Top

International Journal of Bipolar Disorders

Published in:

Open Access 01-12-2015 | Research

Symptom severity of bipolar disorder during the menopausal transition

Authors: Wendy K. Marsh, Bernice Gershenson, Anthony J. Rothschild

Published in: International Journal of Bipolar Disorders | Issue 1/2015

Abstract

Background

Little is known about the mood symptom experience of women with bipolar disorder during the menopausal transition (MT). Yet times of rapid hormonal decline, such as the postpartum, are associated with increased risk of severe mood episodes in bipolar disorder, and the MT is a time of increased risk for unipolar depression in women with or without a history of depression.

Methods

Enrollment included 56 women 40–60 years old diagnosed in the bipolar spectrum who were experiencing menopausal symptoms or were up to 5 years since their final menstrual period. Menopausal stages included early menopause, late menopause, or early postmenopause based on standardized criteria. Observational, prospective standardized mood symptom and reproductive hormone assessments were completed periodically. Concurrent menopausal symptoms as well as history of mood exacerbation during past reproductive events were assessed.

Results

Forty-four women were included in the main analysis. The average Montgomery-Asberg Depression Rating Scale (MADRS) score was 4.43 points higher in the late transition/early postmenopausal stage women (n = 29) compared to the early menopausal stage women (n = 15) (±SE 2.14; p = 0.039), corresponding to a roughly 10 % higher score (range 0–40) in the late/post stage across all study visits. Results were similar for the Young Mania Rating Scale (YMRS), where the average score was 2.54 points higher in the late/early postmenopausal stage women compared to the early menopausal stage women (±SE 1.15; p = 0.027), also roughly 10 % higher (range 0–26). Estradiol and follicle-stimulating hormone (FSH) absolute levels as well as between-visit change in levels were not notably associated with YMRS or MADRS during study observation. Total Greene Climacteric Symptom (menopausal symptom) score was significantly associated with MADRS but not YMRS. History of mood exacerbation premenstrually and/or postpartum was not significantly associated with YMRS or MADRS severity during the MT.

Conclusions

These results support the theory that times of increased reproductive hormonal changes, such as the late MT and early postmenopause, here compared to early MT, are associated with greater mood symptom severity in bipolar spectrum women. Nonetheless, absolute or change in FSH and estradiol levels were not significantly associated with depression or mood elevation severity.

APA. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition. Arlington VA: American Psychiatric Publishing; 2013.

Avis NE, Brambilla D, McKinlay SM, Vass K. A longitudinal analysis of the association between menopause and depression. Results from the Massachusetts Women’s Health Study. Ann Epidemiol. 1994;4(3):214–20.CrossRefPubMed

Blehar MC, DePaulo Jr JR, Gershon ES, Reich T, Simpson SG, Nurnberger Jr JI. Women with bipolar disorder: findings from the NIMH Genetics Initiative sample. Psychopharmacol Bull. 1998;34(3):239–43.PubMed

Bromberger JT. The menopausal transition increases the risk of depressive symptoms and depression diagnosis in women without a history of depression. Evid Based Ment Health. 2006;9(4):110.CrossRefPubMed

Bromberger JT, Kravitz HM, Chang YF, Cyranowski JM, Brown C, Matthews KA. Major depression during and after the menopausal transition: Study of Women’s Health Across the Nation (SWAN). Psychol Med. 2011;41(9):1879–88. doi:10.1017/S003329171100016X.PubMedCentralCrossRefPubMed

Bromberger JT, Matthews KA, Schott LL, Brockwell S, Avis NE, Kravitz HM, et al. Depressive symptoms during the menopausal transition: the Study of Women’s Health Across the Nation (SWAN). J Affect Disord. 2007;103(1–3):267–72. doi:10.1016/j.jad.2007.01.034.PubMedCentralCrossRefPubMed

Bromberger JT, Schott LL, Kravitz HM, Sowers M, Avis NE, Gold EB, et al. Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women’s Health Across the Nation (SWAN). Arch Gen Psychiatry. 2010;67(6):598–607. doi:10.1001/archgenpsychiatry.2010.55.PubMedCentralCrossRefPubMed

Burger HG, Dudley EC, Hopper JL, Groome N, Guthrie JR, Green A, et al. Prospectively measured levels of serum follicle-stimulating hormone, estradiol, and the dimeric inhibins during the menopausal transition in a population-based cohort of women. J Clin Endocrinol Metab. 1999;84(11):4025–30.PubMed

Burger HG, Hale GE, Robertson DM, Dennerstein L. A review of hormonal changes during the menopausal transition: focus on findings from the Melbourne Women’s Midlife Health Project. Hum Reprod Update. 2007;13(6):559–65. doi:10.1093/humupd/dmm020.CrossRefPubMed

Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow BL. Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Arch Gen Psychiatry. 2006;63(4):385–90. doi:10.1001/archpsyc.63.4.385.CrossRefPubMed

