Abstract
Major depressive disorder (MDD) and migraine are both more common among women than men. Women’s reproductive years are associated with increased susceptibility to recurrence of both conditions, suggesting a potential role of sex hormones in aetiology. We examined associations between comorbid migraine and clinical features of MDD in women, including relationships with lifetime reproductive events such as childbirth. Lifetime clinical characteristics and reproductive events in a well-characterised sample of 222 UK women with recurrent MDD, with (n = 98) and without (n = 124) migraine were compared. Women had all been recruited as part of a UK-based ongoing programme of research into the genetic and non-genetic determinants of mood disorders. Multivariate analysis showed a specific association between the lifetime presence of migraine and postpartum depression (PPD) within 6 weeks of delivery (OR = 2.555; 95% CI: 1.037–6.295, p = 0.041). This association did not extend to a broader definition of PPD with onset up to 6 months postpartum. All other factors included in the analysis were not significantly associated with the presence of migraine: family history of depression, younger age at depression onset, history of suicide attempt and severe premenstrual syndrome symptoms. The finding that women with MDD and comorbid migraine may be particularly sensitive to hormonal changes early in the postpartum period leads to aetiological hypotheses and suggests this group may be useful for future studies attempting to characterise PPD and MDD phenotypes. The refinement of such phenotypes has implications for individualising risk and treatment and for future biological and genetic studies.
Highlights
The lifetime prevalence rate of major depressive disorder (MDD) is estimated to be twice as high in women compared to men (Kessler et al 1993), with epidemiological studies showing increased risk of depressive episodes and symptoms in the reproductive phases of women’s lives, including the early postpartum period (O’Hara and Swain 1996; Munk-Olsen et al 2006) and during the menopausal transition (Freeman et al 2006)
There were no significant associations between the presence of migraine in the women with MDD and the demographic characteristics examined (Table 1)
The association remained significant in multivariate analysis which controlled for earlier age of onset of depression and history of suicide attempts, both of which were significantly associated with the presence of migraine in univariate analysis. Our findings suggest this group of women with MDD and comorbid migraine may be sensitive to hormonal changes early in the postpartum
Summary
The lifetime prevalence rate of major depressive disorder (MDD) is estimated to be twice as high in women compared to men (Kessler et al 1993), with epidemiological studies showing increased risk of depressive episodes and symptoms in the reproductive phases of women’s lives, including the early postpartum period (O’Hara and Swain 1996; Munk-Olsen et al 2006) and during the menopausal transition (Freeman et al 2006). MDD is highly comorbid with migraine (Breslau et al 2003; Nguyen and Low 2013), and there is extensive literature demonstrating migraine is more prevalent among women compared to men (Vetvik and MacGregor 2017). During women’s reproductive years, peaks in susceptibility to migraine occur during times of major hormonal changes. There is a reported improvement of migraine symptoms during pregnancy depending on the type of migraine (MacGregor 2007) followed by an increase in the postpartum period (Kvisvik et al 2011)
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