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Cognitive therapy, mindfulness may help with menopausal depression

Psychotherapy and mindfulness techniques could help many women who experience depression during menopause.

(Reuters Health) - Psychotherapy and mindfulness techniques could help many women who experience depression during menopause, according to a review of existing research.

Too few studies have looked at whether cognitive therapies are good alternatives for women who can't or don't want to use pharmaceutical treatments, the authors conclude, but the handful that did mostly showed positive results.

"When I started work in this area, I was struck by the lack of alternative, non-pharmacological, non-hormonal treatment for menopausal symptoms, given the associated risks of hormone therapy and side effects of anti-depressants for some women," said Sheryl Green, lead author of the study, in an e-mail to Reuters Health.

Menopause is a natural transition, but is often accompanied by symptoms like hot flashes, poor sleep and, for nearly half of menopausal women, depression, Green and her colleagues write in the journal Maturitas.

Some researchers think fluctuating hormones are to blame for added vulnerability to depression during the years leading up to and immediately following a woman's last period. There's evidence that hormone replacement therapy and antidepressant drugs can lessen menopausal symptoms.

But few studies have looked at whether cognitive approaches that have been shown to help lift depression in general would also work for menopause-related depression, according to Green, a clinical psychologist in the Women's Health Concerns Clinic at St. Joseph's Healthcare in Hamilton, Ontario, and her coauthors.

Cognitive-behavioral therapy helps patients change the way they think and feel to lead more productive lives. Behavioral therapy focuses more on modifying actions to stem self-destructive behavior. Mindfulness meditation helps patients to better tolerate and deal with stress.

In 2013, Green and her colleagues searched 5,126 studies and found only two on the use of cognitive, cognitive-behavioral or mindfulness therapies for women with major depression during menopause. Both showed that women improved after cognitive-behavioral therapy.

In the first study, half of the 169 menopausal women who had 16 sessions of individual therapy were much less depressed afterwards and 25 percent were no longer depressed at all.

Women were also much less depressed after 16 sessions of a two-hour, twice-weekly group therapy in a second study with 44 participants.

In 2014, Green's team broadened its search, including studies that looked at depression as one of several menopausal symptoms and came up with 12 more.

Women tended to feel less depressed after therapy involving education, coping skills and muscle relaxation for menopausal symptoms in several of those studies. But an educational seminar alone didn't improve their moods.

Women also felt less depressed after mindfulness-based stress reduction and relaxation techniques, plus diaphragmatic breathing, according to studies on hot flashes and mood.

But women didn't always feel less depressed after cognitive therapies. In some cases, Green's team writes, this might be because women need programs geared toward their specific physical issues, such as hot flashes or vaginal dryness, and feelings about going through the transition.

Some of the studies in the review were small, the authors caution, and did not include enough follow-up, didn't have a comparison group or included only women who were mildly depressed.

These limitations and the fact that there wasn't much research to begin with mean more is needed, the authors say.

"Even though the literature is still in its infancy with establishing cognitive-behavioral therapy as an effective treatment for menopausal symptoms, and menopausal depression more specifically, cognitive-behavioral therapy has received empirical support and high acceptability for over three decades with many mental health and physical difficulties," Green said.

"With its low-risk nature, it is something that I continue to practice with menopausal patients who cannot or chose not to take medication - with success," she said.

Dr. Pauline Maki of The North American Menopause Society told Reuters Health she was glad to see a study about alternatives to traditional therapy for depressed women during menopause.

"When we talk about ways one can treat depression during peri- and post-menopausal period, it's important to take an assessment of the state of science. . . to really do a careful, evidence-based analysis of what we know and where the gaps in knowledge are and more importantly where the signal seems to be," said Maki, referring to the evidence that such therapies do indeed help.

Maki, who also directs Women's Mental Health Research at the University of Illinois, said brain scan studies have shown that these cognitive approaches boost depressed mood. "That's pretty convincing evidence to a lot of skeptical people."

Many depressed menopausal women also don't realize how often the mood disorder hits other women during the transition, so more education would help, Maki added.

"I think the more we can discuss it in public, the less stigma there is and the more women will seek help if indeed they're experiencing mood problems," she said.

SOURCE: Maturitas online October 17, 2014.