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Tongta S, Daendee S, Kalandakanond-Thongsong S. Anxiety-like behavior and GABAergic system in ovariectomized rats exposed to chronic mild stress. Physiol Behav 2023; 258:114014. [PMID: 36328075 DOI: 10.1016/j.physbeh.2022.114014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/14/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Stress or low level of estrogen could promote anxiety and depression; thus, it is of interest to investigate the combined effect of mild stress and the lack of estrogen on mental disorders by utilizing an animal model. This study was conducted to assess anxiety- and depressive- like behaviors in ovariectomized (Ovx) rats exposed to chronic mild stress (CMS) and determine the alteration in gamma-aminobutyric acid (GABA)-related transmission. Ovx rats were randomly assigned into four groups: (1) estrogen replacement (E2-NoCMS), (2) estrogen replacement and exposure to CMS (E2-CMS), (3) vehicle (VEH-NoCMS), and (4) vehicle and exposure to CMS (VEH-CMS). Following 4-week CMS, VEH groups (VEH-NoCMS and VEH-CMS) showed a similar level of anxiety-like behavior in elevated T-maze, whereas E2-CMS, VEH-NoCMS and VEH-CMS showed anxiety-like behavior in open field. The depressive-like behavior in the force swimming test tended to be affected by estrogen deprivation than CMS. The alteration of the GABAergic system as determined from the GABA level and mRNA expression of GABA-related transmission (i.e., glutamic acid decarboxylase, GABA transporter and GABAA subunits) showed that the GABA level in the amygdala and frontal cortex was affected by CMS. For mRNA expression, the mRNA profile in the amygdala and hippocampus of VEH-NoCMS and E2-CMS was the same but different from those of VEH-NoCMS and E2-CMS. In addition, compared with E2-NoCMS, the mRNA profile in the frontal cortex was similar in VEH-NoCMS, E2-CMS, and VEH-CMS. These findings indicated that the underlying mechanism of the GABAergic system was differently modified, although VEH-NoCMS and VEH-CMS showed anxiety-like behavior. The findings of this study may provide a comprehensive understanding of the modulation of the GABAergic system during estrogen deprivation under CMS, as observed in menopausal women who were daily exposed to stress.
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Affiliation(s)
- Sushawadee Tongta
- Department of Veterinary Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
| | - Suwaporn Daendee
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani 34190, Thailand
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Nik Hazlina NH, Norhayati MN, Shaiful Bahari I, Nik Muhammad Arif NA. Prevalence of Psychosomatic and Genitourinary Syndrome Among Menopausal Women: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:848202. [PMID: 35308492 PMCID: PMC8927867 DOI: 10.3389/fmed.2022.848202] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The menopausal transition represents the passage from reproductive to non-reproductive life and is characterized by a number of menstrual disturbances. We systematically reviewed the evidence on the prevalence of psychosomatic and genitourinary syndrome among menopausal women and compared the risk of symptoms between premenopausal, perimenopausal, and post-menopausal women. Methods We performed a systematic search in MEDLINE, CINAHL, and ScienceDirect through March 2021. Case series/reports, conference papers and proceedings, articles available only in abstract form, editorial reviews, letters of communication, commentaries, systematic reviews, and qualitative studies were excluded. Two reviewers independently extracted and assessed the quality of data using the Joanna Briggs Institute Meta-Analysis. The outcomes were assessed with random-effects model using the Review Manager software. Results In total, 29 studies had a low risk of bias and were included in the review. Our findings showed that the pooled prevalence of somatic symptoms in post-menopausal women (52.6%) was higher than in the premenopausal and perimenopausal stages (34.6 and 39.5%, respectively). There was a low prevalence of psychological symptoms in premenopausal women (28.4%). The genitourinary syndrome was highest among post-menopausal women (55.1%), followed by perimenopausal (31.9%) and premenopausal (19.2%) women. Conclusion Post-menopausal women have a higher risk of experiencing menopausal symptoms particularly genitourinary syndrome than premenopausal and perimenopausal women. It is pertinent for healthcare professionals to evaluate the symptoms in order to provide them with a better quality of life. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021235958
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Affiliation(s)
- Nik Hussain Nik Hazlina
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Malaysia
- *Correspondence: Mohd Noor Norhayati
| | - Ismail Shaiful Bahari
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Malaysia
| | - Nik Ahmad Nik Muhammad Arif
- Women's Health Development Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Malaysia
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Guerrieri GM, Ben Dor R, Li X, Wei SM, Martinez PE, Neiman LK, Rubinow DR, Schmidt PJ. The Cortisol and ACTH Response to Dex/CRH Testing in Women With and Without Perimenopausal Depression. J Clin Endocrinol Metab 2021; 106:3007-3018. [PMID: 34097071 PMCID: PMC8475231 DOI: 10.1210/clinem/dgab407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Indexed: 12/20/2022]
Abstract
CONTEXT Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are frequent accompaniments of depression, and studies have documented the role of stress and stressful life events in the ontogeny of perimenopausal depressions (PMD). Because HPA axis function in women is further modulated both by aging and ovarian steroids, it is possible that a dysregulated HPA axis contributes to the increased risk of PMD. OBJECTIVE We examined HPA axis function in perimenopausal women with and without depression using the combined dexamethasone-corticotropin-releasing hormone (Dex/CRH) test. METHODS Dex/CRH tests were performed on 20 women with PMD and 20 women who were also perimenopausal but without current or past depression (control women). Main outcome measures were plasma levels of cortisol and adrenocorticotropin (ACTH) and 24-hour urinary free cortisol (UFC). Five women took chronic stable medications, otherwise all women were medically healthy, and both groups were comparable with respect to reproductive stage and age. Standardized symptom rating scales were administered to each woman prior to Dex/CRH testing. RESULTS No group differences were present in either baseline or stimulated ACTH and cortisol secretion. Baseline plasma measures of estradiol, progesterone, and 24-hour UFC levels similarly did not differ in PMD and control women. CONCLUSION Despite reports of increased stress responsiveness in PMD, we observed no abnormalities of HPA axis activity associated with PMD compared with women without depression. These findings suggest that PMD is not uniformly associated with HPA dysregulation and could reflect underlying pathophysiologic processes that are distinct from women with nonreproductive-related depressions.
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Affiliation(s)
- Gioia M Guerrieri
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Division of Anesthesiology, Addiction Medicine, and Pain Medicine, Office of Neuroscience, Food and Drug Administration, Silver Spring, MD, USA
| | - Rivka Ben Dor
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Xiaobai Li
- Biostatistics & Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Shau-Ming Wei
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Pedro E Martinez
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lynnette K Neiman
- Program in Reproductive and Adult Endocrinology, National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Peter J Schmidt
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Correspondence: Peter J. Schmidt, MD, National Institute of Mental Health, 10 CRC, Rm 25330, 10 Center Dr, MSC 1277, Bethesda, MD 20892-1277, USA.
