MedicalResearch.com Interview with:
Hadine Joffe, MD, MSc
Associate Professor of Psychiatry, Harvard Medical School
Vice Chair for Psychiatry Research
Director of Division of Women’s Mental Health / Dept of Psychiatry / Brigham and Women’s Hospital
Director of Psycho-Oncology Research / Dept of Psychosocial Oncology and Palliative Care /Dana Farber Cancer Institute
MedicalResearch.com: What is the background for this study?
Response: We conducted this study to advance our understanding about causes of mood disturbance in the menopause transition that are specifically related to menopause. We used an experimental model to dissect out the contributions of hot flashes and sleep disturbance from contribution of changing levels of estrogen because hot flashes, sleep problems, and estrogen fluctuations co-occur and are difficult to distinguish from one another. Understanding whether hot flashes and/or sleep disturbance are causally related to mood disturbance will help us identify who is at risk for mood changes during the menopause transition. This is incredibly important now that we are finding effective non-hormonal treatments for hot flashes and sleep disruption.
MedicalResearch.com: What are the main findings?
Response: Our study found that both sleep disruption and nighttime hot flashes, but not daytime hot flashes, independently contribute to mood disturbance in women whose estrogen levels are uniformly suppressed as a result of a medically induced menopause. Ours is the first study to identify that nighttime hot flashes, and not daytime hot flashes, are linked with depressive symptoms. This provides more specific information to women and clinicians about the importance of treating nighttime hot flashes/night sweats as part of the approach to improving mood disturbance in this population. Our results also indicate that bothersome daytime hot flashes are not related to menopausal depressive symptoms—which many people believed to be the case. This delineation of the association with nighttime flashes is important because occasionally women have symptoms during the day or night, but not both, and because some shorter-acting treatments can be used selectively for nighttime symptoms. Our results also show that it is not just the sleep problem related to the nighttime flashes that is linked with the mood problem. Rather, both nighttime hot flashes AND sleep problems are of concern.
MedicalResearch.com: What should readers take away from your report?
Response: The take-home message is that both sleep disruption and nighttime hot flashes, but not daytime hot flashes, independently contribute to mood disturbance in women whose estrogen levels have fallen during menopause.
These findings have important clinical implications. Our results suggest that women reporting nighttime hot flashes and sleep disruption should be screened for mood disturbance, and that treatment of mood disturbance in this population should include therapies that improve sleep interruption as well as nighttime hot flashes.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future research should focus on strategies to optimize treatment for women with multiple co-occurring menopause-related symptoms and on possible shared neural mechanisms that may underlie the association among these commonly clustered symptoms.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Independent Contributions of Nocturnal Hot Flashes and Sleep Disturbance to Depression in Estrogen-deprived Women,” Journal of Clinical Endocrinology & Metabolism, press.endocrine.org/doi/10.1210/jc.2016-2348
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