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 may overlap, but QOL is affected doubly for women experiencing menopause-related complaints concomitantly with a unipolar or bipolar disorder. Treatments for the symptoms of menopause and for unipolar or bipolar disorder need to be chosen with careful consideration for the different stages of the menopausal transition, as well as safety, tolerability, and impact on QOL. Menopausal-related symptoms can be treated with hormonal therapies, antidepressants, and herbal supplements, but a critical window of opportunity may exist for these interventions. Bipolar disorder presents differently in women than in men and may require different medication. For instance, in women, lithium may be less effective for patients who have rapid cycling; adjuvant antidepressant medication may be required with valproate or carbamazepine; and lamotrigine may also be effective. Most of the medications that are standard treatment for bipolar disorder affect bone mineral density, and the risk for impaired QOL should be considered when choosing medication for women during this period. Insufficient information is available, however, to assess the best strategy to treat women with bipolar disorder and depression as they age.