Menopausal transition and early postmenopause are marked by intense hormonal changes (hot flashes, psychological disorders, mood disturbance and sleep problems Although depression is a treatable illness that is twice as common among women than men, many people do not respond to or receive treatment. However, no treatment guidelines are available for less severe depressive disorders. Due to their lack of conviction in conventional therapies, a growing number of women are turning to alternative practices. Fish oil or omega-3 fatty acid supplements have grown In popularity In recent years. Our recent clinical trial among 120 middle-aged women indicated that eicosapentaenoic acid omega-3 supplementation could provide some benefits over placebo in psychological distress as well as mild depressive and vasomotor symptoms associated with menopause transition.
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... It has been elegantly demonstrated that climacteric (and thus age-related) physiological and biochemical malfunctions elevate the risk of a number of clinical entities, among them cardiovascular and mood-related problems. The mechanism can be associated with a skewed lipid profile and, at least partly, explained by estrogen deficiency [31,35]. Some biotherapeutics (such as isoflavones, prenylflavonoids, and bovine colostrum) that possess demonstrated efficacy in diminishing the vulvovaginal atrophy and vasomotor symptoms of menopause do exist and have been shown not to elevate the risk of metabolic malfunctions [48]. ...
Menopause, the permanent cessation of the menstrual cycle, marks the end of a woman’s
reproductive lifespan. Menopausal hormonal therapy (MHT) can potentially skew the fatty
acid profile increasing the risk for developing metabolic diseases and disorders of skeletal,
gastrointestinal, and nervous systems. The aim of this study was to investigate the fatty acid
profile of postmenopausal women receiving, and not receiving, hormone replacement therapy.
A total of 156 healthy women with a mean age of 60 participated in this cross-sectional study.
Gas chromatography with an Agilent Technologies 7890A GC system was used to determine fatty acid
content. Statistical analysis was conducted using R software, version 3.4.1. Women receiving MHT
had significantly higher (p < 0.05) concentrations of C14:0 and C16:0. MHT was found to be associated
with a tendency (p = 0.053) to diminish concentrations of C18:1n-9, C20:4, and all unsaturated fatty
acids (p < 0.05). The longer MHT was used, the higher the concentration of C24:1 (p = 0.04) and the
lower the concentration of C18:2n-6 (p = 0.03).
Menopause causes major changes in reproductive and non-reproductive tissues. Estimating that 75% of postmenopausal women experience severe complaints. Changes during the menopausal transition risk-reducing women's quality of life. Supplementation of red clover and fish oil are some supplements that are used to overcome various menopause complaints. There are still few studies that compare the effectiveness of the two to improve quality of life. This study was to compare red clover with fish oil supplementation to improve the QOL in postmenopausal women. The quasi-experimental study with a nonequivalent control group design of 60 postmenopausal women was conducted. Participants were selected by consecutive sampling and equally divided into two groups. Each group was given red clover 400 mg once a day and fish oil supplementation 1000 mg (contains omega-3 marine triglycerides 300 mg as Eicosapentaenoic Acid (EPA) 180 mg and Docosahexaenoic Acid (DHA) 120 mg) once a day for twelve weeks. Quality of life was assessed using WHOQOL-BREF and postmenopausal complaints using a menopause rating scale questionnaire. The data were analyzed by Mann-Whitney U test, Wilcoxon Signed Rank test, and paired sample t-test. The mean (standard deviation) scores of the menopause rating scale (MRS) in the fish oil group were lower (2.10 [3.30]) than in the red clover group (3.97 [5.15]); p = 0.100. There were differences in QOL scores in the domain of psychical health (p=0.006), psychological (0.005), social relationships (0.010), and environment (0.010) in the fish oil group. In contrast, in the red clover group, differences were found in the domain of psychological (p=0.020), social relationships (0.022), and environment (0.002). There was no difference between the two groups.Fish oil supplementation was as effective as red clover to improve quality of life. Fish oil and red clover supplementation should be given to postmenopausal women with menopause complaints.
Psychological distress (PD) and depressive symptoms are commonly observed during menopausal transition. Studies suggest that omega-3 (n-3) fatty acids may help alleviate depression.
The objective was to compare enriched ethyl-eicosapentaenoic acid (E-EPA) supplementation with placebo for the treatment of PD and depressive symptoms in middle-aged women.
