Psy-World

Increases in testosterone levels may increase risk of depression during menopause.

Many epidemiological and clinical studies that have examined associations between reproductive hormones and depression have yielded inconsistent results. Particularly, it is unknown whether hormonal changes during the menopausal transition are linked to depressive symptoms. Thus, the possible association between serum hormone levels during menopause and an increased risk of depressive symptoms was investigated. The longitudinal, community-based, multisite Study of Women's Health Across the Nation (SWAN) enrolled 3292 multiethnic women aged 42 to 52 years who were still menstruating and not using exogenous reproductive hormones. All participants completed self- and interview-administered questionnaires at baseline and once yearly about health, lifestyle, and psychosocial factors. Early follicular phase serum samples were assayed for levels of estradiol, follicle-stimulating hormone, testosterone, and dehydroepiandrosterone sulfate. The study's primary outcome was a score of 16 or higher on the Center for Epidemiological Studies - Depression Scale (CES-D), which signaled high depressive symptoms. Data analysis revealed that 802 women (24.4%) had CES-D scores of 16 or higher. Among these, a significant association was found between testosterone level and a high CES-D score (odds ratio (OR) = 1.15). An increase in testosterone levels from baseline to each annual visit was also significantly associated with increased odds of high depressive symptoms (OR = 1.23). Less education, being Hispanic, and vasomotor symptoms, stressful life events, and low social support at each visit were each independently associated with a CES-D score of 16 or higher. Upsetting life events increased the odds of high depressive symptoms by 2.5- to 5-fold, and high social support decreased the odds by one-fifth. No other hormones were associated with the higher score. When women were perimenopausal and postmenopausal the odds of high depressive symptoms were significantly greater than when they were premenopausal. Bromberger JT, Schott LL, Kravitz HM, Sowers M, Avis NE, Gold EB, Randolph JF Jr, Matthews KA (2010). Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women's Health Across the Nation (SWAN). Arch Gen Psychiatry 67:598-607. Updated August 2010