Re: Curb antidepressant prescribing to improve mental health, say campaigners
Dear Editor
Mahase reports that antidepressants are often ineffective and may be associated with significant harms (side effects, addiction, and withdrawal symptoms). Patients with mild and moderate depression are more likely to benefit from lifestyle medicine and psychosocial interventions (BMJ 2023;383:p2873).
Perimenopausal women with depression may also benefit from hormone replacement therapy (HRT). Mental ill-health in the menopause transition is common (1). Pre-existing mental illness often gets worse, and the risk of new-onset depression doubles in women aged 40-50 (2, 3). Suicidal thoughts are up to 8-times more prevalent in perimenopausal women (4). Perimenopausal negative mood symptoms negatively impact women’s ability to work and function – in an American study lost work productivity and medical costs associated with perimenopausal depression were estimated at ten thousand US dollars per woman per year (5) – and may contribute to higher suicide rates in women aged 45 to 49 years in the UK (6).
Perimenopause-associated depression and anxiety can be effectively treated with HRT +/- additional psychiatric support (7, 8). The NICE menopause guideline states that HRT should be considered for the treatment of psychological symptoms that arise in the menopause transition, and states that there is no clear evidence of benefit for antidepressants to ease low mood in menopausal women who have not been diagnosed with clinical depression (9). However, 1 in 3 perimenopausal women who consult their GP with low mood are offered antidepressants (1). Failure to recognise the link between hormone imbalance and mental ill-health causes unnecessary suffering and wastes valuable NHS resources (10). Improving access to HRT would help curb antidepressant use, improve women’s quality of life, and lead to long-term mental and physical health benefits, with cost-saving implications for the NHS.
Dr Sarah Glynne and Dr Louise Newson, GP Menopause Specialists
References
1. The Fawcett Society. Menopause and the workplace. 2022. Available at: https://www.fawcettsociety.org.uk/Handlers/Download.ashx?IDMF=9672cf45-5... . Accessed 9th December 2023. .
2. Bogren M, Bradvik L, Holmstrand C, Nobbelin L, Mattisson C. Gender differences in subtypes of depression by first incidence and age of onset: a follow-up of the Lundby population. Eur Arch Psychiatry Clin Neurosci. 2018;268(2):179-89.
3. Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25(10):1069-85.
4. Usall J, Pinto-Meza A, Fernandez A, de Graaf R, Demyttenaere K, Alonso J, et al. Suicide ideation across reproductive life cycle of women. Results from a European epidemiological study. J Affect Disord. 2009;116(1-2):144-7.
5. Dibonaventura MD, Wagner JS, Alvir J, Whiteley J. Depression, quality of life, work productivity, resource use, and costs among women experiencing menopause and hot flashes: a cross-sectional study. Prim Care Companion CNS Disord. 2012;14(6).
6. Office for National Statistics. Data and analysis from Census 2021. Suicides in England and Wales: 2021 registrations. Registered deaths in England and Wales from suicide analysed by sex, age, area of usual residence of the deceased, and suicide method. Published 6 September 2022. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri... . Accessed 9th December 2023. .
7. Behrman S, Crockett C. Severe mental illness and the perimenopause. BJPsych Bull. 2023:1-7.
8. Leonhardt M. Low mood and depressive symptoms during perimenopause - Should General Practitioners prescribe hormone replacement therapy or antidepressants as the first-line treatment? Post Reprod Health. 2019;25(3):124-30.
9. NICE guideline (NG 23). Menopause: diagnosis and management. Published 12 Nov 2015. Last updated 05 Dec 2019. Available at: https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-s... . Accessed 9th December 2023. .
10. Newson L, Lewis R. Delayed diagnosis and treatment of menopause is wasting NHS appointments and resources. BMS 30th Annual Scientific Conference 2021. Post Reproductive Health. 2021;27(4):226-231. doi:10.1177/20533691211036953.
