Why depression in women is so misunderstood

Identifying and treating menopausal depression is needed,
Professor Jayashri Kulkarni argues in her Nature Outlook essay

Professor Jayashri Kulkarni has published an essay in Nature Outlook, asking why depression in women is so misunderstood. The focus in this essay is on menopausal depression. She says it takes a huge toll, but is not widely recognised or adequately funded and is under-researched.

Professor Kulkarni writes, "Improving outcomes for people with menopause-related depression requires some significant changes. 

"Most importantly, psychiatrists and other mental-health practitioners who treat women in their 40s and 50s need to enquire about menopause at the outset of treatment, and be willing to prescribe hormone therapies. 

"In addition, clinicians and health-care students alike need to be better educated about this phase of women’s lives. A big part of clinicians’ reluctance to prescribe HRT for menopausal depression is the lack of knowledge about menopause — particularly how it affects the brain."

Read the essay: www.nature.com/articles/d41586-022-02213-w

Review reinforces link between contraceptive pill and depression

Progestin based hormonal contraceptive pills can tip vulnerable
women into depression, review shows

by Anne Crawford

For some time, Monash Central Clinical School psychiatrist Professor Jayashri Kulkarni has treated women telling her they had developed depression since being prescribed certain oral contraception or that their existing depression had become out of control.

There’s convincing evidence the pill can cause depression, and some types are worse than others

Jayashri Kulkarni, Monash University

Since the 1960s, “the pill” has been a popular choice of contraception for many women around the world. On February 1 1961, Australia became the second country in the world to enable access to the pill, thereby allowing women to have control over their fertility and separate sexual activity from reproduction, a major revolution.

Today, the pill is the most popular choice of contraception for Australian women.

The early pills caused many physical side effects such as nausea, vomiting and increased rates of blood clots – which were significant and concerning.

While newer generations of the pill have generally been improved in terms of physical side effects and safety overall, a neglected area of consideration is the impact of the pill on mood.

Read the complete original article published 9 June 2022 in The Conversation 

What has depression got to do with diabetes?

The MDD pathway is complex and multi-

factorial. Image: Tom Karagiannis

by Anne Crawford

Investigating the causes of depression might seem an unusual area for CCS's Department of Diabetes epigenomic medicine group, but that’s exactly what scientists there are doing – and in an ambitious way.

Researchers led by Dr Tom Karagiannis have conducted an interdisciplinary review of the breadth of biological pathways that can lead to Major Depressive Disorder (MDD). MDD is the most severe form of depression; patients experience chronic sadness and hopelessness, find it hard to go about their normal life and can think suicidal thoughts. One in five people is estimated to experience it at least once in their lifetime. Women are twice as likely to have MDD although the suicide rate is higher in men. 

MAPrc ear canal invention a new tool in identifying depression

by Anne Crawford

Bipolar Disorder and Major Depressive Disorder (or MDD) can appear similar in patients but distinguishing them is vital for clinicians to give the right and most efficacious treatment.

Monash Alfred Psychiatry Research Centre (MAPrc) researchers have developed a novel way of doing this – by recording the electrical activity from the outer ear canal. Their findings were published recently in a paper in The World Journal of Biological Psychiatry.

Could magnetic pulses help beat teen depression?

by Anne Crawford

A study showing that repetitive Transcranial Magnetic Stimulation (rTMS) reduced depression and anxiety in young people has pointed to factors suggesting who would be most likely to benefit from the treatment.

TMS, a non-invasive, well-tolerated procedure that uses magnetic pulses to stimulate nerve cells in the brain, is well-established as a treatment for depression in adults but little research has been conducted to test its use in young people.

Participants sought: Depression in menopausal women

We are seeking women to participate in a study on depression in menopausal women. The title of the study is "Double-Blind Randomised Investigation of Tibolone Alone or in Adjunct to Standard Antidepressant Treatment for Depression in Menopausal Women".
All women experience menopause, and a significant number of those women experience ongoing, severe depression during this time. Many women with this type of depression are treated with standard antidepressant medication. However, standard antidepressant medication has only shown small improvements. Hormone treatments which directly target the changes to reproductive hormone systems may be a better overall treatment of perimenopausal depression.

MAPrc study probes dark side of perimenopause

Suicide rates are alarmingly high among middle-aged women, and under-recognised and under-treated perimenopausal depression could be the culprit, says Professor Jayashri Kulkarni, director and founder of the Monash Alfred Psychiatry centre (MAPrc), in an interview posted on the MAPrc site.

Professor Kulkarni discusses early research she and her team have conducted into the hormone therapy Tibolone for addressing depression, which was “very encouraging”.

MAPrc are currently recruiting participants for a study into this.
Click here for more information about the research and to read The Medical Republic interview.

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.

Unlocking the brain with new stimulation technologies

Associate Professor Kate Hoy

Brain connectivity and neuroplasticity are increasingly investigated and becoming better understood, and the insights are being employed with new technologies for treatment of cognitive disorders and brain injuries.

In this article, Elouise Brennan interviews A/Prof Kate Hoy of the Monash Alfred Psychiatry research centre on how the techniques of transcranial direct current stimulation and transcranial magnetic stimulation are being used for schizophrenia, Alzheimer's and depression. Link to full story.

