[Depression during the perimenopause]. / Depressie tijdens de perimenopauze.

BACKGROUND: Women are believed to be more vulnerable to depression during the perimenopause than during the premenopausal period. In clinical practice little attention has been given to the relationship between the menopause and depression. AIM: To provide an overview of the literature on the relationship between the perimenopause and the development of depression and to analyse the relationship between hormonal fluctuations and depression. METHOD: We consulted the databases of PubMed, Web of Science and the Cochrane library, searching for epidemiologic studies on perimenopausal depression. We selected 22 studies relating to the prevalence of and the risk of depression during perimenopause. RESULTS: Most of the 22 epidemiological studies selected suggest that the chances of developing depression during the perimenopause are higher than during during the premenopausal period. We found no unambiguous correlation between the fluctuation of hormones (e.g. oestrogen) and depression. A possible reason for this finding is that it is difficult to measure these hormones accurately. CONCLUSION: The chances of developing depression seem to be higher during the perimenopause than during the premenopause. The difficulty in measuring the fluctuations of female hormones during the perimenopausal stage may be the reason why no correlation between depression and the fluctuations of hormones has yet been unambiguously established. Future studies and meta-analysis could provide a more accurate estimate of the risk of developing depression during the perimenopause and could give detailed information about the relationship between hormonal factors and perimenopausal depression.

Two-year follow-up of a randomized controlled trial of stepped care cognitive behavioral therapy to prevent recurrence of depression in an older population.

OBJECTIVE: This study aims to determine the long-term effect of a stepped care cognitive behavioral therapy prevention program for depression in older people and the factors predicting or moderating outcome. METHODS: In a randomized controlled trial, 136 participants, aged 55 years or older, who had been treated for depression, received during 12 months a stepped care program (SCP) or care as usual (CAU) and were then followed up for a second year. Outcome was defined as the start of a new mental health treatment for depression in a specialized outpatient setting, as recorded in the patients' electronic medical records. RESULTS: Of the 123 patients, 38 required new mental health treatment. Survival analysis showed that participants in SCP (n = 27) required new treatment significantly more than patients receiving CAU (n = 11). Negative life events in the last year were predictive for new treatment in CAU but not in SCP. CONCLUSIONS: An SCP seems to lower the threshold for new specialized mental health treatment for depression, whereas new treatment in CAU patients occurs more often in reaction to recent life events.

Seasonality of mood disorders in adults with lifetime attention-deficit/hyperactivity disorder (ADHD).

BACKGROUND: The objective of this study was to estimate the prevalence of Seasonal Affective Disorder (SAD) in adults with lifetime Attention-Deficit/Hyperactivity Disorder (ADHD). METHOD: Patients eligible for this study had lifetime impairing symptoms of ADHD and a current and/or past co-morbid mood disorder according to their medical record. The Seasonal Pattern Assessment Questionnaire (SPAQ) was administered by a telephone interview to assess seasonality. RESULTS: The overall rate of SAD in this clinical population of adults with ADHD was estimated at 27%. Females were more at risk to develop SAD than men. LIMITATIONS: The SPAQ is a screening, not a diagnostic instrument. CONCLUSIONS: SAD symptoms are frequently comorbid with ADHD in adults. These results have clinical relevance for the recognition and treatment of SAD with bright light therapy in adults with ADHD.