© Borgis - New Medicine 4/2010, s. 173-174
*Ewa Ogłodek, Aleksander Araszkiewicz
Depression in menopausal women
Chair and Clinic of Psychiatry of the Nicolaus Copernicus University,
Collegium Medicum in Bydgoszcz, Poland
Head of Department: prof. Aleksander Araszkiewicz, MD, PhD
The Beck Depression Inventory is a 21-item test where each of the items corresponds to a specific category of depressive symptoms and/or attitude. Each category describes a specific behavioural manifestation of depression and consists of a graded series of four self-evaluative statements. It is also a tool used to identify the presence and determine the severity of symptoms according to the criteria of the ICD-10. In the case of a climacteric patient with depression, treatment with sertraline and trazodone significantly improved her clinical condition, reducing anxiety and depressive symptoms. Depression treatment in menopausal women should include therapy with antidepressants and/or psychotherapy.
The term ?depression? has many meanings in the contemporary world. In everyday language it is used to indicate a bad disposition, reduced mood, and low spirits, regardless of the causes of such condition.
In psychiatry this term applies to a specific kind of mood and emotion disorders that can be considered as a disease. The condition for proper diagnosis of depression is to treat it as a syndrome rather than a symptom of another disease or the expression of psychosocial difficulties (1).
A 48-year-old patient treated at the Department of Psychiatry of Collegium Medicum in Bydgoszcz was examined for mood disorders that had appeared in the period of menopause and had persisted for 2 months before her going to the clinic. The patient had no somatic diseases. Over the last year she gained 12 kg, which negatively affected her general psychophysical condition. Before administering psychiatric treatment, the patient showed first degree obesity (BMI = 31.1).
In order to evaluate the mood, a questionnaire was used ? the Beck Depression Inventory (BDI), completed by the patient on her own (tab. 1). The patient completed the questionnaire twice: before the intended psychiatric treatment and 6 weeks after administering anti-depressive treatment. Throughout the whole period of therapy the patient was treated with sertraline, 50 mg a day, and was administered 50 mg of trazodone for the night.
With regard to the treatment for depression, a clinically significant improvement in the patient was observed over the subsequent 6 and 12 weeks of treatment. Over six weeks the degree of depression was reduced from moderate (BDI = 32) to mild (BDI = 22), and after 12 weeks a lack of depression was diagnosed (BDI = 10). The Beck questionnaire turned out to be an easy tool to apply in the patient during the menopausal period. It is worth emphasizing that the examined person showed the following dominant features of depression: the feeling of sadness, anxiety about the future, aversion to herself, concern about her appearance and sexual attractiveness, the feeling of irritation, and sleep difficulties. The patient did not report suicidal thoughts.
The total result of BDI was significantly influenced by the assessments concerning appearance and health, namely the ones that can be associated with the patient?s health situation. Such a profile of results obtained in particular items of the Beck questionnaire indicates psychological rather than biological (endogenous) cause of the lowered mood. The patient?s body mass after 12 weeks was reduced; the patient did not show first degree obesity, only overweight (BMI = 27).
The following symptoms of depression were dominant in the presented patient: lowered mood, sense of guilt, lowered respect for herself, increased fatigability, difficulties with falling asleep, and increased appetite. Additionally, the patient showed the characteristics of a somatic syndrome in the form of: losing satisfaction from work which used to give her pleasure; lack of pleasure from her hobby (collecting pictures); and she woke up 3 hours before the planned time, at 4 o?clock in the morning, with lowered mood. In the literature we can find information that depression is two to three times more frequent in the population of women than in men. In the general population of women as many as 20-25% have suffered from depressive disorders during their lives.
In particular, women are susceptible to mood disorders during the menopausal period. In depression during the menopausal period, high levels of anxiety and psychomotor excitation are frequent. Depressive symptoms occur in 45-70% of people with diagnosed anxiety, and anxiety symptoms occur in 60-80% of patients with diagnosed depression (2). Some authors (3) inform that in the self-assessment of depressiveness of women in the menopausal period: 40% of the examined persons perceived menopause as emotionally difficult, 51% regarded it as constantly ?depressive?, and as many as 90% reported increased hypersensitivity and periodic ?depressiveness? over this period. Other research shows that the greatest likelihood of depressive disorders in the menopausal period can be observed among women going to family doctors in connection with menopause. According to other authors, among patients around the age of menopause going to a family doctor 19.1% have suffered from classified affective disorders (4). It is necessary for women suffering from depression, especially with a moderate or heavy depressive episode during the menopausal period, to take anti-depressive medications. In treatment for depression the new generation of anti-depressive medications is preferred, especially selective serotonin reuptake inhibitors (SSRI ? citalopram, s-citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline), medications influencing the serotonin system with a different mechanism of operation (tianeptine), or monoamine oxidase inhibitors (IMAO-A ? moclobemide). Apart from the indicated factors, the literature draws attention to the possible operation of hunger and satiety hormones in the menopausal period and depression, responsible, among other things, for body mass. A possible factor is changes in levels of the hormones ghrelin and insulin and Y neuropeptide, and the level of free fatty acids in the serum (5).
Treatment for mood disorders in women in the menopausal period requires an interdisciplinary approach, with consideration of introducing antidepressants and/or hormone replacement therapy.
Treatment for depression in women in the menopausal period should include treatment with antidepressants and/or psychotherapy. The results of the above test indicate the effectiveness of treating depression with a serotoninergic drug, manifesting in mood improvement, reduction of anxiety and the desired lowering of body mass.
The Beck Depression Inventory (BDI) may be used for screening evaluation of depression, allowing family doctors to effectively and quickly identify patients from a high-risk group during the menopausal period.
1. García-Portilla MP: Depression and perimenopause: a review. Actas Esp Psiquiatr 2009; 37(4): 213-221.1. 2. Miller LJ, Girgis C, Gupta R: Depression and related disorders during the female reproductive cycle. Women?s Health 2009; 5(5): 577-587. 3. Martin-Du-pan RC: Personal losses, menopause, and estrogen treatment. Rev Med Suisse 2009; 3; 5(206): 1292. 4. Graziottin A, Serafini A: Depression and the menopause: why antidepressants are not enough? Menopause Int 2009; 15(2): 76-81. 5. Bauld R, Brown RF: Stress, psychological distress, psychosocial factors, menopause symptoms and physical health in women. Maturitas 2009 20; 62(2): 160-165.