Participants sought: Cognitive Enhancement in Depression using Non-invasive Brain Stimulation

EEG Electrode cap in use

The Monash Alfred Psychiatry Research Centre (MAPrc) is conducting this study to investigate the effectiveness of non-invasive electrical brain stimulation methods to increase cognitive ability in individuals with Major Depressive Disorder (MDD). The study also aims to better understand the relationship between depression, stimulation, cognitive enhancement, and brain activity.

Mental health in the media with MAPrc

Prof Paul Fitzgerald explaining about

Transcranial Magnetic Stimulation

ABC Catalyst: Brain stimulation, broadcast 6 October 2015

Dr Maryanne Demasi explores magnetic transcranial stimulation or TMS with Professor Paul Fitzgerald. In the case of treating depression, the magnetic field is applied to the left prefrontal cortex, the part of the brain most responsible for happiness. Paul  says, "We tend to find about 45% of the patients we treat get a really substantial antidepressant response. Another 20% or so get benefit without it perhaps being life-changing. And about 35%, the patients don't respond at all."

Radio 3AW Talking health 4 October 2015: Professor Jayashri Kulkarni on 'borderline personality disorder' with Dr Sally Cockburn, how the term was invented 80 years ago and doesn't really help or explain the disorder (they don't quite have psychosis, they don't have depression, so it must be 'personality'!). Prof Kulkarni says that 85% of individuals diagnosed with the disorder had an early life trauma. They don't have a good internal sense of who they are. The major and most dangerous symptom is self harm.

Participants sought: Are you interested in a non-medication treatment for depression?

Does concurrent transcranial direct current stimulation augment the antidepressant efficacy of cognitive control training for major depression?

This study is looking at whether cognitive control training can help alleviate the symptoms of depression. It is also investigating whether a mild form of brain stimulation called transcranial electrical stimulation can be used to boost the impact of cognitive control training. Transcranial electrical stimulation is a safe, mild and non-invasive means of stimulating nerves cells in the brain.

Publication: The unique symptom profile of perimenopausal depression

Perimenopause is associated with increased depression symptoms in women. Symptoms at this time are thought to be qualitatively different from those in childbearing years. This research investigated whether depressive symptoms during perimenopause can be distinguished from those in the childbearing years.

Publication: Risk factors for depression during perimenopause

Perimenopause is often associated with varying levels of psychological distress. Research has identified this time as a period of increased risk for both depression and psychosis. However, we know that the majority of women do not experience these difficulties during perimenopause. This chapter examines the current research literature looking at the factors associated with mental health difficulties during perimenopause, including both protective factors and those associated with increased risk.

Reference: Gibbs, Z., Kulkarni, J. Risk factors for depression during perimenopause. Diana Barnes (ed), Women's Reproductive Mental Health Across the Lifespan (2014) pp. 215-233

Is gluten linked to depression?

A recent pilot study completed by Monash University and Alfred researchers has found that many patients with self reported non coeliac gluten sensitivity continued to suffer from gastrointestinal symptoms on a gluten free diet, but had an improved mental state. Prof Peter Gibson, who co-authored the study said that the results were surprising. "We found that gluten ingestion was associated with significantly higher depression scores compared to a placebo diet," Prof Gibson said. A larger study, currently in its recruitment phase, will further examine these results. See pilot study

Participants sought: Metformin for weight loss and depression

People with depression who are also overweight are more likely to have chronic symptoms. It may be that inflammation and high insulin levels associated with being overweight make depression worse. Metformin in a medication usually used for diabetes that lowers inflammation and insulin levels and has been shown to help with weight loss. The Monash Alfred Psychiatry Research centre is investigating the effectiveness of metformin in combination with standard antidepressants at causing weight loss and improving depressive symptoms.

Participants sought: Predicting optimized treatment in depression

MAPrc is investigating patient response versus non patient response (i.e “controls” – defined as participants who do not suffer from depression and are not on medication) to antidepressant medications. A combination of brain measures (physical and mental) and body functions will be analysed to determine patient response to antidepressant medications using genetic, psychological and physiological measures. Currently, there are no accurate predictors of how patients will respond to antidepressant treatment. We would love to hear from you: Link

Participants sought: Are you interested in trying a new non-medication treatment for Depression?

The Monash Alfred Psychiatry Research Centre (MAPrc) is seeking volunteers who are currently experiencing depression to help us investigate a new antidepressant treatment.  This study is looking at whether cognitive control training can help alleviate the symptoms of depression. It is also investigating whether a mild form of brain stimulation called transcranial electrical stimulation can be used to boost the impact of cognitive control training. Transcranial electrical stimulation is a safe, mild and non-invasive means of stimulating nerves cells in the brain.

Participants sought: Non-medication treatment for depression

New non-medication treatment for Depression: volunteers wanted. MAPrc are looking for volunteers aged 18-65 who are currently experiencing depression to take part in a study investigating a new cognitive therapy for depression. It is also investigating whether a mild form of brain stimulation called transcranial direct current stimulation (tDCS) can be used to boost the impact of cognitive control training. Participants will be compensated for their time and travel costs.