Competing interests:
No competing interests
11 December 2023
Dr Sarah Glynne
GP Menopause Specialist
Dr Louise Newson (GP Menopause Specialist, Newson Health, Stratford-upon-Avon)
Portland Hospital Consulting Rooms, 212 Great Portland St, London W1W 5QN
Rapid Response:
Re: Curb antidepressant prescribing to improve mental health, say campaigners
Dear Editor
Mahase reports that antidepressants are often ineffective and may be associated with significant harms (side effects, addiction, and withdrawal symptoms). Patients with mild and moderate depression are more likely to benefit from lifestyle medicine and psychosocial interventions (BMJ 2023;383:p2873).
Perimenopausal women with depression may also benefit from hormone replacement therapy (HRT). Mental ill-health in the menopause transition is common (1). Pre-existing mental illness often gets worse, and the risk of new-onset depression doubles in women aged 40-50 (2, 3). Suicidal thoughts are up to 8-times more prevalent in perimenopausal women (4). Perimenopausal negative mood symptoms negatively impact women’s ability to work and function – in an American study lost work productivity and medical costs associated with perimenopausal depression were estimated at ten thousand US dollars per woman per year (5) – and may contribute to higher suicide rates in women aged 45 to 49 years in the UK (6).
Perimenopause-associated depression and anxiety can be effectively treated with HRT +/- additional psychiatric support (7, 8). The NICE menopause guideline states that HRT should be considered for the treatment of psychological symptoms that arise in the menopause transition, and states that there is no clear evidence of benefit for antidepressants to ease low mood in menopausal women who have not been diagnosed with clinical depression (9). However, 1 in 3 perimenopausal women who consult their GP with low mood are offered antidepressants (1). Failure to recognise the link between hormone imbalance and mental ill-health causes unnecessary suffering and wastes valuable NHS resources (10). Improving access to HRT would help curb antidepressant use, improve women’s quality of life, and lead to long-term mental and physical health benefits, with cost-saving implications for the NHS.
Dr Sarah Glynne and Dr Louise Newson, GP Menopause Specialists
References
1. The Fawcett Society. Menopause and the workplace. 2022. Available at: https://www.fawcettsociety.org.uk/Handlers/Download.ashx?IDMF=9672cf45-5... . Accessed 9th December 2023. .
2. Bogren M, Bradvik L, Holmstrand C, Nobbelin L, Mattisson C. Gender differences in subtypes of depression by first incidence and age of onset: a follow-up of the Lundby population. Eur Arch Psychiatry Clin Neurosci. 2018;268(2):179-89.
3. Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25(10):1069-85.
4. Usall J, Pinto-Meza A, Fernandez A, de Graaf R, Demyttenaere K, Alonso J, et al. Suicide ideation across reproductive life cycle of women. Results from a European epidemiological study. J Affect Disord. 2009;116(1-2):144-7.
5. Dibonaventura MD, Wagner JS, Alvir J, Whiteley J. Depression, quality of life, work productivity, resource use, and costs among women experiencing menopause and hot flashes: a cross-sectional study. Prim Care Companion CNS Disord. 2012;14(6).
6. Office for National Statistics. Data and analysis from Census 2021. Suicides in England and Wales: 2021 registrations. Registered deaths in England and Wales from suicide analysed by sex, age, area of usual residence of the deceased, and suicide method. Published 6 September 2022. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri... . Accessed 9th December 2023. .
7. Behrman S, Crockett C. Severe mental illness and the perimenopause. BJPsych Bull. 2023:1-7.
8. Leonhardt M. Low mood and depressive symptoms during perimenopause - Should General Practitioners prescribe hormone replacement therapy or antidepressants as the first-line treatment? Post Reprod Health. 2019;25(3):124-30.
9. NICE guideline (NG 23). Menopause: diagnosis and management. Published 12 Nov 2015. Last updated 05 Dec 2019. Available at: https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-s... . Accessed 9th December 2023. .
10. Newson L, Lewis R. Delayed diagnosis and treatment of menopause is wasting NHS appointments and resources. BMS 30th Annual Scientific Conference 2021. Post Reproductive Health. 2021;27(4):226-231. doi:10.1177/20533691211036953.
Competing interests: No competing interests