Depression and its influence on reproductive endocrine and menstrual cycle markers associated with perimenopause: the Harvard Study of Moods and Cycles.
BACKGROUND
Few studies have determined the impact of a lifetime history of major depression on an early transition to menopause.


METHODS
Reproductive and psychiatric interviews and early follicular-phase blood specimens were obtained at study enrollment and every 6 months during 36 months of follow-up from 332 women with and 644 women without a history of major depression, 36 to 45 years of age. We used menstrual cycle markers to determine inception of perimenopause, defined as time from study enrollment to a follow-up interview with: (1) 7-day or more change in menstrual cycle length; (2) a change in menstrual flow amount or duration; or (3) amenorrhea lasting at least 3 months.


RESULTS
Women with a history of depression had 1.2 times the rate of perimenopause of women with no such history (95% confidence interval, 0.9-1.6). Compared with nondepressed women, depressed women with more pronounced depressive symptoms at study enrollment (Hamilton Rating Scale for Depression scores >8) had twice the risk of an earlier perimenopausal transition. Among the women with greater depressive symptoms (Hamilton scores >8), those who also reported use of antidepressants had nearly 3 times the risk of an earlier perimenopausal transition (hazard ratio, 2.7; 95% confidence interval, 1.5-4.8) of nondepressed women. Women with a lifetime history of depression also had higher follicle-stimulating hormone and luteinizing hormone levels and lower estradiol levels at study enrollment and during the follow-up period after adjustment for covariates.


CONCLUSIONS
A lifetime history of major depression may be associated with an early decline in ovarian function.
Harlow
Bernard L
BL
Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115, USA. bharlow@rics.bwh.harvard.edu
Wise
Lauren A
LA
Otto
Michael W
MW
Soares
Claudio N
CN
Cohen
Lee S
LS
D000328:Adult; D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use; D002979:Climacteric / Q000502:physiology*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D004958:Estradiol / Q000097:blood*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D005500:Follow-Up Studies; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood*; D008597:Menstrual Cycle / Q000502:physiology*; D008875:Middle Aged; D010050:Ovarian Function Tests; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors
D000928:Antidepressive Agents; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone