14 Nov 2016

Tibolone could help perimenopausal depression

Tibolone can reduce depression symptoms in perimenopausal
women. Image: Menopause Living Today
by Anne Crawford 

Researchers from the Monash Alfred Psychiatry Research Centre (MAPrc) have published a case study of a woman who unexpectedly suffered depression severe enough to cause her to attempt suicide twice.

The researchers wrote a letter about the case study in the ‘Australian & New Zealand Journal of Psychiatry’, published online in October.

The case was of an ordinarily high-functioning 53-year-old woman with no psychiatric history who presented as an outpatient of the Women’s Mental Health Clinic. The woman had experienced the abrupt onset of anxious and depressive symptoms. These culminated in two ‘high lethality’ suicide attempts, the letter said.

The woman shifted to a private setting after two public admissions where her depression stabilised somewhat on high-dose anti-depression medication venlafaxine and olanzapine. However, she improved significantly after her GP prescribed Tibolone, a medication for hormone replacement therapy (HRT), after physical menopausal symptoms of hot flushes and sweating emerged.

The authors want to point out that women with no previous psychiatric history could present for the first time with new, unexpected and unexplained depressive symptoms, often accompanied by pronounced anxiety.

This could occur at any time over the decade of perimenopausal change, that is, from age 40 onwards, the paper said.

But it warned that recognising the symptoms as being related to menopause could be difficult: psychiatric symptoms could present before the physical symptoms of menopause. Menopausal hormone fluctuations impact central nervous system neurotransmitters many years before blood tests detected hormonal changes, it said.

“This case highlights the need to consider the recognition and treatment of perimenopausal depression as a severe depression that needs different targeted treatment,” said Professor Jayashri Kulkarni, one of the authors and the director of MAPrc.

“Unfortunately, the fastest growing rate of suicide in Australia is in women aged 45 to 52 and perimenopausal depression affects 19% of midlife women,” Professor Kulkarni said. “At MAPrc we have been conducting clinical trials of hormone treatment for depression in this age group of women with promising results.”

Prompt attention to the hormonal aspects of treatment would aid a speedier recovery and prevent further psychosocial damage, the paper said. Treatment of perimenopausal depression may require also require antidepressant and psychological interventions and ongoing psychosocial support was also important in recovery, it concluded.

Worsley A, Smythe J, Kulkarni J. A case of perimenopausal depression. Aust N Z J Psychiatry. 2016 Oct 3. pii: 0004867416671597. [Epub ahead of print]
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