Effects and Management of the Menopausal Transition in Women With Depression and Bipolar Disorder

Unipolar and bipolar disorders are major causes of disease burden for women in the United States.For some women, the menopausal transition can represent a time of increased vulnerability to depression,a greater risk of recurrence or instability of bipolar disorder, and an overall poorer quality of life(QOL). The physical and psychological changes of menopause and symptoms of depression mayoverlap, but QOL is affected doubly for women experiencing menopause-related complaints concomitantlywith a unipolar or bipolar disorder. Treatments for the symptoms of menopause and forunipolar or bipolar disorder need to be chosen with careful consideration for the different stages of themenopausal transition, as well as safety, tolerability, and impact on QOL. Menopausal-related symptomscan be treated with hormonal therapies, antidepressants, and herbal supplements, but a criticalwindow of opportunity may exist for these interventions. Bipolar disorder presents differently inwomen than in men and may require different medication. For instance, in women, lithium may beless effective for patients who have rapid cycling; adjuvant antidepressant medication may be requiredwith valproate or carbamazepine; and lamotrigine may also be effective. Most of the medicationsthat are standard treatment for bipolar disorder affect bone mineral density, and the risk forimpaired QOL should be considered when choosing medication for women during this period. Insufficientinformation is available, however, to assess the best strategy to treat women with bipolar disorderand depression as they age.