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Teenage stress increases risk of depression during menopause

Traumatic experiences during the teenage years increases the risk of experiencing depression during menopause

Ingrid Torjesen

Thursday, 30 March 2017

Women who experience multiple traumatic events during childhood or adolescence have a significantly increased risk of depression in the years leading into menopause, a study* published in Journal of Clinical Psychiatry has found.

In particular, women who experienced their first traumatic event in their teens are especially susceptible to depression during perimenopause, even if they had previously never had depression, shows the study which is the first to focus on the role of childhood adversity in the onset of major depressive disorder (MDD) during the menopause transition.

The study included 243 women aged between 35 and 47 years old at enrollment (all deemed premenopausal with normal menstrual cycles), who underwent behavioural, cognitive, and endocrine evaluations at predetermined intervals from 1996-2012. Over the 16 years, each woman completed roughly 12 assessments for cognition and mood, as well as blood samples to measure hormone levels. Between study years 14 and 16, phone interviews were conducted to assess menopause status, and in year 16, researchers used an Adverse Childhood Experiences Questionnaire (ACE-Q) to assess the relationship between stressful or traumatic events experienced in adolescents and health outcomes.

Replies to the questionnaire showed that 39.5%, 22.2% and 38.3% of women reported having experienced 0, 1 or 2 or more ACEs, respectively. The most commonly reported ACE were emotional abuse, parental separation or divorce, or living with someone with alcohol or substance abuse. Most ACEs had occurred before the onset of puberty, suggesting that these traumatic and stressful events typically begin quite early in development.

A total of 52 women (22.4%) were diagnosed with MDD prior to experiencing any menstrual irregularity (premenopause), while 48 (20.7%) experienced their first MDD during perimenopause. Notably, women who reported two or more ACEs after the onset of puberty were 2.3 times more likely to have their first experience of MDD during perimenopause, compared to those who did not experience any ACEs, but were not more likely to have been diagnosed with MDD previously.

Lead author C Neill Epperson, professor of Psychiatry and Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania, and director of the Penn Center for Women's Behavioral Wellness, said: "Our results show that women who experience at least two adverse events during their formative years - whether it be abuse, neglect, or some type of family dysfunction - are more than twice as likely to experience depression during perimenopause and menopause as women who either experienced those stressors earlier in life, or not at all.

"This suggests that not only does early life stress have significant and long-lasting effects on the development and function of the regions of the brain responsible for emotions, mood, and memory, but the timing of when the event occurs may be equally as important."

The authors suggest that the hormonal changes that occur during menopause may unmask previously undetected risk for depression in women who experienced ACEs, particularly when the events occurred after puberty.

"There's clearly a strong link between childhood adversity and risk of depression, throughout a woman's life, but particularly during the transition to menopause," said Ellen W Freeman, a research professor of Obstetrics & Gynecology at Penn. "Our study points to the need for more research examining the long-term brain effects of childhood adversity, particularly around the time of puberty."

* Epperson CN, Sammel MD, Bale TL, et al. Adverse Childhood Experiences and Risk for First-Episode Major Depression During the Menopause Transition. J Clin Psychiatry 2017;78(3):e298–e307. DOI: 10.4088/JCP.16m10662

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