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Süss H, Willi J, Grub J, Ehlert U. Psychosocial factors promoting resilience during the menopausal transition. Arch Womens Ment Health 2021; 24:231-241. [PMID: 32719937 PMCID: PMC7979610 DOI: 10.1007/s00737-020-01055-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/16/2020] [Indexed: 01/23/2023]
Abstract
Despite significant biological, psychological, and social challenges in the perimenopause, most women report an overall positive well-being and appear to be resilient to potentially negative effects of this life phase. The objective of this study was to detect psychosocial variables which contribute to resilience in a sample of perimenopausal women. A total of 135 healthy perimenopausal women aged 40-56 years completed a battery of validated psychosocial questionnaires including variables related to resilience, well-being, and mental health. First, using exploratory factor analysis, we examined which of the assessed variables related to resilience can be assigned to a common factor. Second, linear regression analyses were performed to investigate whether a common resilience factor predicts well-being and mental health in the examined sample of women. Optimism (LOT-R-O), emotional stability (BFI-K-N), emotion regulation (ERQ), self-compassion (SCS-D), and self-esteem (RSES) in perimenopausal women can be allocated to a single resilience-associated factor. Regression analyses revealed that this factor is related to higher life satisfaction (SWLS; β = .39, p < .001, adj. R2 = .20), lower perceived stress (PSS-10; β = - .55, p < .001, adj. R2 = .30), lower psychological distress (BSI-18; β = - .49, p < .001, adj. R2 = .22), better general psychological health (GHQ-12; β = - .49, p < .001, adj. R2 = .22), milder menopausal complaints (MRS II; β = - .41, p < .001, adj. R2 = .18), and lower depressive symptoms (ADS-L; β = - .32, p < .001, adj. R2 = .26). The α levels were adjusted for multiple testing. Our findings confirm that several psychosocial variables (optimism, emotional stability, emotion regulation, self-compassion, and self-esteem) can be allocated to one common resilience-associated factor. This resilience factor is strongly related to women's well-being as well as mental health in perimenopause.
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Affiliation(s)
- Hannah Süss
- Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, 8050 Zurich, Switzerland ,URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Jasmine Willi
- Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, 8050 Zurich, Switzerland ,URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Jessica Grub
- Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, 8050 Zurich, Switzerland ,URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, 8050, Zurich, Switzerland. .,URPP Dynamics of Healthy Aging Research Priority Program, University of Zurich, Zurich, Switzerland.
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Serrano-Checa R, Hita-Contreras F, Jiménez-García JD, Achalandabaso-Ochoa A, Aibar-Almazán A, Martínez-Amat A. Sleep Quality, Anxiety, and Depression Are Associated with Fall Risk Factors in Older Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4043. [PMID: 32517112 PMCID: PMC7312056 DOI: 10.3390/ijerph17114043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/07/2023]
Abstract
Gait, dynamic balance, and functional mobility problems are well-known fall risk factors. Furthermore, sleep disturbances, anxiety, and depression are prevalent among older women. This study aimed to analyze the associations of sleep quality, anxiety, and depression with functional mobility, gait speed, and dynamic balance in community-dwelling postmenopausal women aged ≥ 60 years. A total of 271 women (69.18 ± 5.69 years) participated in this study. Functional mobility (Timed Up-and-Go Test), dynamic balance (3-meter tandem walk test), gait speed (OptoGait® optical detection system), sleep quality (Pittsburgh Sleep Quality Index), and anxiety and depression (Hospital Anxiety and Depression Scale) were assessed. Our results showed that poor sleep efficiency and the use of sleeping medication were related to decreased gait speed (R2 = 0.072). Poor functional mobility was linked to depression and the use of sleeping medication (R2 = 0.159). Additionally, increased symptoms of anxiety and depression were associated with worsened dynamic balance (R2 = 0.127). In conclusion, poorer sleep quality is associated with slower gait speed and reduced functional mobility, which is also related, along with impaired dynamic balance, to higher levels of anxiety and depression.
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Affiliation(s)
- Rodrigo Serrano-Checa
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (R.S.-C.); (F.H.-C.); (A.A.-O.); (A.A.-A.); (A.M.-A.)
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (R.S.-C.); (F.H.-C.); (A.A.-O.); (A.A.-A.); (A.M.-A.)
| | - José Daniel Jiménez-García
- MOVE-IT Research Group and Department of Physical Education, Faculty of Education Sciences, University of Cádiz, 11003 Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11009 Cádiz, Spain
| | - Alexander Achalandabaso-Ochoa
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (R.S.-C.); (F.H.-C.); (A.A.-O.); (A.A.-A.); (A.M.-A.)
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (R.S.-C.); (F.H.-C.); (A.A.-O.); (A.A.-A.); (A.M.-A.)
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (R.S.-C.); (F.H.-C.); (A.A.-O.); (A.A.-A.); (A.M.-A.)
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Khayum MA, Moraga-Amaro R, Buwalda B, Koole M, den Boer JA, Dierckx RAJO, Doorduin J, de Vries EFJ. Ovariectomy-induced depressive-like behavior and brain glucose metabolism changes in female rats are not affected by chronic mild stress. Psychoneuroendocrinology 2020; 115:104610. [PMID: 32088632 DOI: 10.1016/j.psyneuen.2020.104610] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/23/2019] [Accepted: 01/29/2020] [Indexed: 01/11/2023]
Abstract
The increased incidence of depression in women going through peri-menopause suggests that fluctuations in estrogen levels may increase the risk of developing depression. Nonetheless, this psychiatric disorder is likely to be multifactorial and consequently an additional trigger may be needed to induce depression in this population. Stress could be such a trigger. We therefore investigated the effect of ovarian estrogen depletion and chronic mild stress (CMS) on depressive-like behavior and brain metabolism in female rats. Approximately 2 and 9 weeks after estrogen depletion by ovariectomy, behavioral changes were assessed in the open-field test and the forced swim test, and brain metabolism was measured with [18F]FDG PET imaging. A subset of animals was subjected to a 6-weeks CMS protocol starting 17 days after ovariectomy. Short-term estrogen depletion had a significant effect on brain metabolism in subcortical areas, but not on behavior. Differences in depressive-like behavior were only found after prolonged estrogen depletion, leading to an increased immobility time in the forced swim test. Prolonged estrogen depletion also resulted in an increase in glucose metabolism in frontal cortical areas and hippocampus, whereas a decrease glucose metabolism was found in temporal cortical areas, hypothalamus and brainstem. Neither short-term nor prolonged estrogen depletion caused anxiety-like behavior. Changes in body weight, behavior and brain glucose metabolism were not significantly affected by CMS. In conclusion, ovarian estrogen depletion resulted in changes in brain metabolism and depressive-like behavior, but these changes were not enhanced by CMS.
