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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Menopause is merely a clinically discernible clue symbolic of the multitude of changes preceding or following the cessation of menses by many years. Because of the time span involved, separating changes observed in the menopausal transition from other age-related maturational events presents serious methodologic problems. Of the host of psychologic and psychosomatic symptoms, only hot flushes and associated sweats occur more frequently in this epoch, while an interplay between hormonal and age-related maturational events presents serious methodologic problems. Of the host of psychologic and psychosomatic symptoms, only hot flushes and associated sweats occur more frequently in this epoch, while an interplay between hormonal and age-related effects is assumed in atrophic changes involving the genitourinary organs. The relation between menopause and osteoporosis is suggestive but by no means proven, as is the risk for cardiovascular disease. Empiric evidence points to the usefullness of estrogen for the management of vasomotor instability, the symptoms associated with atrophy of the genitourinary tract, and in the prophylaxis of osteoporosis, but not in the treatment of anxiety, depression, and other psychiatric disorders.
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PMID:Management of the Menopause. 7 6

Sixty-four patients with severe menopausal symptoms completed a four month double-blind placebo trial with conjugated equine oestrogens (premarin). Using a graphic rating scale system of assessment, a statistically significant improvement with premarin was observed in 12 psychological and symptomatic scores (Table 3). From a comparison between these results and the results of the 20 patients without vasomotor symptoms it would appear that many of these symptomatic improvements result from the relief of hot flushes (i.e. a domino effect). However, the improvement in memory and reduction of anxiety in these 20 patients suggest that oestrogens have a direct tonic effect on the mental state which is independent of vasomotor symptoms. Sixty-one patients with less severe menopausal symptoms completed the second twelve month double-blind placebo trial and, as assessed by graphic rating scales, a significant improvement with premarin was observed in five psychological and symptomatic scores (Table 3). In both the twelve and four month studies the marked placebo effect of "youthful skin appearance", and on skin greasiness in the twelve month study, indicate that no reliance can be placed on patient judgement of skin texture and appearance. Despite the lessening of the domino effect there was a slight improvement with premarin over placebo in 15 of the remaining 16 symptoms and it is likely that the cumulative effect of these small improvements results in an overall enhancement of well-being. The relief of atrophic vaginitis by premarin did not result in an improvement in libido and this suggests that the ability and the desire to have sexual intercourse are not related. The strength and duration of the placebo effect were well demonstrated in the three standard psychiatric scoring systems, the Beck score (for depression), the General Health Questionnaire and the Eysenck Personality Index (formula: see text) (for neuroticism). We observed a highly significant placebo effect extending for six months in all three, the improvement with premarin over placebo being non-significant. We must conclude that these tests are not sufficiently sensitive to assess psychological or symptomatic changes in menopausal women and that these changes are best assessed by the graphic rating scales. The number of side-effects and complications was assessed in the 61 patients in the long study. A higher incidence of minor side-effects was observed during premarin therapy; this was most marked in relation to leg cramps but radio-isotope scanning revealed no evidence of leg vein thrombosis in these patients or indeed in any patient in the study. Premarin caused no elevation of systolic or diastolic blood pressure; indeed there was a progressive fall in blood pressure throughout the study with no significant difference between premarin and placebo...
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PMID:Oestrogen therapy and the menopausal syndrome. 32 5

A double-blind controlled study of the effect of piperazine estrone sulfate on sleep, depression, anxiety, and hot flushes was conducted in 34 perimenopausal women aged 45-55. 1/2 of the group received placebo for 6 weeks, then piperazine estrone sulfate (1.5 mg twice daily) for 8 weeks, while 1/2 remained on placebo throughout. Sleep was recorded electrophysiologically every week after adaptation and baseline readings. Mood and anxiety were rated daily by means of visual analogue scales. Hot flushes were counted daily. Observer rating scales of anxiety and depression were completed at the beginning and end of the baseline placebo period and at the end of the 1st and 2nd treatment month. During the 1st month of active treatment, the amount of intervening wakefulness in the first 6 hours of sleep decreased significantly more in the estrone group than in those on placebo. Between the baseline period and the 2nd treatment month, the estrone group showed a significantly greater decrease in the total amount of wakefulness and in the frequency of awakenings. Their total amount of rapid eye movement sleep increased. Mood and anxiety improved and the number of hot flushes decreased to a similar degree in both groups.
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PMID:Effect of oestrogen on the sleep, mood, and anxiety of menopausal women. 33 4