Dennerstein L, Guthrie JR, Clark M, Lehert P, Henderson VW. A population-based study of depressed mood in middle-aged. Australian-born women. Menopause. 2004;11(5):563–8.CrossRefPubMed

Dennerstein L, Smith AM, Morse C, Burger H, Green A, Hopper J, et al. Menopausal symptoms in Australian women. Med J Aust. 1993;159(4):232–6.PubMed

Freeman EW. Associations of depression with the transition to menopause. Menopause. 2010;17(4):823–7. doi:10.1097/gme.0b013e3181db9f8b.CrossRefPubMed

Freeman EW, Sammel MD, Boorman DW, Zhang R. Longitudinal pattern of depressive symptoms around natural menopause. JAMA Psychiatry. 2014;71(1):36–43. doi:10.1001/jamapsychiatry.2013.2819.CrossRefPubMed

Freeman EW, Sammel MD, Lin H. Temporal associations of hot flashes and depression in the transition to menopause. Menopause. 2009;16(4):728–34. doi:10.1097/gme.0b013e3181967e16.PubMedCentralCrossRefPubMed

Freeman EW, Sammel MD, Lin H, Nelson DB. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry. 2006;63(4):375–82.CrossRefPubMed

Freeman EW, Sammel MD, Liu L, Gracia CR, Nelson DB, Hollander L. Hormones and menopausal status as predictors of depression in women in transition to menopause. Arch Gen Psychiatry. 2004a;61(1):62–70.CrossRefPubMed

Freeman EW, Sammel MD, Rinaudo PJ, Sheng L. Premenstrual syndrome as a predictor of menopausal symptoms. Obstet Gynecol. 2004b;103(5 Pt 1):960–6.CrossRefPubMed

Freeman MP, Smith KW, Freeman SA, McElroy SL, Kmetz GE, Wright R, et al. The impact of reproductive events on the course of bipolar disorder in women. J Clin Psychiatry. 2002;63(4):284–7.CrossRefPubMed

Goldstein BI, Velyvis VP, Parikh SV. The association between moderate alcohol use and illness severity in bipolar disorder: a preliminary report. J Clin Psychiatry. 2006;67(1):102–6.CrossRefPubMed

Greene JG. A factor analytic study of climacteric symptoms. J Psychosom Res. 1976;20(5):425–30.CrossRefPubMed

Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012;19(4):387–95. doi:10.1097/gme.0b013e31824d8f40.PubMedCentralCrossRefPubMed

Kendall DA, Stancel GM, Enna SJ. The influence of sex hormones on antidepressant-induced alterations in neurotransmitter receptor binding. J Neurosci. 1982;2(3):354–60.PubMed

Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry. 1987;150:662–73.CrossRefPubMed

Kennedy N, Boydell J, Kalidindi S, Fearon P, Jones PB, van Os J, et al. Gender differences in incidence and age at onset of mania and bipolar disorder over a 35-year period in Camberwell, England. Am J Psychiatry. 2005;162(2):257–62.CrossRefPubMed

Kennedy SH, Andersen HF, Lam RW. Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlafaxine XR: a meta-analysis. J Psychiatry Neurosci. 2006;31(2):122–31.PubMedCentralPubMed

Kleine-Budde K, Touil E, Moock J, Bramesfeld A, Kawohl W, Rossler W. Cost of illness for bipolar disorder: a systematic review of the economic burden. Bipolar Disord. 2013. doi:10.1111/bdi.12165.PubMed

Lukasiewicz M, Gerard S, Besnard A, Falissard B, Perrin E, Sapin H, et al. Young Mania Rating Scale: how to interpret the numbers? Determination of a severity threshold and of the minimal clinically significant difference in the EMBLEM cohort. Int J Methods Psychiatr Res. 2013;22(1):46–58. doi:10.1002/mpr.1379.CrossRefPubMed

Maartens LW, Knottnerus JA, Pop VJ. Menopausal transition and increased depressive symptomatology: a community based prospective study. Maturitas. 2002;42(3):195–200.CrossRefPubMed

Marsh WK, Ketter TA, Crawford SL, Johnson JV, Kroll-Desrosiers AR, Rothschild AJ. Progression of female reproductive stages associated with bipolar illness exacerbation. Bipolar Disord. 2012;14(5):515–26. doi:10.1111/j.1399-5618.2012.01026.x.PubMedCentralCrossRefPubMed

Marsh WK, Ketter TA, Rasgon NL. Increased depressive symptoms in menopausal age women with bipolar disorder: age and gender comparison. J Psychiatr Res. 2009. doi:10.1016/j.jpsychires.2008.11.003.PubMed

Marsh WK, Templeton A, Ketter TA, Rasgon NL. Increased frequency of depressive episodes during the menopausal transition in women with bipolar disorder: preliminary report. J Psychiatr Res. 2008;42(3):247–51. doi:10.1016/j.jpsychires.2006.12.006.CrossRefPubMed