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Affiliation(s)
- M A Khayum
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - R Moraga-Amaro
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands; Research School of Behavioural and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - B Buwalda
- Behavioral Physiology, University of Groningen, Nijenborgh 7, 9747 AG, Groningen, the Netherlands
| | - M Koole
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - J A den Boer
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands; PRA-Health Sciences, Van Swietenlaan, 9728 NZ, Groningen, the Netherlands
| | - R A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - J Doorduin
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - E F J de Vries
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
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Süss H, Ehlert U. Psychological resilience during the perimenopause. Maturitas 2020; 131:48-56. [DOI: 10.1016/j.maturitas.2019.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/14/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
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Cao LH, Qiao JY, Huang HY, Fang XY, Zhang R, Miao MS, Li XM. PI3K-AKT Signaling Activation and Icariin: The Potential Effects on the Perimenopausal Depression-Like Rat Model. Molecules 2019; 24:E3700. [PMID: 31618892 PMCID: PMC6832648 DOI: 10.3390/molecules24203700] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 12/17/2022] Open
Abstract
Icariin is a prenylated flavonol glycoside isolated from Epimedium herb, and has been shown to be its main bioactive component. Recently, the antidepressant-like mechanism of icariin has been increasingly evaluated and demonstrated. However, there are few studies that have focused on the involvement of the phosphatidylinositol 3-kinase (PI3K)/serine-threonine protein kinase (AKT) signaling in mediating the perimenopausal depression effects of icariin. Perimenopausal depression is a chronic recurrent disease that leads to an increased risk of suicide, and poses a significant risk to public health. The aim of the present study was to explore the effect of icariin on the expression of the PI3K-AKT pathway related to proteins in a rat model of perimenopausal depression. Eighty percent of the left ovary and the entire right ovary were removed from the model rats. A perimenopausal depression model was created through 18 days of chronic unpredictable stimulation, followed by the gavage administration of target drugs for 30 consecutive days. We found that icariin administered at various doses significantly improved the apparent symptoms in the model rats, increased the organ indices of the uterus, spleen, and thymus, and improved the pathological changes in the ovaries. Moreover, icariin administration elevated the serum levels of female hormone estradiol (E2), testosterone (T), and interleukin (IL)-2, decreased those of follicle stimulating hormone (FSH) and luteotropic hormone (LH), promoted the expression levels of estrogen receptor (ER) and ERα in the hypothalamus, and increased those of serotonin (5-HT), dopamine (DA), and noradrenaline (NA) in the brain homogenate. Furthermore, icariin elevated the expression levels of AKT, phosphorylation-akt (p-AKT), PI3K (110 kDa), PI3K (85 kDa), and B-cell lymphoma 2 (Bcl-2) in the ovaries, and inhibited those of Bax. These results show that icariin administration rebalanced the disordered sex hormones in perimenopausal depression rats, regulated the secretion of neurotransmitters in the brain, boosted immune function, and improved the perimenopausal syndrome. The mechanism of action may be related to the regulation of the expression of PI3K-AKT pathway-related proteins.
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Affiliation(s)
- Li-Hua Cao
- International TCM Immunopharmacology Research Center, Henan University of Chinese Medicine, Zhengzhou 450046, China.
| | - Jing-Yi Qiao
- International TCM Immunopharmacology Research Center, Henan University of Chinese Medicine, Zhengzhou 450046, China.
- Department of Pharmacology, Henan University of Chinese Medicine, Zhengzhou 450046, China.
| | - Hui-Yuan Huang
- Department of Pharmacology, Henan University of Chinese Medicine, Zhengzhou 450046, China.
| | - Xiao-Yan Fang
- Department of Pharmacology, Henan University of Chinese Medicine, Zhengzhou 450046, China.
| | - Rui Zhang
- Department of Pharmacology, Henan University of Chinese Medicine, Zhengzhou 450046, China.
| | - Ming-San Miao
- International TCM Immunopharmacology Research Center, Henan University of Chinese Medicine, Zhengzhou 450046, China.
- Department of Pharmacology, Henan University of Chinese Medicine, Zhengzhou 450046, China.
| | - Xiu-Min Li
- Microbiology and Immunology Department, New York Medical College, Valhalla, NY 10595, USA.
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Siegel A, Bachem R, Levin Y, Zhou X, Solomon Z. Long-Term Trajectories of Marital Adjustment in Israeli Couples Over Decades: Does Gender Matter? JOURNAL OF ADULT DEVELOPMENT 2019. [DOI: 10.1007/s10804-019-09338-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Garay RP, Charpeaud T, Logan S, Hannaert P, Garay RG, Llorca PM, Shorey S. Pharmacotherapeutic approaches to treating depression during the perimenopause. Expert Opin Pharmacother 2019; 20:1837-1845. [PMID: 31355688 DOI: 10.1080/14656566.2019.1645122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Introduction: Although postnatal depression is now well recognized, there is also a risk of depressive symptoms during perimenopause. The mechanisms underlying perimenopausal depression are still poorly understood; however, there are available treatment options. Areas covered: This review describes: the current pharmacotherapeutic approaches for perimenopausal depression, their strengths and weakness, and provides recommendations on how current treatment can be improved in the future. An electronic search identified specific guidelines for the treatment of perimenopausal depression released in 2018, as well as recent clinical studies on the subject. Expert opinion: The 2018 guidelines recommend selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) as front-line medications for perimenopausal depression, but SSRIs and SNRIs are not always effective. The efficacy of estrogen in perimenopausal depression is well documented, but estrogen is not FDA-approved to treat mood disturbances in perimenopausal women. Clinical practice guidelines currently recommend to restrict hormone therapy to the symptomatic treatment of menopause (not for the prevention of chronic diseases). Research with new estrogenic compounds is under way to improve their benefit/risk ratio in perimenopausal depression.
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Affiliation(s)
- Ricardo P Garay
- Department of Pharmacology and Therapeutics , Craven , France.,CNRS, National Centre of Scientific Research , Paris , France
| | | | - Susan Logan
- Department of Obstetrics & Gynecology, National University Hospital , Singapore , Singapore
| | | | | | | | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore , Singapore , Singapore
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Assessment of perimenopausal depression: A review. J Affect Disord 2019; 249:216-222. [PMID: 30776662 DOI: 10.1016/j.jad.2019.02.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/04/2019] [Accepted: 02/11/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Within the female life cycle, the perimenopause is considered as a critical period for the development of depression. Prevalence rates are particularly high during this phase. Perimenopausal depression is characterized by affective symptoms as well as menopause-specific somatic complaints. Currently, a variety of questionnaires are used to assess mood during the perimenopause. The aim of this review is to determine the instruments employed to assess perimenopausal depression. METHODS We searched the databases PubMed, Cochrane Library and PsycINFO for human studies investigating perimenopausal depression, and subsequently screened for the assessment instruments used to measure mood and menopause. A total of 37 articles were included. RESULTS Altogether, 14 different instruments were applied to assess mood during menopause. The CES-D was by far the most frequently used depression scale, appearing in 16 out of the 37 studies. The methods used to identify perimenopausal status and symptoms were inconsistent. LIMITATIONS Due to lacking information about data and methodology, a selection bias is conceivable. Additionally, a publication bias is possible. Finally, there is inevitable subjectivity in the screening process of a systematic search. CONCLUSIONS The assessment of depression in the menopausal transition is highly heterogeneous, reducing the overall comparability of study results. Furthermore, menopausal complaints are not sufficiently taken into account. Accordingly, the use of a menopause-specific depression scale is highly recommended in order to account for physical and mood-related symptoms in the menopausal transition.
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Bromberger JT, Epperson CN. Depression During and After the Perimenopause: Impact of Hormones, Genetics, and Environmental Determinants of Disease. Obstet Gynecol Clin North Am 2018; 45:663-678. [PMID: 30401549 PMCID: PMC6226029 DOI: 10.1016/j.ogc.2018.07.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vulnerability to depression is increased across the menopause transition and in the early years after the final menstrual period. Clinicians should systematically screen women in this age group; if depressive symptoms or disorder are present, treatment of depression should be initiated. Potential treatments include antidepressants for moderate to severe symptoms, psychotherapy to target psychological and interpersonal factors, and hormone therapy for women with first-onset major depressive disorder or elevated depressive symptoms and at low risk for adverse effects. Behavioral interventions can improve physical activity and sleep patterns.