This study investigated the influence of hormone therapy on affect in a double blind crossover trial. The sample consisted of 49 women who had previously undergone hysterectomy and bilateral oophorectomy. Therapy consisted of 3 mth each of ethinyl estradiol--50 mcg/day; levonorgestrel--250 mcg/day; "Nordial"--a combination of these 2 substances; and placebo. Affect was measured by the Hamilton Depression Rating Scale, verbal reports by women and self-ratings on visual analogue scales. Ethinyl estradiol was found to have a beneficial influence on aspects of affect such as Hamilton scores, anxiety, irritability, and insomnia. The influence of hormones on Hamilton scores could be partly but not fully explained by the alleviation of hot flushes. Norgestrel showed less favorable changes initially but these tended to diminish by the 3rd therapy month. Most of the women studied were not clinically depressed. Anxiety symptoms were the major features exhibited in the group of women investigated. The results of this study suggest that visual analogue rating scales are of questionable validity in assessing affect in patients without any appreciable psychiatric morbidity.
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PMID:Hormone therapy and affect. 39 15

The decline in oestrogen secretion at the time of the menopause may give rise to symptoms involving the genital and autonomic nervous systems. There is evidence that it may also contribute to the incidence of psychological features, such as depression, and to the development of post-menopausal osteoporosis. Oestrogen replacement therapy clearly reverses the genital changes and the hot flushes, and may prevent the development of osteoporosis and lead to improvement in depression. Recent evidence indicates an association between oestrogen replacement therapy and endometrial cancer, although the exact nature of the relationship, and the factors which might alter it, remain unknown. Current data do not permit the physician to make a decision with conviction concerning the indications for, nature of and duration of oestrogen replacement in the symptomatic post-menopausal woman, but it is recommended that she be given such therapy in effective dosage and in association with regular progestagen supplement in order to achieve medical curettage. Further research is required in order to resolve many of the relevant controversies.
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PMID:Oestrogen replacement--a boon or a curse? 87 Dec 77

The symptomatic and endocrine changes following hysterectomy and bilateral oophorectomy have been studied in 100 patients, 1 to 31 years after surgery. The most frequent symptoms at the time of interview were depression (62 patients), insomnia (48 patients), loss of libido (46 patients) and dyspareunia (38 patients). Vasomotor symptoms were recorded in 28 patients. Although 94 patients claimed that hot flushes were the first symptomatic changes noticed, 60 had complete relief from these symptoms within 6 months of surgery; 34 patients had no symptoms and only 4 patients were taking oestrogen therapy at the time of interview. Plasma oestradiol and testosterone levels were 78 per cent and 27 per cent respectively below the mean values of day 1 to 10 of the menstrual cycle, similar to those found at comparable years after a normal menopause. The plasma FSH level was about 14 times and the plasma LH level about twice the respective preoperative value. Unlike after the normal menopause, these gonadotrophin levels did not show any decline with increasing age. There was no correlation between plasma hormone levels and the presence of vasomotor symptoms or depression.
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PMID:Endocrine changes and symptomatology after oophorectomy in premenopausal women. 92 14

In a review of mental health aspects of menopause, emphasis is laid on the psychiatric morbidity that precedes any somatic menopausal symptoms. Only sweating and hot flushes are directly related to the menopause. Complaints such as irritability, headaches, fatigue, depression, and ''mental imbalance'' increase prior to the menopause and decrease after it. Various situational factors have been considered as possible precipitants of emotional disturbances: a child marrying, or having 3 or more children. However, studies indicate that women in the year of the menopause were less likely to develop an episode of mental illness requiring admission to a hospital than at other times. Estrogens do improve symptoms of flushes, dryness and sweats. Changes in emotional imbalance are less clear. Women who come for treatment of menopausal symptoms may frequently be suffering from depression which makes toleration of these symptoms more difficult.
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PMID:Mental health aspects. 95 92

