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Child Psychiatrist /Adult Psychiatrist

Psychosocial Interventions Improve Depression and Anxiety During Menopause

Keypoint: People experiencing psychological symptoms of menopause may benefit from CBT or mindfulness.

Improve Depression and Anxiety

Psychosocial interventions of cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBI) improve depression and anxiety during menopause, according to systematic review and meta-analysis findings published in the Journal of Affective Disorders. These interventions also improved cognition and quality of life for individuals experiencing menopause.

Although menopause is commonly associated with physiological symptoms like menstrual cycle changes, hot flashes, and night sweats, people experiencing menopause also frequently experience cognitive impairment, depression, and anxiety. Hormone replacement therapy is typically the first line treatment for physiological symptoms of menopause, but relatively little is known about the efficacy of psychosocial interventions for the improvement of non-physiological symptoms.

To this aim, investigators conducted a systematic review and meta-analysis to determine if cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBI) are effective in improving depression and anxiety among people experiencing menopause. The investigators searched publication databases from inception to August 2023 for randomized controlled trials assessing CBT and MBI for menopausal transition and reported at least 1 outcome related to cognition, mood, or quality of life.

Overall, 30 studies were included for analysis, with a pooled sample size of 3501 participants. On average, participants were between 47 to 59 years of age, 2686 were undergoing gradual menopause, and 815 had treatment-induced menopause. OF the included studies, 20 reported mood outcomes, 4 assessed cognition, and 24 evaluated quality of life outcomes. Most psychosocial interventions were primarily group-based and conducted in person.

For the meta-analysis, a total of 11 studies had available data on anxiety and 12 studies had data for depression outcomes. The investigators found that anxiety significantly improved with both MBI (d, -0.56; 95% CI, -0.74 to -0.39) and CBT (d, -0.22; 95% CI, -0.35 to -0.10). Similarly, depressive symptoms among people experiencing menopause were significantly reduced with MBI (d, -0.27; 95% CI, -0.45 to -0.09) and CBT (d, -0.33; 95% CI, -0.45 to -0.21). However, there was considerable heterogeneity of MBI data for anxiety (I2, 85.48%) and significant heterogeneity of CBT data for depression (I2, 85.48%).

The investigators also found that cognition (d, -0.23; 95% CI, -0.40 to -0.06) and quality of life (d, -0.78; 95% CI, -0.93 to -0.63) were significantly improved with psychosocial interventions, though there was considerable heterogeneity of data and smaller sample sizes for these analyses.

The overall quality of included studies was moderate, although 66.7% of the studies were judged to have some concerns for risk for bias, 23.3% of the studies had high risk for bias, and 10.0% had low risk for bias.

“The findings of this review add to existing menopause literature by supporting the effectiveness of psychosocial interventions on non-physiological symptoms of mood, cognition, and quality of life,” the investigators noted. Study authors concluded, “Our review could inform the development of menopause services, in which enhanced professional training could pave the way for integrating mindfulness and CBT as conventional healthcare service options. At the center of treatment is the understanding of menopausal symptoms and embracing sufficient social support.”

These findings may be limited by the failure to collect data regarding menopausal status, a lack of consideration or defining of participants who may identify as non-binary or trans men, and relatively short follow-up times for symptom changes.

Note: This article originally appeared on Psychiatry Advisor

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