Women with moderate-to-severe PD (n = 120) were randomly assigned to receive 1.05 g E-EPA/d plus 0.15 g ethyl-docosahexaenoic acid/d (n = 59) or placebo (n = 61) for 8 wk. The main outcomes were 8-wk changes in PD scores [Psychological General Well-Being Schedule (PGWB)] and depressive scales [20-item Hopkins Symptom Checklist Depression Scale (HSCL-D-20) and the 21-item Hamilton Depression Rating Scale (HAM-D-21)].
At baseline, women with PD were mildly to moderately depressed, and 24% met the major depressive episode (MDE) criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. After 8 wk, outcomes improved in both groups, but no significant differences were noted between them. Stratification analyses for MDE diagnosis at baseline indicated that differences in adjusted 8-wk changes between the E-EPA group without MDE (n = 46) and the placebo group (n = 45) were 8.0 (95% CI: 0.6, 15.3; P = 0.034) for the PGWB, -0.2 (95% CI: -0.01, -0.4; P = 0.040) for the HSCL-D-20, and -2.7 (95% CI: -0.3, -5.1; P = 0.030) for the HAM-D-21. Differences in adjusted 8-wk changes between the E-EPA group with MDE (n = 13) and the placebo group (n = 16) were not significant.
To our knowledge, this is the first trial of n-3 supplementation in the treatment of PD and depressive symptoms in middle-aged women. In women with PD without MDE at baseline, the 8-wk changes in PD and depressive scales improved significantly more with E-EPA than with placebo. This trial was registered at http://www.controlled-trials.com as ISRCTN69617477.
These practice guidelines for the biological treatment of unipolar depressive disorders were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal for developing these guidelines was to systematically review all available evidence pertaining to the treatment of the complete spectrum of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating patients with these conditions. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for depressive disorders, as well as from meta-analyses and reviews on the efficacy of antidepressant medications and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and was then categorized into four levels of evidence (A-D). The first part of these WFSBP guidelines on unipolar depressive disorders covered the acute and continuation treatment of major depressive disorder (Bauer et al., 2002). This second part of the guidelines covers the management of the maintenance-phase treatment of major depressive disorder, as well as the treatment of chronic and subthreshold depressive disorders (dysthymic disorder, double depression, minor depressive disorder and recurrent brief depression). These guidelines are primarily concerned with thebiological treatment (including antidepressants, lithium, other psychopharmacological and hormonal medications, and electroconvulsive therapy) of young adults and also, albeit to a lesser extent, children, adolescents and older adults.
Nonbipolar major depression is estimated by the World Health Organization (WHO) Global Burden of Disease (GBD) Study to be the leading cause of disease-related disability among women in the world today (Murray & Lopez, 1996). This conclusion is based on epidemiological data that have documented a high prevalence of major depression among women around the world in conjunction with estimates of disease burden based on expert judgements. This chapter reviews the epidemiological research that underlies the WHO GBD estimates as well as more recent epidemiological research on women and depression. The discussion begins with a review of basic descriptive epidemiological patterns and then turns to epidemiological evidence about the cause of the higher prevalence of depression among women than men. PREVALENCE The fact that women have a higher prevalence of depression than do men is one of the most widely documented findings in psychiatric epidemiology, having been found throughout the world using a variety of diagnostic schemes and interview methods (Andrade et al., 2003; Nolen-Hoeksema, 1987). The prevalence of major depression among women in community epidemiological studies is typically estimated to be between one and a half and three times that of men, although there is enormous variation in the estimated total population prevalence of major depression across these studies. Lifetime prevalence estimates of major depressive episode range between 6 and 17%. Twelve-month prevalence estimates range between 1 and 10%. Current prevalence estimates range between less than 1 and 6%.