Elective hysterectomy has become culturally patterned as a normal part of the life cycle with more than half of all American women destined for hysterectomy if current rates continue. In keeping with this widespread acceptance, both women and their doctors frequently express satisfaction with the operation. The sequelae that do occur appear to be serious in only a few women, though more minor disturbances do appear in a sizable number. Repeated or controlled studies indicate that hysterectomy may yield problems for some women in the following areas: rejection by male partners, hot flushes after conservation of ovarian tissue, severe hot flushes after ovariectomy, long-term psychourinary problems, weight changes, lingering fatigue and prolonged convalescence, painful intercourse, depression, sleep disturbances, and other psychiatric symptoms. Prospective studies using matched control groups are needed which follow patients at least 2 years postoperatively, as repeated studies have shown "sleeper effect" after hysterectomy with sequelae developing after the first 6 months or even after 1 year. The impact of varying surgical techniques and the long-term endocrine impact of hysterectomy need to be detailed as well as further study undertaken on the psychosomatic sequelae.
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PMID:Reactions to hysterectomy: fact or fiction? 105 27

The effect of Danazol, a new gonadotropin inhibitor, was examined in four categories of patients. (1) Ten normal women medicated orally with Danazol, 800 mg. daily for 91 days, showed no depression of serum LH, estrone, estradiol, or progesterone below control, second-day levels. The serum FSH was slightly depressed; (2) Two anovulatory patients having elevated serum LH values were treated with Danazol, 400 to 800 mg. daily, for 1 to 3 days at midcycle. One patient repeatedly showed a temperature rise and LH flood within 24 hours of initial medication. Both had menstrual periods 7 to 9 days later. (3) Two normal midcycle ovulators were treated with 400 and 800 mg; of Danazol, respectively, for 1 day in the midfollicular phase and one apparently ovulated promptly prematurely. (4) Two patients having severe hot flushes following surgical menopause were treated with Danazol, 800 mg; daily, without reducing FSH or LH but with disappearance of hot flushes.
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PMID:The effects of danazol on gonadotropins and steroid blood levels in normal and anovulatory women. 111 90

An approach employing a range of standardized questionnaires, which included the Nottingham Health Profile (NHP), the Psychological General Well-Being (PGWB) index and the Mood Adjective Check List (MACL), was used to assess health-related quality of life (QoL) in conjunction with a study comparing two doses of transdermal oestrogen (50 or 100 micrograms/24 h) combined with an oral progestogen (5 mg medroxyprogesterone acetate for 14 days each cycle). In addition to the QoL measures, climacteric symptoms were self-rated and also summarized by means of the Kupperman index. In all, 59 women, median age 52 (39-71) years, who completed 4 months of therapy were evaluated. The use of a battery of standardized questionnaires enabled a comprehensive evaluation to be made of perceived health, well-being and day-to-day functioning. Not only was symptomatic relief, e.g. reduced frequency of sweating episodes, sleep disturbance and hot flushes, observed during treatment, but there were also improvements in terms of sleep, energy and emotions. The frequency of health-related problems associated with paid employment, housework, social life, home life and sex life decreased, indicating enhanced ability to take part in daily activities. The PGWB index showed improvement in the subscales representing well-being, anxiety, depression, vitality, health and self-control, while the mood scales indicated that the women experienced less tension and more satisfaction. Although the results of this study need to be further documented on the basis of a placebo-controlled trial, the findings nevertheless imply that the use of a battery of standardized questionnaires optimizes the possibility of evaluating climacteric complaints reliably before and after treatment.
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PMID:A new methodological approach to the evaluation of quality of life in postmenopausal women. 150 61


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