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Affiliation(s)
- Joyce T Bromberger
- Department of Epidemiology, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA; Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Cynthia Neill Epperson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA; Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA; Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA
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The longitudinal relation of stress during the menopausal transition to fibrinogen concentrations: results from the Study of Women's Health Across the Nation. Menopause 2018; 23:518-27. [PMID: 26886885 DOI: 10.1097/gme.0000000000000579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Life course theory suggests that exposures during critical or sensitive periods have particularly profound effects on health. Most research on this subject has focused on the occurrence of such windows early in life. We investigated whether perimenopause, a period of dramatic neuroendocrine changes at midlife, represents a sensitive period for response to stress by evaluating the relation of perceived stress to fibrinogen, a biomarker for inflammation. METHODS The study sample was composed of participants in the Study of Women's Health Across the Nation, a longitudinal study on women's health during the menopausal transition (n = 3,287). We fitted linear mixed effects models to estimate the longitudinal relationship between stress and menopausal stage and the association between stress and fibrinogen over the menopausal transition. RESULTS Women in early and late perimenopause reported perceiving higher levels of stress than premenopausal women (P < 0.05), adjusted for confounding variables. This increased perception of stress during perimenopause, however, was unrelated to changes in fibrinogen. CONCLUSIONS Although neuroendocrine changes during the menopausal transition may exacerbate the negative health effects of stress, the findings of this study do not suggest such interaction, as measured by changes in fibrinogen. The significant association observed between perceived stress and menopause status, however, may still have important implications, given prior literature linking perceived stress with numerous health outcomes.
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Colvin A, Richardson GA, Cyranowski JM, Youk A, Bromberger JT. The role of family history of depression and the menopausal transition in the development of major depression in midlife women: Study of women's health across the nation mental health study (SWAN MHS). Depress Anxiety 2017; 34:826-835. [PMID: 28489293 PMCID: PMC5585035 DOI: 10.1002/da.22651] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/13/2017] [Accepted: 04/21/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study evaluated whether family history of depression predicts major depression in midlife women above and beyond static risk factors (such as personal history of depression prior to midlife) and risks that may change dynamically across midlife (such as menopausal, psychosocial, and health profiles). METHODS Participants were 303 African American and Caucasian women (42-52 years at baseline) recruited into the Study of Women's Health across the Nation (SWAN) Mental Health Study (MHS) in Pittsburgh. Major depression was assessed annually with Structured Clinical Interviews for DSM-IV. Family mental health history was collected at the ninth or tenth annual follow-up. Random effects logistic regression was used to assess the relationship between family history of depression and midlife depression, controlling for baseline sociodemographic characteristics and time-varying risk factors. RESULTS Family history of depression was associated with midlife depression after adjusting for participant's history of major depression prior to midlife, trait anxiety and baseline age, and time-varying menopausal status, body mass index, very upsetting life events, and chronic difficulties (OR = 2.24, 95% CI = 1.17-4.29, P = .02). Higher odds of major depression were found when women were late perimenopausal or postmenopausal relative to when they were premenopausal or early perimenopausal (OR = 3.01, 95% CI = 1.76-5.15, P < .0001). However, menopausal status was only associated with major depression among women without a family history. CONCLUSIONS Family history of depression predicts major depression in midlife women independent of the menopausal transition and other time-varying covariates. Notably, the menopausal transition was associated with increased risk only among women without a family history of depression.
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Affiliation(s)
- Alicia Colvin
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Gale A. Richardson
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Ada Youk
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Joyce T. Bromberger
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA,Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
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Abstract
This article reviews the literature on the use of antidepressants for symptoms associated with perimenopause. In some perimenopausal women, mood instability, insomnia and vasomotor symptoms cause significant distress. Studies of antidepressants for perimenopausal symptoms are summarized, with a focus on perimenopausal depression and vasomotor symptoms. Antidepressants should be considered as an alternative to hormone therapy for perimenopausal depression and hot flashes, especially when hormone therapy is contraindicated, or as an augmentation strategy for women who are only partially responsive to hormone therapy.
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Affiliation(s)
- Deborah R Kim
- Psychosomatic Medicine, Department of Psychiatry, Hospital of the University of Pennsylvania, 3535 Market Street, 2nd Floor Philadelphia, PA 19104, USA,
| | - Hadine Joffe
- Perinatal and Reproductive Psychiatry Department of Psychiatry Massachusetts General Hospital, 185 Cambridge St, 2nd Floor Boston, MA 02114, USA
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Freeman EW. Depression in the menopause transition: risks in the changing hormone milieu as observed in the general population. Womens Midlife Health 2015; 1:2. [PMID: 30766689 PMCID: PMC6214217 DOI: 10.1186/s40695-015-0002-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/18/2015] [Indexed: 01/05/2023] Open
Abstract
There is accumulating evidence but no definitive answers about the incidence of depressed mood in the menopause transition and its association with the changing hormonal milieu. While a changing hormonal milieu is the natural condition for all women, only a minority of mid-life women experience debilitating depressive symptoms or clinical depression. This review focuses on associations between depressed mood and the menopause transition, primarily as identified in longitudinal, population-based studies in the past decade. Further aims were to present reported associations between depressed mood and reproductive hormones in the menopause transition as evaluated in the general population and associations of depressive symptoms or clinical depression with menopausal hot flashes or poor sleep in perimenopausal women. There is evidence to support the role of the changing endocrine milieu in the development of depressed mood in the menopause transition, but the contribution of hormones as measured is small. Disentangling the numerous factors that are associated with depression in midlife women is a major challenge for research and for clinical care, where treatments are needed to improve the most distressing menopausal symptoms.
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Affiliation(s)
- Ellen W. Freeman
- Department of Obstetrics/Gynecology and Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3701 Market Street, Suite 820 (Mudd Suite), Philadelphia, PA 19104 USA
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Voronova EI. [The systematics of psychogenic depressions (reactions of complicated grief)]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:31-39. [PMID: 26978492 DOI: 10.17116/jnevro201511511231-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Reactive depression provoked by the loss of loved ones is a controversial problem of modern psychiatry based on the diametrically opposite conceptions. The author suggests a clinical typology of these depressions based on a psychopathological analysis of trigger mechanisms and constitutional predisposition. MATERIAL AND METHODS Fifty-five patients, aged from 31 to 65 years (mean age 46.9±13.9 years), were examined. The course of depression, including previous psychogenia, was followed up for 5-15 years (mean 11.5±3.6 years). RESULTS AND CONCLUSION Three types of catathymic complexes (affective dissonance, affective resonance and affective imbalance) can be considered as a significant parameter responsible for trigger mechanisms of these psychogenias and their further dynamics. Each type determines not only the psychopathological structure of psychogenic depression but has a predictive validity thus allowing to predict the dynamics of depression and its nosological attribution.
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Affiliation(s)
- E I Voronova
- Sechenov First Moscow State Medical University, Moscow, Mental Health Research Center, Moscow
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Miller LJ, Ghadiali NY, Larusso EM, Wahlen KJ, Avni-Barron O, Mittal L, Greene JA. Bipolar disorder in women. Health Care Women Int 2014; 36:475-98. [PMID: 25315819 DOI: 10.1080/07399332.2014.962138] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article summarizes research pertinent to the clinical care of women with bipolar disorder. With bipolar disorder, female gender correlates with more depressive symptoms and different comorbidities. There is a high risk of symptom recurrence postpartum and possibly during perimenopause. Women with bipolar disorder have increased risk of sexually transmitted diseases, unplanned pregnancies, excessive weight gain, metabolic syndrome, and cardiovascular disease. Mood stabilizing medications, specific psychotherapies, and lifestyle changes can stabilize mood and improve functioning. Pharmacologic considerations include understanding interactions between mood stabilizing medications and contraceptive agents and risks and benefits of mood stabilizing medication during pregnancy and lactation.
