Novel tool to help women navigate perimenopausal depression

Dr Caroline Gurvich (pictured) and MAPrc researchers have
developed a rating scale for perimenopause depression

by Anne Crawford

Researchers at Monash Alfred Psychiatry Research Centre (MAPrc) have developed a new rating system to help diagnose perimenopausal depression, a relatively neglected area of women’s health.

Perimenopause or the transition into menopause is a time when women are at increased risk for new onset depression, as well as relapse of depression. Perimenopause is diagnosed clinically and includes the time immediately preceding menopause, when women can have varying menstrual cycle lengths, and ends one year after the final menstrual period. This is usually during the mid- to late 40s, and typically continues for about four to five years.

The MAPrc study, published in Translational Psychiatry, noted that while there were many
overlapping symptoms between major depression and depression during the menopause transition, research suggested there were key differences that indicate perimenopausal depression may be a unique subtype of depression.

Overlapping symptoms included muscle pain, weight gain, low energy levels, decreased self-esteem, feelings of isolation, cognitive impairment and decreased libido. But while major depression is often characterised by sadness, moods experienced in perimenopausal depression comprised anger, irritability and paranoia which may manifest as out-of-character verbal outbursts over minor stressors.

Yet there is currently no validated scale designed to measure perimenopausal depression, the study said.

To this end the researchers, including first author Professor Jayashri Kulkarni and senior author Dr Caroline Gurvich, developed and validated a new rating scale, Meno-D, specifically designed to reflect the subset of symptoms.

“I have been collecting data from women in the perimenopause period for 10 years and developed the questions for the rating scale from clinical practice. The menopausal process affects many brain systems as well as body and this is often not acknowledged by clinicians, and certainly not known by most women,” Professor Kulkarni explained.

“The psychological symptoms of menopause can often present much earlier than the physical symptoms (up to five years earlier),” Dr Gurvich said. “Therefore, it is important to consider whether changes in mental state for women in their mid-40s could be related to perimenopause.”

The Meno-D is a 12-item self-reporting or clinician-rated questionnaire, which rates the severity of symptoms of perimenopausal depression. It assesses such factors as the patient’s self-esteem, sense of isolation, paranoid thinking, anxiety, interest in socialising, changes in libido and sexual activity, any decrease in energy, physical pain, changes in weight, subjective changes in memory and concentration, and increases in irritability and/or sleep disturbances.

The tool will allow for better detection and diagnosis of perimenopausal depression as early as possible to enable more specific treatments, such as hormone therapy, to be tailored to improve the quality of life for women involved.

“Awareness about the psychological symptoms that often accompany menopause is increasing,” Dr Gurvich said. “The Meno-D provides clinicians and researchers with a tailored scale to measure the severity of different symptoms of perimenopausal depression – this is important to characterise symptoms as well as monitor changes in symptoms following treatment,” she said.

Kulkarni J, Gavrilidis E, Hudaib A2, Bleeker C, Worsley R, Gurvich C. Development and validation of a new rating scale for perimenopausal depression-the Meno-D. Transl Psychiatry. 2018 Jun 28;8(1):123. doi: 10.1038/s41398-018-0172-0.

For more information about treatment trials in perimenopausal depression please email maprc.wmhresearch@monash.edu

See also http://www.maprc.org.au/news/beware-suicide-link-perimenopausal-depression