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Article
Symptom severity of bipolar disorder during the menopausal transition
Open Access Articles
  • Wendy K. Marsh, University of Massachusetts Medical School
  • Bernice G. Gershenson, University of Massachusetts Medical School
  • Anthony J. Rothschild, University of Massachusetts Medical School
UMMS Affiliation
Department of Psychiatry; Department of Orthopedics and Physical Rehabilitation
Date
12-1-2015
Document Type
Article
Abstract
BACKGROUND: Little is known about the mood symptom experience of women with bipolar disorder during the menopausal transition (MT). Yet times of rapid hormonal decline, such as the postpartum, are associated with increased risk of severe mood episodes in bipolar disorder, and the MT is a time of increased risk for unipolar depression in women with or without a history of depression. METHODS: Enrollment included 56 women 40-60 years old diagnosed in the bipolar spectrum who were experiencing menopausal symptoms or were up to 5 years since their final menstrual period. Menopausal stages included early menopause, late menopause, or early postmenopause based on standardized criteria. Observational, prospective standardized mood symptom and reproductive hormone assessments were completed periodically. Concurrent menopausal symptoms as well as history of mood exacerbation during past reproductive events were assessed. RESULTS: Forty-four women were included in the main analysis. The average Montgomery-Asberg Depression Rating Scale (MADRS) score was 4.43 points higher in the late transition/early postmenopausal stage women (n = 29) compared to the early menopausal stage women (n = 15) (+/-SE 2.14; p = 0.039), corresponding to a roughly 10 % higher score (range 0-40) in the late/post stage across all study visits. Results were similar for the Young Mania Rating Scale (YMRS), where the average score was 2.54 points higher in the late/early postmenopausal stage women compared to the early menopausal stage women (+/-SE 1.15; p = 0.027), also roughly 10 % higher (range 0-26). Estradiol and follicle-stimulating hormone (FSH) absolute levels as well as between-visit change in levels were not notably associated with YMRS or MADRS during study observation. Total Greene Climacteric Symptom (menopausal symptom) score was significantly associated with MADRS but not YMRS. History of mood exacerbation premenstrually and/or postpartum was not significantly associated with YMRS or MADRS severity during the MT. CONCLUSIONS: These results support the theory that times of increased reproductive hormonal changes, such as the late MT and early postmenopause, here compared to early MT, are associated with greater mood symptom severity in bipolar spectrum women. Nonetheless, absolute or change in FSH and estradiol levels were not significantly associated with depression or mood elevation severity.
Rights and Permissions
Citation: Int J Bipolar Disord. 2015 Dec;3(1):35. doi: 10.1186/s40345-015-0035-z. Epub 2015 Aug 22. Link to article on publisher's site
Comments

© 2015 Marsh et al. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Related Resources
Link to Article in PubMed
Keywords
  • Bipolar disorder,
  • Menopause,
  • Neuroendocrinology,
  • Estrogen
PubMed ID
26296381
Creative Commons License
Creative Commons Attribution 4.0
Citation Information
Wendy K. Marsh, Bernice G. Gershenson and Anthony J. Rothschild. "Symptom severity of bipolar disorder during the menopausal transition" Vol. 3 Iss. 1 (2015) ISSN: 2194-7511 (Linking)
Available at: http://works.bepress.com/wendy_marsh/34/