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Affiliation(s)
- Laura J Miller
- a Department of Psychiatry, Loyola Stritch School of Medicine, Edward Hines Jr. VA Hospital , Hines , Illinois , USA
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Colvin A, Richardson GA, Cyranowski JM, Youk A, Bromberger JT. Does family history of depression predict major depression in midlife women? Study of Women's Health Across the Nation Mental Health Study (SWAN MHS). Arch Womens Ment Health 2014; 17:269-78. [PMID: 24952069 PMCID: PMC4120816 DOI: 10.1007/s00737-014-0433-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/11/2014] [Indexed: 11/29/2022]
Abstract
This study aims to determine whether family history of depression predicts major depression in midlife women independent of psychosocial and health profiles at midlife. Participants were 303 African American and Caucasian women (42-52 years at baseline) recruited into the Study of Women's Health Across the Nation (SWAN) and the Women's Mental Health Study (MHS) in Pittsburgh. Major depression was assessed annually with the Structured Clinical Interview for DSM-IV. Family mental health history was collected at the ninth or tenth follow-up. Multivariable logistic regression was used to determine whether family history of depression predicted major depression in midlife, adjusting for covariates. The odds of experiencing major depression during the study were three times greater for those with a family history than for those without a family history (OR = 3.22, 95% CI = 1.95-5.31). Family history predicted depression (OR = 2.67, 95% CI = 1.50-4.78) after adjusting for lifetime history of depression, age, trait anxiety, chronic medical conditions, and stressful life events. In analyses stratified by lifetime history of depression, family history significantly predicted depression only among women with a lifetime history of depression. Family history of depression predicts major depression in midlife women generally, but particularly in those with a lifetime history of depression prior to midlife.
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Affiliation(s)
- Alicia Colvin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
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Mauas V, Kopala-Sibley DC, Zuroff DC. Depressive symptoms in the transition to menopause: the roles of irritability, personality vulnerability, and self-regulation. Arch Womens Ment Health 2014; 17:279-89. [PMID: 24957780 DOI: 10.1007/s00737-014-0434-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
Although the transition to menopause represents a period of risk for depressive symptoms, there is little research into personality or trait-like factors that may confer vulnerability to depression during the transition to menopause. This study investigated whether the personality trait of self-criticism moderated the effects of irritability on depressive symptoms in women transitioning to menopause and whether these effects were mediated by lower levels of emotional regulation. Participants were 376 women, of whom 157 had entered the transition phase to menopause. These women in the transition phase completed measures of self-criticism, irritable mood, emotional regulation, and depressive symptoms. All analyses controlled for attitudes toward menopause and somatic symptoms. Moderated mediation regression analyses showed that higher levels of irritability were associated with poorer emotional regulation in highly self-critical women, but not in less self-critical women, and poorer emotional regulation was, in turn, related to higher levels depressive symptoms. Findings suggest that the transition to menopause may represent an especially vulnerable period for women with high levels of self-criticism. Although irritability is transitory for most women, for women who are highly self-critical, irritability may tax their ability to self-regulate and lead to more encompassing symptoms of depression.
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Affiliation(s)
- Viviana Mauas
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Quebec, H3A 1B1, Canada
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Objective cognitive performance is related to subjective memory complaints in midlife women with moderate to severe vasomotor symptoms. Menopause 2014; 20:1236-42. [PMID: 23676633 DOI: 10.1097/gme.0b013e318291f5a6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Memory complaints increase as women transition from the premenopausal stage to the postmenopausal stage. We explored the extent to which subjective memory complaints were associated with objective cognitive test performance, affective symptoms, and menopausal symptoms in midlife women with moderate to severe vasomotor symptoms. We predicted that subjective memory complaints would be related to affective symptoms and lower performance on tests of memory and attention. METHODS Sixty-eight midlife women (mean age, 53 y; 54% African American) with at least 35 hot flashes per week completed the Memory Functioning Questionnaire, a battery of objective cognitive tests, a menopausal symptom inventory, and mood questionnaires. Linear regression analyses were conducted to examine predictors (symptoms and objective cognitive scores) of ratings on each of four Memory Functioning Questionnaire subscales and a validated single-item rating of current memory. RESULTS Negative affect and delayed verbal memory predicted a single-item rating of current memory. Negative affect and poorer scores on tests of attention and working memory predicted Frequency of Forgetting. Lower positive affect, higher vasomotor symptoms, and increased age predicted lower Retrospective Memory Functioning. Increased age predicted Use of Mnemonics. CONCLUSIONS These findings strengthen the growing body of evidence indicating that women with memory complaints during the menopausal transition have an accurate appraisal of their memory function and that their complaints relate to affect and, to a lesser extent, vasomotor symptoms. Given that cognitive performance is within the reference range, these findings suggest that women can detect subtle changes in memory performance during the menopausal transition.
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Karaoulanis SE, Rizouli KA, Rizoulis AA, Angelopoulos NV. Lack of association of acute phase response proteins with hormone levels and antidepressant medication in perimenopausal depression. BMC Psychiatry 2014; 14:164. [PMID: 24894416 PMCID: PMC4084572 DOI: 10.1186/1471-244x-14-164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 05/19/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Major depression is associated with higher plasma levels of positive acute-phase proteins, as well as with lower plasma levels of negative acute-phase proteins. The aim of this study is to examine the levels of acute-phase response proteins and whether these levels are influenced by reproductive hormones and antidepressant medication in the perimenopausal depression. METHODS Sixty-five women (age range: 40-58 years old) participated in this study. All women were in the perimenopausal phase. The diagnosis of depression was made through a psychiatric interview and with the aid of Hamilton Depression Rating Scale 17 (HAM-D 17). The acute-phase response proteins, such as haptoglobin (HP), transferrine (TRf), α1-antitrypsin, complement protein 3 (C3), complement protein 4 (C4) and C-reactive protein (CRP) and the reproductive hormones, for example follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), were analyzed using standard laboratory methods. Pearson's correlations were applied to evaluate the relationship between acute-phase proteins and hormones. RESULTS Perimenopausal women were divided into three groups. The first group consisted of normal controls, the second one involved depressed perimenopausal women, who were taking selective serotonin reuptake inhibitors (SSRIs), and the third one included depressed women that were not treated with SSRIs. Depressed women in perimenopause, when being compared to non-depressed women, did not differ as to serum levels of acute-phase proteins. There was a positive correlation between HP and E2 in depressed perimenopausal women, who were not taking SSRIs. CONCLUSIONS The lack of association between acute-phase proteins and depressive mood mentioned in this study does not support previous findings in patients with major depression. This negative finding in perimenopausal depression indicates either the absence or a more complex nature of the interactions between acute-phase proteins, low-grade inflammation and depression. The hormonal profile of women is a part of this complexity, because it seems that in perimenopause the hormonal changes are accompanied by changes of acute-phase response proteins. Particularly, in perimenopausal depression, there is an interaction between HP and E2. Therefore, it seems that perimenopause is a period of a woman's life during which hormonal, immune and metabolic changes occur and interact with each other making women vulnerable to depression.