A variety of symptoms are reported frequently as being part of a menopausal syndrome. These include hot flashes, night sweats, menstrual irregularities, vaginal dryness, depression, nervous tension, palpitations, headaches, insomnia, lack of energy, difficulty concentrating, and dizzy spells. The question of whether and how symptoms occur together is an important one for women who want to know which symptoms can be attributed to menopause and which to aging generally or to other physical or psychosocial factors. To address this question, the present article examines the following avenues of research: (1) the clustering or grouping of symptoms; (2) the temporal association of different symptoms with stages of the menopausal transition; (3) the consistency of symptom reporting across culture, race, and ethnicity; and (4) the consistency of risk factors for symptoms. Results of the factor analysis studies do not support a single syndrome consisting of menopausal and psychological or somatic symptoms. The prevalence of symptom reporting across the transition also argues against a menopausal syndrome because vasomotor symptoms follow a unique pattern that differs from other symptoms. Cross-cultural differences suggest that symptom reporting is not universal. Finally, although there is some overlap in risk factors for symptoms, menopausal status is more consistently related to vasomotor symptoms than psychological or physical ones. Results of these investigations all argue against a universal menopausal syndrome. Future research should focus on how symptoms are interrelated, what factors are uniquely related to vasomotor symptoms, and identifying whether there is a subgroup of women who are more likely to report symptoms.
Context Perimenopause is a time of transition for women at midlife. Women want
to know whether they are starting this change and physicians need to know
the accuracy of a clinical examination in identifying perimenopausal women.These
women should be counseled about alleviating climacteric symptoms, using contraception,
and preventing diseases such as osteoporosis.
Objective To systematically review the accuracy of self-assessment, symptoms,
signs, and laboratory tests in diagnosing women in perimenopause.
Data Sources English-language articles that presented data relevant to diagnosis
of perimenopause were identified in a MEDLINE search from 1966 to 2001. References
of these articles and other publications also were reviewed.
Study Selection Cross-sectional or longitudinal studies of women aged 40 years or older
that used the definition of perimenopause as 3 to 11 months of amenorrhea
or irregular periods, included a premenopausal control group, and reported
a clinical examination finding. Of 1246 articles identified, 16 studies were
included in the analysis.
Data Extraction Two authors independently reviewed articles for quality (L.A.B. and
C.M.S.). Discrepancies were resolved by a third author (K.N.).
Data Synthesis The prior probability of perimenopause is directly related to a woman's
age. After considering age, the following yielded the greatest positive likelihood
ratios (LRs+): self assessment of going through the transition (LR+ range,
1.53-2.13), symptoms of hot flashes (LR+ range, 2.15-4.06), night sweats (LR+
1.90; 95% confidence interval [CI], 1.63-2.21), vaginal dryness (LR+ range,
1.48-3.79), high follicle-stimulating hormone levels (LR+ 3.06; 95% CI, 2.06-4.54),
and low inhibin B levels (LR+ 2.05; 95% CI, 0.96-4.39). Self-assessment of
perimenopausal status had the smallest negative LR (range, 0.18-0.36).
Conclusions No one symptom or test is accurate enough by itself to rule in or rule
out perimenopause. Clinicians should diagnose perimenopause based on menstrual
history and age without relying on laboratory test results.
Patients with depression have been extensively reported to be associated with the abnormality of omega-3 polyunsaturated fatty acids (PUFAs), including significantly low eicosapentaenoic acid and docosahexaenoic acid in cell tissue contents (red blood cell membrane, plasma, etc.) and dietary intake. However, more evidence is needed to support its relation. In this study, we conducted an 8-week, double-blind, placebo-controlled trial, comparing omega-3 PUFAs (9.6 g/day) with placebo, on the top of the usual treatment, in 28 patients with major depressive disorder. Patients in the omega-3 PUFA group had a significantly decreased score on the 21-item Hamilton Rating Scale for Depression than those in the placebo group (P
Objective:
Studies have reported that countries with high rates of fish oil consumption have low rates of depressive disorder. The authors studied a specific omega-3 fatty acid, the ethyl ester of eicosapentaenoic acid (E-EPA), as an adjunct to treatment for depressive episodes occurring in patients with recurrent unipolar depressive disorder who were receiving maintenance antidepressant therapy.
Method:
Twenty patients with a current diagnosis of major depressive disorder participated in a 4-week, parallel-group, double-blind addition of either placebo or E-EPA to ongoing antidepressant therapy. Seventeen of the patients were women, and three were men.
Results:
Highly significant benefits of the addition of the omega-3 fatty acid compared with placebo were found by week 3 of treatment.
Conclusions:
It is not possible to distinguish whether E-EPA augments antidepressant action in the manner of lithium or has independent antidepressant properties of its own.