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The influence of menopause status and postmenopausal use of hormone therapy on presentation of major depression in women

Kornstein, Susan G. MD1; Young, Elizabeth A. MD2†; Harvey, Annie T. PhD3; Wisniewski, Stephen R. PhD4; Barkin, Jennifer L. PhD5; Thase, Michael E. MD6; Trivedi, Madhukar H. MD7; Nierenberg, Andrew A. MD8; Rush, A. John MD9

Menopause:
doi: 10.1097/gme.0b013e3181d770a8
Special Section: Menopause, Cognition and Mental Health
Abstract

Objective: The purpose of this study was to determine whether there are differences in depression characteristics among premenopausal, perimenopausal, and postmenopausal women with major depressive disorder. This study also evaluated these differences between postmenopausal women with major depressive disorder who are taking and not taking hormone therapy.

Methods: Analyses conducted with data from the Sequenced Treatment Alternatives to Relieve Depression study focused on female outpatients with nonpsychotic major depressive disorder seeking treatment in 41 primary or psychiatric care settings across the United States. Baseline demographic and clinical characteristics were compared among women not taking hormone therapy who were premenopausal (n = 950), perimenopausal (n = 380), or postmenopausal (n = 562). These comparisons were also made between postmenopausal women (n = 768) taking (n = 171) or not taking (n = 562) hormone therapy.

Results: After adjusting for sociodemographic and clinical baseline differences, premenopausal women were more likely to present with irritability than were either perimenopausal or postmenopausal women and were more likely to have decreased appetite and less likely to have early-morning insomnia than were perimenopausal women. Postmenopausal women were more likely to have suicidal ideation and poorer physical functioning than were either of the other groups and were more likely to have sympathetic arousal and gastrointestinal symptoms than were premenopausal women. After adjusting for baseline differences, postmenopausal women taking hormone therapy had better physical functioning, fewer melancholic features, less sympathetic arousal, and more lack of involvement in activities than did women not taking hormone therapy.

Conclusions: Menopause status and postmenopausal use of hormone therapy may influence the clinical presentation of major depressive episodes in women.

In Brief

This study compares depression characteristics among premenopausal, perimenopausal, and postmenopausal women with major depressive disorder as well as between postmenopausal women with major depressive disorder who were taking and not taking hormone therapy. The findings indicate that menopause status and postmenopausal use of hormone therapy may influence the clinical presentation of major depressive episodes in women.

Author Information

From the 1Department of Psychiatry and Institute for Women's Health, Virginia Commonwealth University, Richmond, VA; 2Department of Psychiatry and Molecular and Behavioral Neurosciences Institute, University of Michigan, Ann Arbor, MI; 3Via Christi Research, Via Christi Regional Medical Center, Wichita, KS; 4Epidemiology Data Center, GSPH, University of Pittsburgh, Pittsburgh, PA; 5Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA; 6Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; 7Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, TX; 8Department of Psychiatry, Massachusetts General Hospital, Boston, MA; and 9Departments of Clinical Sciences and Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, and Duke-National University of Singapore, Singapore.

Received January 18, 2010; revised and accepted January 26, 2010.

Funding/support: This project has been funded with federal funds from the National Institute of Mental Health, National Institutes of Health, under contract N01MH90003 to University of Texas Southwestern Medical Center at Dallas (principal investigator, A.J. Rush). The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