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Affiliation(s)
- Sokratis E Karaoulanis
- Department of Psychiatry, University Hospital of Larissa, University of Thessalia, Mezourlo, Larissa, P,O, Box 41110, Greece.
| | - Katerina A Rizouli
- Department of Immunology, University Hospital of Larissa, University of Thessalia, Larissa, Greece
| | - Andreas A Rizoulis
- Department of Endocrinology, University Hospital of Larissa, University of Thessalia, Larissa, Greece
| | - Nikiforos V Angelopoulos
- Department of Psychiatry, University Hospital of Larissa, University of Thessalia, Mezourlo, Larissa, P.O. Box 41110, Greece
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Alexander JL, Dennerstein L, Woods NF, McEwen BS, Halbreich U, Kotz K, Richardson G. Role of stressful life events and menopausal stage in wellbeing and health. Expert Rev Neurother 2014; 7:S93-113. [DOI: 10.1586/14737175.7.11s.s93] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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26
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Gibbs Z, Lee S, Kulkarni J. Factors Associated with Depression During the Perimenopausal Transition. Womens Health Issues 2013; 23:e301-7. [DOI: 10.1016/j.whi.2013.07.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 07/03/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022]
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What factors determine whether a woman becomes depressed during the perimenopause? Arch Womens Ment Health 2012; 15:323-32. [PMID: 22932961 DOI: 10.1007/s00737-012-0304-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 08/07/2012] [Indexed: 10/27/2022]
Abstract
Perimenopause has long been associated with psychological distress, both anecdotally and clinically. Research has identified this time as a period of increased risk for both first-episode depression and for depression reoccurrence. However, we know that the majority of women do not experience these difficulties during perimenopause. This review examines the current research literature looking at the factors associated with depression during perimenopause, with a view to identifying those factors which are protective and those factors which predict increased risk. From the literature, it is evident that some women have a hormonal vulnerability to mood disorders. However, this does not account for the phenomenon of perimenopausal depression in and of itself. Rather, there appears to be a complex interplay between hormonal vulnerability, the psychosocial resources one has (coping skills and social support), their overall well-being (exercise and other lifestyle factors) and the demands on their coping resources (stressful life events). The complexity of the relationship between perimenopause and depression means that there is a need to look beyond either as a sole explanation of mood during midlife. Education is required for both general practitioners and for women regarding the individual risks of psychological distress during perimenopause, as well as the knowledge of the life factors which we know to be protective.
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Worsley R, Davis SR, Gavrilidis E, Gibbs Z, Lee S, Burger H, Kulkarni J. Hormonal therapies for new onset and relapsed depression during perimenopause. Maturitas 2012; 73:127-33. [DOI: 10.1016/j.maturitas.2012.06.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 01/08/2023]
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Flores-Ramos M, Heinze G, Silvestri-Tomassoni R. Association between depressive symptoms and reproductive variables in a group of perimenopausal women attending a menopause clinic in México City. Arch Womens Ment Health 2010; 13:99-105. [PMID: 19730981 DOI: 10.1007/s00737-009-0107-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 08/19/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study was to explore the association between depressive symptoms and some variables related to the reproductive life, such as history of premenstrual dysphoric disorder, antecedent of postpartum depression, previous use of hormonal contraceptives, and current hot flushes, in a group of perimenopausal women attending a menopause clinic. Perimenopausal women, 45 to 55 years old, who had not received hormonal replacement therapy and/or psychotropic medication, were invited to participate in this study. 141 perimenopausal women were included; we obtained their psychiatric and gynecological data, and we evaluated their depressive symptomatology using the CES-D scale. There were a significantly higher number of cases of previous depressive episodes, PMDD and PPD history in depressed patients compared with non-depressed women; current hot flushes prevalence was similar between depressed and non-depressed women. Patients with a PMDD history were more likely to have experienced previous depressive episodes, a PPD history and high levels of depression. Variables associated with the level of depression were a previous history of PMDD, current hot flushes, and previous depressive episodes. The occurrence of perimenopausal depression is related to a previous history of PMDD, PPD, and depressive episodes; hot flushes only increase the severity of the depressive episode.
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Affiliation(s)
- Mónica Flores-Ramos
- Psychiatry and Mental Health Department, Universidad Nacional Autónoma de México (UNAM), CP 01030 México, D.F, México.
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Qu F, Cai X, Gu Y, Zhou J, Zhang R, Burrows E, Huang H. Chinese medicinal herbs in relieving perimenopausal depression: a randomized, controlled trial. J Altern Complement Med 2009; 15:93-100. [PMID: 19769482 DOI: 10.1089/acm.2008.0267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To explore the effects of GengNianLe (GNL, also called perimenopausal depression relieving formula), a defined formula of Chinese medicinal herbs in relieving perimenopausal depression in Chinese women. METHODS Between September 2004 and April 2008, 47 Chinese women were randomized into a GNL group (n = 21) and a control group which received tibolone (n = 26) using a randomization chart. Depression was rated with the 24-item Hamilton Depression Scale (HAMD). The serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E(2)) were detected before and after the treatment. RESULTS After 12 weeks of treatment, HAMD scores in both groups decreased significantly (p < 0.05) with no significant difference between the groups (p > 0.05). The levels of FSH decreased significantly and the level of E(2) increased significantly in both groups, and they changed more in the control group. No side-effect of treatment was reported in either group during treatment. CONCLUSIONS The Chinese medicinal formula GNL showed promise in relieving perimenopausal depression and merits further study.
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Affiliation(s)
- Fan Qu
- Women's Hospital, School of Medicine, Hangzhou, Zhejiang 310006, China
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Lipovac M, Chedraui P, Gruenhut C, Gocan A, Stammler M, Imhof M. Improvement of postmenopausal depressive and anxiety symptoms after treatment with isoflavones derived from red clover extracts. Maturitas 2009; 65:258-61. [PMID: 19948385 DOI: 10.1016/j.maturitas.2009.10.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 10/28/2009] [Accepted: 10/30/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effect of isoflavones derived from red clover extracts (MF11RCE) over anxiety and depressive symptoms among postmenopausal women. METHODS One hundred and nine postmenopausal women aged 40 or more were randomly assigned to receive two daily capsules of MF11RCE (80mg red clover isoflavones, Group A) or placebo of equal appearance (Group B) for a 90-day period. After a washout period of 7 days, medication was crossed over and taken for 90 days more. Anxiety and depressive symptoms were measured at baseline, 90 and 187 days with the Hospital Anxiety and Depression Scale (HADS) and Zung's Self Rating Depression Scale (SDS). RESULTS After receiving the MF11RCE compound the total HADS (anxiety and depression subscale scores also) and the total SDS scores decreased significantly. This effect was equivalent to a 76.9% reduction in the total HADS score (76% for anxiety and 78.3% for depression) and an 80.6% reduction in the total SDS score. After placebo, total HADS (anxiety and depression subscale also) and total SDS scores also decreased significantly in comparison to baseline but only equivalent to an average 21.7% decline. CONCLUSION Red clover derived isoflavones (MF11RCE) were effective in reducing depressive and anxiety symptoms among postmenopausal women.
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Affiliation(s)
- Markus Lipovac
- Division of Obstetrics and Gynecology General Teaching Hospital Korneuburg, Austria
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Chedraui P, Pérez-López FR, Morales B, Hidalgo L. Depressive symptoms in climacteric women are related to menopausal symptom intensity and partner factors. Climacteric 2009; 12:395-403. [DOI: 10.1080/13697130902718150] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Miller LJ, Girgis C, Gupta R. Depression and Related Disorders during the Female Reproductive Cycle. WOMENS HEALTH 2009; 5:577-87. [DOI: 10.2217/whe.09.44] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
For some women, times of reproductive transition represent times of high risk for the onset or exacerbation of depressive symptoms. In order to maintain emotional stability, the female brain must adapt to fluctuations in hormones that affect neurotransmitter functioning. Difficulty with this adaptation, along with stresses related to social role transitions, may confer heightened vulnerability to depression. In this review, we summarize data regarding the course, expression and risks of depression and related symptoms during puberty and menarche, the luteal phase of the menstrual cycle, the perinatal period and perimenopause. We note treatment strategies that have been found to be effective for depressive symptoms during specific phases of the female reproductive cycle.
