. 2004;8(6):487-97.
[30] Nelson DB, Sammel MD, Freeman EW, Liu L, Langan E, Gracia CR. Predicting participation in prospective studies of ovarian aging. Menopause. 2004;11(5):543-8.
[31] Jensvold MF, Halbreich U, Hamilton JA. Psychopharmacology and Women: Sex, Gender and Hormones. First Edition, Washington, American Psychiatric Association; 1996.
[32] Harlow BL, Signorello LB. Factors associated with early menopause. Maturitas. 2000;35(1):3-9.
[33] Harlow BL, Wise LA, Otto MW, Soares CN, Cohen LS. Depression and its influence on reproductive endocrine and menstrual cycle markers associated with perimenopause: the Harvard Study of Moods and Cycles. Arch Gen Psychiatry. 2003;60(1):29-36.
[34] Hyde Riley E, Inui TS, Kleinman K, Connelly MT. Differential association of modifiable health behaviors with hot flashes in perimenopausal and postmenopausal women. J Gen Intern Med. 2004;19(7):740-6.
[35] Soares CN, Almeida OP, Joffe H, Cohen LS. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebocontrolled trial. Arch Gen Psychiatry. 2001;58(6):529-34.
[36] Cohen LS, Soares CN, Joffe H. Diagnosis and management of mood disorders during the menopausal transition. Am J Med. 2005;118 Suppl 12B:93-7.
[37] Rasgon NL, Altshuler LL, Fairbanks LA, Dunkin JJ, Davtyan C, Elman S, et al. Estrogen replacement therapy in the treatment of major depressive disorder in perimenopausal women. J Clin Psychiatry. 2002;63 Suppl 7:45-8.
[38] Zweifel JE, O'Brien WH. A meta-analysis of the effect of hormone replacement therapy upon depressed mood. Psychoneuroendocrinology. 1997;22(3):189-212.
[39] Boyd RC, Amsterdam JD. Mood disorders in women from adolescence to late life: an overview. Clin Obstet Gynecol. 2004;47(3):515-26.
[40] Schmidt PJ. Depression, the perimenopause, and estrogen therapy. Ann N Y Acad Sci. 2005;1052:27-40.