Tuesday, November 11, 2014


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 to offset the symptoms of menopausal depression, but the handful that have done so have mostly shown positive results.

Cognitive-behavioural therapy helps patients change the way they think and feel to lead more productive lives. Behavioural therapy focuses more on modifying actions to stem self-destructive behaviour. Mindfulness meditation helps patients to better tolerate and deal with stress.
In 2013 Dr Sheryl M Green [pictured left], co-author of The Cognitive Behavioral Workbook for Menopause, and her colleagues searched 5,126 studies and found only two on the use of cognitive, cognitive-behavioural or mindfulness therapies for women with major depression during menopause. Both studies showed that women improved after cognitive-behavioural 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 per cent 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. However, an educational seminar alone didn’t improve their moods. They also felt less depressed after mindfulness-based stress reduction and relaxation techniques, plus diaphragmatic breathing, according to studies on hot flashes and mood.

However, 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-behavioural therapy as an effective treatment for menopausal symptoms, and menopausal depression more specifically, cognitive-behavioural therapy has received empirical support and high acceptability for over three decades with many mental health and physical difficulties,' Dr Green says. 'With its low-risk nature, it is something that I continue to practise with menopausal patients who cannot or choose not to take medication---with suceess.'
Resource: Green SM, Key BL, and McCabe RE. ‘Cognitive-behavioral, behavioral, and mindfulness-based therapies for menopausal depression: A review.’ Maturitas. DOI: http://dx.doi.org/10.1016/j.maturitas.2014.10.004


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