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Affiliation(s)
- Laura J Miller
- Laura J Miller, MD, Vice Chair for Academic Clinical Services Director, Women's Mental Health, Department of Psychiatry, Brigham & Women's Hospital/Faulkner Hospital, 75 Francis Street, Boston, MA 02115, USA, Tel.: +1 617 525 7469,
| | - Christina Girgis
- Christina Girgis, MD, Department of Veteran Affairs, Edward Hines, Jr. Hospital, P.O. Box 5000, Hines, IL 60141, USA
| | - Renu Gupta
- Renu Gupta, MD, Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood Street, M/C 913, Chicago, IL 60612, USA, Tel.: +1 312 996 4685, Fax: +1 312 355 1095,
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Abstract
Epidemiologic studies have documented that the majority of women do not become depressed during the menopause transition. However, recent longitudinal studies suggest that in some women, the events related to the menopause transition could play a role in the onset of depression. In this article we review evidence suggesting a relationship between the menopause transition and depression. Additionally, we describe several findings that suggest a role of ovarian hormones in the onset of these depressions, including the clustering of episodes of depression during the stage of the menopause transition that is accompanied by estradiol withdrawal, and the therapeutic effects of short-term estradiol in depressed perimenopausal women. Finally, we discuss possible causes of affective disturbances during the menopause transition.
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Affiliation(s)
- Veronica Harsh
- National Institute of Mental Health, Section on Behavioral Endocrinology
| | | | | | - Peter J. Schmidt
- National Institute of Mental Health, Section on Behavioral Endocrinology
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Li Y, Yu Q, Ma L, Sun Z, Yang X. Prevalence of depression and anxiety symptoms and their influence factors during menopausal transition and postmenopause in Beijing city. Maturitas 2008; 61:238-42. [PMID: 18951736 DOI: 10.1016/j.maturitas.2008.09.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 08/23/2008] [Accepted: 09/01/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the prevalence of depression and anxiety symptoms and their influence factors in women during menopausal transition and postmenopause. METHODS A cross-sectional investigation was conducted with a composed questionnaire on general conditions, social support scoring, the Zung self-evaluating depression and anxiety scoring. All of the parameters were input into a database and analyzed with t-test, chi(2) and logistic regression using SPSS. RESULTS A total of 1280 women aged 45-59 in Beijing city were interviewed with the questionnaire mentioned above. The prevalence of depression symptoms and anxiety in these women was 306 (23.9%) and 131 (10.2%), respectively. Risk factors associated with depression included strait financial status, social support, dyspareunia and dry vagina, hot flashes and sweating, satisfaction with family, children fail college or job and divorced or separated. Risk factors associated with anxiety included history of premenstrual dysphoric disorder (PMDD), hot flashes, vaginal dryness or dyspareunia and some negative life events. CONCLUSIONS Depression and anxiety were common symptoms in Chinese women during menopausal transition and postmenopause. Some psycho-social factors may play a role in the prevalence of them.
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Affiliation(s)
- Ying Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100730, China
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Treating the climacteric symptoms in Indian women with an integrated approach to yoga therapy. Menopause 2008; 15:862-70. [DOI: 10.1097/gme.0b013e318167b902] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee Y, Kim H. Relationships between menopausal symptoms, depression, and exercise in middle-aged women: a cross-sectional survey. Int J Nurs Stud 2008; 45:1816-22. [PMID: 18692187 DOI: 10.1016/j.ijnurstu.2008.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 07/03/2008] [Accepted: 07/03/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the relationship between the severity of menopausal symptoms and depression in Korean women, 40-60 years of age, and to compare the severity of menopausal symptoms and depression between subjects who exercise regularly and subjects who do not exercise regularly. METHODS Data for this cross-sectional, descriptive study were collected by administering questionnaires eliciting general information, menopausal symptoms, the Beck Depression Index and an exercise history to 648 middle-aged women who participated in a women's health promotion program held in the public health center located in Incheon, Korea. RESULTS There was a significant positive correlation between the severity of menopausal symptoms and depression. The severity of menopausal symptoms and depression in subjects who exercised more than three times a week were significantly lower than in the subjects who did not exercise. Menopausal symptoms differed significantly by education, marital status, economic level, and menopausal status. Economic status was related to education level and marital status. The correlation between body mass index and hot flushes was significant, but the magnitude of the correlation coefficient was small (r=.208, p=.000). CONCLUSIONS Women who were depressed had more menopausal symptoms than women who were not depressed, and women who exercised regularly were less depressed and less symptomatic than women who did not exercise.
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Affiliation(s)
- Youngwhee Lee
- Department of Nursing, Inha University, #253 Younghyun-dong, Nam-gu, Incheon 402-751, Republic of Korea
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Steinberg EM, Rubinow DR, Bartko JJ, Fortinsky PM, Haq N, Thompson K, Schmidt PJ. A cross-sectional evaluation of perimenopausal depression. J Clin Psychiatry 2008; 69:973-80. [PMID: 18505304 PMCID: PMC2727626 DOI: 10.4088/jcp.v69n0614] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Overall, the clinical spectrum of depression during the perimenopause is not well characterized. This cross-sectional study examined the following: (1) clinical characteristics of women who presented to the National Institute of Mental Health midlife mood disorders clinic (between March 1990 and January 2004) with peri-menopausal major and minor depressions and (2) the impact on these characteristics of either a prior episode of depression or the presence of hot flushes. METHOD Historical variables, reproductive status, symptom ratings, and plasma hormone measures were examined in 116 women between the ages of 40 and 55 years who met research criteria for perimenopause-related depression (a current episode of major or minor depression according to the Structured Clinical Interview for DSM-IV or Primary Care Evaluation of Mental Disorders supplemented with a past history form). RESULTS Clinical characteristics did not differ in those women with first-onset (39%) versus recurrent depressions or in those with (57%) and without hot flushes. Depressive episodes clustered in the later stages of the menopause transition and the first year postmenopause. Seven women (6%) reported a past postpartum major depression, and 55% of women reported a history of premenstrual dysphoria (PMD). CONCLUSIONS We found no evidence that either hot flushes or a previous episode of depression conveys a distinct clinical profile in these women. The clustering of onsets of depression suggests the hormone events that characterize the late menopause transition may be relevant to the onset of this form of depression. Finally, although we observed a high rate of PMD, neither postpartum depression nor PMD are consistent accompaniments of perimenopausal depression.