McEwen BS, Alves SE, Bulloch K, Weiland NG. Ovarian steroids and the brain: implications for cognition and aging. Neurology. 1997;48(5 Suppl 7):S8–15.CrossRefPubMed

Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–9.CrossRefPubMed

Payne JL, Roy PS, Murphy-Eberenz K, Weismann MM, Swartz KL, McInnis MG, et al. Reproductive cycle-associated mood symptoms in women with major depression and bipolar disorder. J Affect Disord. 2007;99(1–3):221–9. doi:10.1016/j.jad.2006.08.013.CrossRefPubMed

Rasgon NL, Altshuler LL, Fairbanks LA, Dunkin JJ, Davtyan C, Elman S, et al. Estrogen replacement therapy in the treatment of major depressive disorder in perimenopausal women. J Clin Psychiatry. 2002;63 Suppl 7:45–8.PubMed

Robertson Blackmore E, Craddock N, Walters J, Jones I. Is the perimenopause a time of increased risk of recurrence in women with a history of bipolar affective postpartum psychosis? A case series. Arch Womens Ment Health. 2008;11(1):75–8. doi:10.1007/s00737-008-0215-2.CrossRefPubMed

Rubinow DR, Schmidt PJ, Roca CA. Hormone measures in reproductive endocrine-related mood disorders: diagnostic issues. Psychopharmacol Bull. 1998;34(3):289–90.PubMed

Sachs GS, Thase ME, Otto MW, Bauer M, Miklowitz D, Wisniewski SR, et al. Rationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry. 2003;53(11):1028–42.CrossRefPubMed

Schmidt PJ, Haq N, Rubinow DR. A longitudinal evaluation of the relationship between reproductive status and mood in perimenopausal women. Am J Psychiatry. 2004;161(12):2238–44.CrossRefPubMed

Schurhoff F, Bellivier F, Jouvent R, Mouren-Simeoni MC, Bouvard M, Allilaire JF, et al. Early and late onset bipolar disorders: two different forms of manic-depressive illness? J Affect Disord. 2000;58(3):215–21.CrossRefPubMed

Sedgwick P. SAS Institute Inc. Cary, NC: SAS Institute Inc.; 2012.

Simon NM, Otto MW, Wisniewski SR, Fossey M, Sagduyu K, Frank E, et al. Anxiety disorder comorbidity in bipolar disorder patients: data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry. 2004;161(12):2222–9. doi:10.1176/appi.ajp.161.12.2222.CrossRefPubMed

Sit D, Rothschild AJ, Wisner KL. A review of postpartum psychosis. J Womens Health (Larchmt). 2006;15(4):352–68. doi:10.1089/jwh.2006.15.352.CrossRef

Soares CN, Almeida OP, Joffe H, Cohen LS. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial. Arch Gen Psychiatry. 2001;58(6):529–34.CrossRefPubMed

Sowers MR, Zheng H, McConnell D, Nan B, Harlow S, Randolph Jr JF. Follicle stimulating hormone and its rate of change in defining menopause transition stages. J Clin Endocrinol Metab. 2008a;93(10):3958–64. doi:10.1210/jc.2008-0482.PubMedCentralCrossRefPubMed

Sowers MR, Zheng H, McConnell D, Nan B, Harlow SD, Randolph Jr JF. Estradiol rates of change in relation to the final menstrual period in a population-based cohort of women. J Clin Endocrinol Metab. 2008b;93(10):3847–52. doi:10.1210/jc.2008-1056.PubMedCentralCrossRefPubMed

Steinberg EM, Rubinow DR, Bartko JJ, Fortinsky PM, Haq N, Thompson K et al. A cross-sectional evaluation of perimenopausal depression. J Clin Psychiatry. 2008:e1–e8. doi:http://dx.doi.org/ej07m03790 [pii].

Woods NF, Smith-DiJulio K, Percival DB, Tao EY, Mariella A, Mitchell S. Depressed mood during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. Menopause. 2008;15(2):223–32. doi:10.1097/gme.0b013e3181450fc2.CrossRefPubMed

Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429–35.CrossRefPubMed

Title: Symptom severity of bipolar disorder during the menopausal transition
Authors: Wendy K. Marsh
Bernice Gershenson
Anthony J. Rothschild
Publication date: 01-12-2015
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Bipolar Disorders / Issue 1/2015
Electronic ISSN: 2194-7511
DOI: https://doi.org/10.1186/s40345-015-0035-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Symptom severity of bipolar disorder during the menopausal transition

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Patterns of response to aripiprazole, lithium, haloperidol, and placebo across factor scores of mania

Common use of dietary supplements for bipolar disorder: a naturalistic, self-reported study

Validity and reliability of the Finnish version of the Functioning Assessment Short Test (FAST) in bipolar disorder

Developmental staging models in bipolar disorder

Low self-recognition and awareness of past hypomanic and manic episodes in the general population

Will mania survive DSM-5 and ICD-11?