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Summary of the National Institute on Aging-sponsored conference on depressive symptoms and cognitive complaints in the menopausal transition

Maki, Pauline M. PhD1; Freeman, Ellen W. PhD2; Greendale, Gail A. MD3; Henderson, Victor W. MD, MS4; Newhouse, Paul A. MD5; Schmidt, Peter J. MD6; Scott, Nelda F. MD7; Shively, Carol A. PhD8; Soares, Claudio N. MD, PhD, FRCP9

doi: 10.1097/gme.0b013e3181d763d2
Special Section: Menopause, Cognition and Mental Health

Objective: The National Institutes of Health and The North American Menopause Society sponsored a symposium to understand the impact of the menopausal transition on mood symptoms and cognitive disorders and to identify research priorities for further investigation.

Methods: The symposium was divided into a morning session on depressive symptoms and an afternoon session on cognitive function. There were four speakers per session, and each session covered four methodological approaches, including longitudinal cohort studies, randomized intervention trials, pharmacological challenge studies, and clinical diagnosis. Interactive panel discussions focused on translating research findings to clinical practice.

Results: Most women do not experience serious depressive symptoms during the menopausal transition, but a subgroup of women is at increased risk. Slight changes in memory function and processing speed are evident during the menopausal transition, and physiological factors associated with hot flashes may contribute to memory problems. Clinical trial evidence indicates that estradiol therapy can be effective in treating perimenopausal depression. There is some limited evidence of a cognitive benefit with estrogen-alone therapy in younger postmenopausal women and stronger evidence that certain forms of combination hormone therapy produce modest deficits in verbal memory in younger postmenopausal women.

Conclusions: Routine evaluation of depressive symptoms in perimenopausal women is warranted by the literature. Quick and valid screening tools for assessing depression in the clinic are available online and free of charge. Identifying a cognitively neutral or beneficial combination therapy for the treatment of menopausal symptoms in naturally postmenopausal women is an important goal for future research.

This article summarizes the proceedings from the National Institutes of Health-sponsored presymposium entitled "Depressive Symptoms and Cognitive Complaints in the Menopausal Transition." The presymposium was aimed at understanding the impact of the menopausal transition on mood, symptoms, and cognitive disorders and identifying research priorities for further investigation.

From the 1Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL; 2Departments of Obstetrics and Gynecology and Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA; 3David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; 4Departments of Health Research and Policy and of Neurology and Neurological Sciences, Stanford University, Stanford, CA; 5Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT; 6Section on Behavioral Endocrinology Branch, National Institute of Mental Health, Bethesda, MD; 7Cook County Medical Center, Chicago, IL; 8Departments of Pathology, Psychology, and Physiology/Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC; and 9Departments of Psychiatry and Behavioral Neurosciences and Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.

Received February 1, 2010; revised and accepted February 2, 2010.

The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging (NIA) or the National Institutes of Health.

Funding/support: The project described was supported by award R13AG033944 from the NIA.

Financial disclosure/conflicts of interest: Dr. Maki has received consultant/advisory board services from the Council on Menopause Management and research support from Wyeth Pharmaceuticals. Dr. Freeman has disclosed grants/research support from Forest. Dr. Henderson has disclosed consultant/advisory board services to the Alexander Foundation for Women's Health, Council on Menopause Management, Geriatric Neurology Section of the American Academy of Neurology; John Douglas French Alzheimer's Foundation; and the National Aphasia Association. Dr. Newhouse has disclosed consultant/advisory board services to Neuroderm; grants/research support from the NIA, the National Institute of Mental Health, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Lilly, and Novartis; and speaker's bureau services to Pfizer. Dr.Soares has disclosed grants/research support from Allergan NationalCentre of Excellence, AstraZeneca, Canadian Institute of HealthResearch, Lilly, Hamilton Community Foundation, Lundbeck, Physicians Services Incorporated Foundation, and Wyeth and researchsupport from and consultant/speaker's bureau/advisory board services to AstraZeneca, Bayer Healthcare Pharmaceuticals, and Wyeth.Drs. Schmidt, Greendale, Shively, and Scott have nothing to declare.

Address correspondence to: Pauline M. Maki, PhD, Department of Psychiatry (MC 913), University of Illinois at Chicago, Chicago, IL 60612. E-mail:

©2010The North American Menopause Society