
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: TUESDAY, September 27, 1994                   TAG: 9410040042
SECTION: EXTRA                    PAGE: 1   EDITION: METRO 
SOURCE: Jane Brody Many are the myths
DATELINE:                                 LENGTH: Medium

ARE DEPRESSION, MENOPAUSE LINKED?

In her newly published memoir, Barbara Bush reveals that in the mid-1970s she was overcome by depression so severe that she feared she might purposely end her life by crashing her car. The former First Lady attributed her emotional distress to the hormonal changes of menopause, compounded by the stress of her husband's job as director of central intelligence.

By linking her depression to menopause, Bush perpetuates a centuries-old belief that the hormonal swings that accompany this life stage can touch off what had long been called involutional (a term referring to the body's changes at menopause) melancholia.

Popular literature and the clinical experience of psychiatrists have convinced many lay people and professionals that menopause increases the risk of depression in women who were never before clinically depressed and whose depression was not attributable to any life event.

Numerous studies among American women have concluded that in otherwise emotionally healthy women, menopause by itself does not cause depression. In fact, the studies show, there is no particular link between menopause and depression; if anything, it is far more common among younger women than in those from 45 to 55, when most women enter menopause.

For example, a community survey of 511 women in New Haven, Conn., beginning in 1967 and repeated in 1969 and 1976, found no evidence of an increase in depressive symptoms in the menopausal years. Rates of depressive symptoms were highest in women under 35 and decreased gradually with age, according to one author, Dr. Myrna Weissman, professor of psychiatry and epidemiology at Columbia University. A much larger follow-up study among 18,000 men and women in five urban areas confirmed that ``depression is now occurring in women at younger ages and the rate decreases at menopause,'' she said.

But she added that the same study had since been done in nine other countries and that the data, now being analyzed, might show that a relationship between menopause and depression was not a myth in countries where women still had more traditional roles.

Weissman does not discount the possibility that Bush's depressive episode was related to menopause, but she questions whether hormonal factors were responsible.

``Barbara Bush had led a traditional family life, with her major role being raising children,'' she said. ``As her children left home, the loss of this role may have made her more vulnerable to depression at that time. When women are not in the work force, depression may be more common at menopause, reflecting the woman's stage of life, not necessarily her hormones.''

Some women acknowledge that depression at menopause is directly related to feelings that they are getting old and fears that they will become less attractive and sexually undesirable. It is also possible that for women prone to depression, a major life event such as menopause can set off a depressive episode.

For example, after a hysterectomy, in which a woman's uterus and hormone-producing ovaries are removed, depression is far more common than with other operations. While depression might not be unexpected after such traumatic surgery, women who are depressed are more likely to have such surgery, said Dr. Winnifred Cutler, author of ``Menopause'' (W.W. Norton, $12.95) and founder of the Athena Institute for Women's Wellness in Haverford, Pa

To be sure, menopause can be an emotionally challenging time for some women who experience symptoms much like those associated with the premenstrual tension syndrome: mood swings, irritability, anxiety, irrational anger and weepiness. Such symptoms have been associated with the premenstrual decline in estrogen, a mood-elevating hormone, which also may account for similar symptoms at menopause if estrogen levels drop precipitously. When such women get replacement hormones, their moods commonly lift and they feel more in control.

Among those who become depressed at menopause, their negative emotional state may result more from physical factors than psychological ones. According to Dr. Lonnie Barbach, a San Francisco psychologist who is the author of ``The Pause'' (Dutton), studies at the American Institute for Research in Cambridge, Mass., showed that women who felt ill, reporting that they had two or more distressing physical symptoms of menopause, were four times as likely to be depressed as women who reported having no more than one symptom. Depressing symptoms might include vaginal dryness, hot flashes or night sweats.

``The worse you feel physically and the more anxious you are about your physical health, the more likely you are to feel depressed,'' Barbach wrote.

by CNB