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Affiliation(s)
- Emma M. Steinberg
- Behavioral Endocrinology Branch, National Institute of Mental Health, Bethesda MD, USA
| | - David R. Rubinow
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill NC, USA
| | | | - Paige M. Fortinsky
- Behavioral Endocrinology Branch, National Institute of Mental Health, Bethesda MD, USA
| | - Nazli Haq
- Behavioral Endocrinology Branch, National Institute of Mental Health, Bethesda MD, USA
| | - Karla Thompson
- Nursing Department, Clinical Center, National Institutes of Health, Bethesda MD, USA
| | - Peter J. Schmidt
- Behavioral Endocrinology Branch, National Institute of Mental Health, Bethesda MD, USA
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von Irmer J, Seiffge-Krenke I. Der Einfluss des Familienklimas und der Bindungsrepräsentation auf den Auszug aus dem Elternhaus. ZEITSCHRIFT FUR ENTWICKLUNGSPSYCHOLOGIE UND PADAGOGISCHE PSYCHOLOGIE 2008. [DOI: 10.1026/0049-8637.40.2.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Im Vergleich zur Vielzahl an soziologischen Studien über den Auszug aus dem Elternhaus existieren sehr wenige psychologische Studien, die die Ursachen und Prädiktoren von unterschiedlichem Auszugsverhalten untersuchen. Die Frage, ob Unterschiede im Auszugsverhalten auf Unterschiede im Familienklima zurückgehen, steht im Zentrum dieses Beitrags. In einer Längsschnittsstudie an 93 Familien wurden drei Gruppen mit unterschiedlichem Auszugsverhalten gefunden: rechtzeitig Ausziehende, Nesthocker und Spätauszieher/wieder Eingezogene. Während der Adoleszenz wurde das Familienklima von allen Familienmitgliedern erhoben, später wurde die Bindungsrepräsentation erfasst. Zusammengenommen wurde gefunden, dass das Familienklima zu einem altersgerechten Auszug einen Beitrag leistet, indem eine höhere Konfliktneigung und gleichzeitige frühere Unterstützung der Autonomie in der Adoleszenz einen Individuationsprozess anstoßen. Eine sichere Bindungsrepräsentation geht ebenfalls mit einem zeitgerechten Auszug einher.
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Muhwezi WW, Agren H, Neema S, Maganda AK, Musisi S. Life events associated with major depression in Ugandan primary healthcare (PHC) patients: issues of cultural specificity. Int J Soc Psychiatry 2008; 54:144-63. [PMID: 18488408 DOI: 10.1177/0020764007083878] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The study compared life events experienced by depressed patients seen at primary healthcare (PHC) centres with those among healthy community controls. METHOD Data was collected from 74 depressed patients and 64 unmatched controls from village locales of patients. Interview instruments included the depression module of the Mini International Neuropsychiatric Interview (MINI) and Interview for Recent Life Events (IRLE). Associations between type of respondent and demographic variables were examined. Statistical comparisons were done for the two groups on other variables. RESULTS Most depressed patients were single by marital status, lacked formal employment and had less post-primary education.They had experienced more life events; job changes, discomforting working hours, unfavourable working conditions, and job losses; personal health problems; loss of valuables; difficulties with intimate partners and family members' marital problems. Independent life events were more among depressed patients and clustered around work, health, bereavement and marriage. Most events reported by depressed patients had high negative impact ratings compared to controls. CONCLUSION Compared to healthy community controls, depressed patients reported more undesirable life events. The relationship between life events and depression implies that in PHC settings of poor countries, deploying mental health-oriented workers to manage life events may lessen escalation of distress.
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Woods NF, Alexander JL, Dennerstein L, Richardson G. Impact of clinician and patient attitudes on clinical decision making for the symptomatic menopausal woman with or without comorbidity. Expert Rev Neurother 2008; 7:S27-34. [PMID: 18039065 DOI: 10.1586/14737175.7.11s.s27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Culture, individual health beliefs and distressing symptoms frequently determine women's perceptions of their menopausal transitions. Women's perceptions of mental health problems and the acceptability of different interventions greatly affect if and what a woman is willing to try as a treatment option and whether or not she will accept the possibility that her menopausal symptoms represent a comorbidity with a diagnosis, such as depression or anxiety. These perceptions have a significant impact on women's choices with regard to health practices, as well as on whether or not they will seek out medical care for their distressing symptom(s). Working with a woman's beliefs, sharing decision making, and empowering her through health education are all critical aspects of the treatment of the patient with comorbid perimenopausal symptoms, regardless of their etiology.
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Alexander JL, Dennerstein L, Woods NF, Kotz K, Halbreich U, Burt V, Richardson G. Neurobehavioral impact of menopause on mood. Expert Rev Neurother 2008; 7:S81-91. [PMID: 18039071 DOI: 10.1586/14737175.7.11s.s81] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The menopausal transition is a time of risk for mood change ranging from distress to minor depression to major depressive disorder in a vulnerable subpopulation of women in the menopausal transition. Somatic symptoms have been implicated as a risk factor for mood problems, although these mood problems have also been shown to occur independently of somatic symptoms. Mood problems have been found to increase in those with a history of mood continuum disorders, but can also occur de novo as a consequence of the transition. Stress has been implicated in the etiology and the exacerbation of these mood problems. Estrogen and add-back testosterone have both been shown to positively affect mood and well-being. In most cases, the period of vulnerability to mood problems subsides when the woman's hormonal levels stabilize and she enters full menopause.
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Harsh V, Schmidt PJ, Rubinow DR. The menopause transition: the next neuroendocrine frontier. Expert Rev Neurother 2008; 7:S7-10. [PMID: 18039070 DOI: 10.1586/14737175.7.11s.s7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Veronica Harsh
- National Institutes of Health, Behavioral Endocrinology Branch, National Institute of Mental Health, Department of Health & Human Services, Bldg 10-CRC, Room 65340, 10 Center Drive MSC 1276, Bethesda, MD 20892-1276, USA.
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Yonker JE, Adolfsson R, Eriksson E, Hellstrand M, Nilsson LG, Herlitz A. Verified hormone therapy improves episodic memory performance in healthy postmenopausal women. AGING NEUROPSYCHOLOGY AND COGNITION 2006; 13:291-307. [PMID: 16887775 DOI: 10.1080/138255890968655] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Studies of hormone therapy (HT) and cognition have yielded conflicting results. The aim of this observational study was to examine the effect of estradiol, via serum verified HT (estradiol, estriol, progesterone) and endogenous estradiol, on 108 healthy postmenopausal women's cognitive performance. The results demonstrated that the 43 HT-users performed at a significantly higher level than non-users on episodic memory tasks and on a verbal fluency task, whereas HT-users and non-users did not differ on tasks assessing semantic memory and spatial visualization. In addition, there was a positive relationship between serum estradiol level and episodic memory performance, indicating that postmenopausal HT is associated with enhanced episodic memory and verbal fluency, independent of age and education. These observational results suggest that HT use may be sufficient to exert small, yet positive effects on female sensitive cognitive tasks. Hormone therapy compliance and formulation is discussed as confounding factors in previous research.
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Abstract
OBJECTIVE A variety of results from both population and laboratory studies suggest that stress and hot flashes (HFs) are correlated and that HFs are more severe in women with lower coping abilities. The objective of this pilot study was to obtain information on the feasibility and effect of participation in a mindfulness-based stress reduction (MBSR) program on HF severity and menopause-related quality of life. DESIGN Fifteen women volunteers reporting a minimum of seven moderate to severe HFs per day at study intake attended the eight weekly MBSR classes at the University of Massachusetts Medical School. Participants were assessed for menopause-related quality of life before beginning and at the conclusion of the MBSR program. Women also kept a daily log of their HFs through the course of the 7 weeks of the MBSR program and for 4 weeks after it. RESULTS Women's scores on quality-of-life measures increased significantly, and the median reported HF severity, calculated as the weekly average of a daily HF severity score, decreased 40% over the course of the 11 weeks of the assessment period. The women were individually interviewed at the completion of their participation, and the results of the interviews were consistent with the results from daily diaries. CONCLUSIONS These results provide preliminary positive evidence of the feasibility and efficacy of MBSR in supporting women who are experiencing severe HFs, and it warrants further investigation.
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Affiliation(s)
- James Carmody
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Depression. Obstet Gynecol 2004; 104:49S-55S. [PMID: 15458933 DOI: 10.1097/01.aog.0000138798.46600.d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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