Hormonal,syndromal and EEG mapping studies in menopausal syndrome patients with and without depression as compared with controls

The aim of the study was to investigate brain function in menopausal depression by EEG mapping, as compared with menopausal syndrome patients without depression and normal controls, and to correlate neurophysiological with clinical and hormonal findings in order to elucidate the pathogenesis of depression in the menopause. Methods: One hundred and twenty-nine menopausal women, aged 45–60 years, with no previous hormonal replacement therapy were investigated in regard to hormones (estradiol E₂], follicle stimulating hormone FSH], clinical symptomatology (Kupperman Index KI], Hamilton depression score HAMD]) and brain function (EEG mapping). Based on KI and DSM-III-R research criteria for major depression, 3 groups were available for statistics (after removal of protocol violators): group A had a KI of <15 and no depression (n = 29); group B had a KI of ≥ 15 and no depression (n = 29) and group C had a KI of ≥ 15 and fulfilled the criteria for major depression (n = 60). Results: EEG maps of depressed patients demonstrated less total power and absolute power in the delta, theta and beta band, more relative delta and less alpha power as well as a slower delta/theta and faster alpha and beta centroid than controls, suggesting a vigilance decrement. Group B did not differ from group A. Correlation maps showed significant relationships between estradiol levels and EEG measures (the lower the E₂, the worse the vigilance) and between the EEG measures and the Hamilton depression (HAMD) score (the worse the vigilance, the higher the depression score). There were no correlations between the hormones E₂ and FSH and the syndromes KI and HAMD. In the target variable, the asymmetry index, depressed patients showed less alpha power over the right than left frontal lobe, whereas normal controls exhibited the opposite. Group B did not differ from group A. The frontal asymmetry index was significantly correlated with the Hamilton depression score and suggests right frontal hyper- and left frontal hypoactivation in depression. Conclusion: Although hormonal findings are not directly linked to psychic changes, low estradiol levels do contribute to a decreased vigilance at the neurophysiological level, which is in turn correlated with higher depressive and menopausal symptomatology at the behavioural level. Depression is furthermore correlated to a right frontal hyper- and left frontal hypoactivation.