Financial disclosure/conflicts of interest: Susan G. Kornstein, MD-Grants/research support: National Institute of Mental Health, Bristol-Myers Squibb, Lilly, Forest Laboratories, Wyeth, Novartis, Boehringer-Ingelheim, Pfizer, Takeda. Advisory board or received honoraria: Wyeth, Pfizer, Lilly, Bristol-Myers Squibb, Forest Laboratories, Takeda, Endo. Book royalties: Guilford Press. Elizabeth A. Young, MD-Research support: National Institute of Mental Health and National Institute of Child Health and Human Development. Annie T. Harvey, PhD-Research support: Pfizer Inc. Except for income received from her primary employer, no other financial support or compensation was received from any individual or corporate entity for research or professional service and there are no personal financial holdings that could be perceived as constituting a potential conflict of interest. Stephen R. Wisniewski, PhD-Research support: National Institute of Mental Health. Advisory/consulting: Cyberonics, Inc. Michael E. Thase, MD-Advisory/consulting/speakers honoraria: AstraZeneca, Bristol-Myers Squibb, Cephalon, Cyberonics, Inc., Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutica, MedAvante, Inc., Neuronetics, Inc., Novartis, Organon, Inc., Sanofi-Aventis, Sepracor, Inc., Shire US, Inc., and Wyeth Pharmaceuticals. Equity holdings: MedAvante, Inc. Royalty/patent or other income: American Psychiatric Publishing, Inc., Guilford Publications, and Herald House. Dr. Thase did not accept research funding from pharmaceutical studies during the Sequenced Treatment Alternatives to Relieve Depression study but currently has grants from Eli Lilly and Company and Sepracor, Inc. Madhukar H. Trivedi, MD-Research support: Bristol-Myers Squibb Company, Cephalon, Inc., Corcept Therapeutics, Inc., Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutica, National Institute of Mental Health, National Alliance for Research in Schizophrenia and Depression, Pfizer Inc., Predix Pharmaceuticals, Wyeth-Ayerst Laboratories. Advisory/consulting: Abbott Laboratories, Inc., Akzo (Organon Pharmaceuticals Inc.), Bayer, Bristol-Myers Squibb Company, Cyberonics, Inc., Forest Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceutica Products, LP, Johnson & Johnson PRD, Eli Lilly and Company, Meade Johnson, Parke-Davis Pharmaceuticals, Inc., Pfizer, Inc., Pharmacia & Upjohn, Sepracor, Solvay Pharmaceuticals, Inc., Wyeth-Ayerst Laboratories. Speaking: Akzo (Organon Pharmaceuticals Inc.), Bristol-Myers Squibb Company, Cyberonics, Inc., Forest Pharmaceuticals, Janssen Pharmaceutica Products, LP, Eli Lilly and Company, Pharmacia & Upjohn, Solvay Pharmaceuticals, Inc., Wyeth-Ayerst Laboratories. Andrew A. Nierenberg, MD-Research support: Bristol-Myers Squibb Company, Cederroth, Cyberonics, Inc., Forest Pharmaceuticals Inc., GlaxoSmithKline, Janssen Pharmaceutica, Lichtwer Pharma, Eli Lilly and Company, PamLabs, Pfizer Inc., National Institute of Mental Health, National Alliance for Research in Schizophrenia and Depression, Stanley Foundation, Wyeth-Ayerst Laboratories. Advisory/consulting: AstraZeneca, Basilea Pharmaceutica, Brain Cells, Inc., Bristol-Myers Squibb Company, Dainippon Sumitomo, Eli Lilly and Company, EpiQ, Genaissance, GlaxoSmithKline, Jazz Pharmaceuticals, Innapharma, Merck, Neuronetics, Novartis, Pfizer, Inc., PGx Health, Sepracor, Shire, Targacept, Takeda. Speaking: Eli Lilly and Company, GlaxoSmithKline, Organon, Inc., Wyeth-Ayerst Laboratories, Massachusetts General Hospital Psychiatry Academy (MGHPA talks are supported through Independent Medical Education grants from the following pharmaceutical companies in 2008: AstraZeneca, Eli Lilly, and Janssen Pharmaceuticals.). Equity holdings (exclude mutual funds/blinded trusts): Appliance Computing, Inc. A. John Rush, MD-Research support: National Institute of Mental Health. Advisory/consulting: Advanced Neuronetic Systems, Inc., AstraZeneca, Best Practice Project Management, Inc., Bristol-Myers Squibb Company, Cyberonics, Inc., Forest Pharmaceuticals, Inc., GlaxoSmithKline, Healthcare Technology Systems, Inc., Jazz Pharmaceuticals, Eli Lilly and Company, Magellan Health Services, Merck & Co., Inc., Neuronetics, Ono Pharmaceutical, Organon USA Inc., Personality Disorder Research Corp., Pfizer Inc., and Wyeth-Ayerst Laboratories Inc. Speaking: Cyberonics, Inc., Forest Pharmaceuticals, Inc., GlaxoSmithKline, Eli Lilly & Company, and Merck & Co., Inc. Equity Holdings (exclude mutual funds/blinded trusts): Pfizer Inc. Royalty/patent, other income: Guilford Publications, Healthcare Technology Systems, Inc.

Address correspondence to: Susan G. Kornstein, MD, Department of Psychiatry and Institue for Women's Health, Virginia Commonwealth University School of Medicine, PO Box 980710, Richmond, VA 23298-0710. E-mail: skornste@vcu.edu

©2010The North American Menopause Society