Impacto dos transtornos depressivos e ansiosos sobre as manifestações da menopausa

Abstract

ResumoObjetivo: Determinar, pela primeira vez, em uma amostra ambulatorial brasileira, o impacto dos diagnósticos psiquiátricos sobre os sintomas da menopausa presentes no índice de menopausa de Blatt-Kupperman (B-K). Métodos: Avaliamos consecutivamente, através do instrumento diagnóstico estruturado MINI 4.4 e da entrevista psiquiátrica tradicional, mulheres (n = 86) em atendimento no ambulatório de menopausa do Instituto de Ginecologia da Universidade Federal do Rio de Janeiro. As pacientes incluídas no estudo (n = 48) foram avaliadas pela escala B-K até 6 meses antes ou depois da entrevista pelo MINI e divididas em dois grupos: o grupo com algum transtorno depressivo-ansioso (GTDA) (n = 26) e o grupo-controle (GC) (n = 22). Resultados: O GTDA apresentou uma pontuação significativamente maior do que o GC na escala de B-K (22,6 versus 13,7). Entre os sintomas significativamente mais intensos no GTDA estão parestesia e melancolia. Além disso, observamos que as pacientes do GTDA queixavam-se de um maior número de sintomas do que as pacientes do GC (6,8 vs. 4,8). Entre os sintomas significativamente mais relatados no GTDA, estão parestesia, fraqueza e melancolia. Conclusão: Apesar da limitação da pequena amostra, pudemos observar o significativo viés dos transtornos depressivos e ansiosos sobre as pacientes em tratamento por queixas referentes à menopausa. Por esse motivo, o perfil sintomático de cada paciente deve ser sempre observado, evitando o ginecologista basear-se na intensidade global dos sintomas do B-K para decidir sobre o tratamento. Descritores: Depressão, ansiedade, menopausa, índice de Blatt-Kupperman. AbstractObjective: To establish for the first time in a Brazilian outpatient sample the impact of depressive and anxiety disorders over the symptoms of the Blatt-Kupperman menopausal index (B-K). Methods: Women (n = 86) receiving care in the menopause clinic at Instituto de Ginecologia da Universidade Federal do Rio de Janeiro were consecutively assessed using a structured diagnostic instrument (MINI 4.4) and a traditional psychiatric interview. Patients included in the study (n = 48) were assessed using the B-K scale within 6 months before or after the MINI. The total sample was divided into the anxiety and depressive disorder group (GTDA) (n = 26) and the control group (CG) (n = 22). Results: B-K total scores were greater in the GTDA comparing with the CG (22.6 vs. 13.7). Paresthesia and melancholia were significantly more severe in the GTDA. GTDA patients also complained of a greater number of symptoms (6.8 vs. 4.8) than the GC. Paresthesia, weakness and melancholia were significantly more present in the GTDA. Conclusion: Although the small sample limitation we could observe a great bias of depressive and anxiety disorders over menopause outpatients. For that reason, the symptomatic profile of each patient must always be observed by the gynecologist, avoiding exclusive observation of B-K total score to decide about the treatment.

Negative affect symptoms, anxiety sensitivity, and vasomotor symptoms during perimenopause

“…Likewise, the prevalence of anxiety disorders and symptoms in our study resemble the rates found by other studies. Veras et al 24 found that 33.3% of peri- and postmenopausal Brazilian women were diagnosed with anxiety disorders according to the MINI, and the prevalence of anxiety symptoms reported by Polisseni et al 2 was 56.3%. Other studies, however, reported frequencies ranging from 9 to 21%, and these lower rates may be associated with broader inclusion criteria and the rating scales used.…”

“…In Brazilian studies with perimenopausal women, the prevalence of the diagnosis of depression has ranged from 18.7 to 34.3%, while the prevalence of depressive symptoms has been reported as 46.9%. 2,24,25 In a cross-sectional study of the SWAN cohort, 68.6% of perimenopausal women reported depressive symptoms. Likewise, the prevalence of anxiety disorders and symptoms in our study resemble the rates found by other studies.…”

Factors related to depressive complaints on climacteric: a cross-sectional study

“…[18] The association of depressive symptoms with advancing age is indeed consistent and grounded in the literature. [14,19] Menopause is a period marked by hormonal changes, which result in physical, psychological and social consequences. Therefore, it is a considerably stressful phase, and may lead to changes in mood and even depression.…”

“…In this sense, studies have shown that unemployment is predictive for the development of depressive symptoms. [17,19] Studies have reported that low family income can be an important factor in justifying increased rates of depression because it is connected to social conditions such as unemployment, low education, poor quality housing and inadequate food. Such conditions, exclusive or combined, favor the development of a hopeless state, which has the immediate effect of reducing the ability to handle stressful situations properly, reducing willingness to withstand adverse and frustrating events.…”

Características sociodemográficas e clínicas das internações psiquiátricas de mulheres com depressão

“…Ao observamos que o maior número de mulheres (194 -25,4%) encontrava-se com idade entre 41 a 50 anos, torna-se oportuno ressaltar que nesta faixa etária ocorre o climatério, que consiste no final da vida reprodutiva da mulher, onde se destacam alterações hormonais significativas, que em sua grande maioria resultam em sintomas físicos, psicológicos e sociais, configurando uma fase de considerável estresse e de maior vulnerabilidade psíquica da mulher (15)(16) .…”