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Bidirectional relationship observed between hot flashes, depressive symptoms in menopausal women
Researchers observed a bidirectional relationship between vasomotor symptoms, or VMS, and depressive symptoms in menopausal women, but VMS are not related to the first onset of major depressive disorder in the menopausal transition, according to a meta-analysis of 16 studies published in Menopause.
“It is plausible that there is a bidirectional relationship between VMS and depression during the menopausal transition,” Rifani B. Natari, MSc, of the School of Pharmacy at The University of Queensland in Australia, and colleagues wrote. “VMS share similar physiological process with depression during this period. Change in neurotransmitter levels in the brain, due to estrogen depletion, narrows the thermoneutral zone in the brain, hence disrupting the thermoregulation process leading to VMS.”
Natari and colleagues analyzed data from 16 longitudinal studies with 10,008 women across the menopausal transition, conducted through July 2016. Included studies, conducted in Australia, the United States and Taiwan, assessed the relationship between menopausal women, VMS and depression using a longitudinal study design; baseline ages ranged from 35 to 55 years. Researchers included five papers from the Study of Women’s Health Across the Nation (SWAN); four papers from the Penn Ovarian Aging Study (POAS); and two papers from the Seattle Midlife Women’s Health study, all of which measured incident cases of major depressive disorder, prevalent cases of major depressive disorder, depressive symptoms, daily mood observation and exacerbation of VMS by depression. Studies that explored only the concurrent relationship between VMS and depression were excluded. Follow-up period ranged from 12 to 252 days in studies that used daily observations and from 1 to 15 years for other studies.
In two studies that explored the bidirectional association between VMS and depressive symptoms, researchers found that the likelihood that VMS lead to depressive symptoms was higher than the likelihood that depressive symptoms increased VMS. Only one of the studies was significant in both directions, with an OR of 3.06 that depressive symptoms increased VMS in menopausal women (95% CI, 1.43-6.58) and an OR of 8.88 that VMS increased depressive symptoms (95% CI, 2.57-30.68).
“The association between VMS leading to depressive symptoms is stronger than the converse, but it might be due to a short observation period,” the researchers wrote.
Researchers found no evidence that VMS lead to first onset or recurrence of major depressive disorder during the menopausal transition. In studies with large numbers of participants, researchers found that VMS might lead to depressive symptoms; however, when depressive symptoms were treated as a continuous variable, researchers found no association between VMS and depression, except in one study.
In one study, night sweats, but not hot flashes, were associated with high depressive symptoms scores over time, according to researchers.
Two studies explored the likelihood of VMS exacerbating negative moods through sleep disruption, using daily observation. When sleep disruption was added to the models, any association between VMS and depressive symptoms was reduced.
Researchers also observed that a history of either major depressive disorder or depressive symptoms exacerbates VMS.
“As VMS can wax and wane over time, the differences in VMS measurement might contribute to the different associations between VMS and depressive symptoms reported in the studies,” the researchers wrote. “We suggest that the occurrence of VMS is not sufficient to cause depressive symptoms. For VMS to alter mood would require the symptoms to reach a level that women found bothersome. When VMS were categorized as frequent or bothersome, there was a stronger relationship with depression than when VMS were simply based on reports of experiencing a symptom.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.