Journal article
Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations
Menopause (New York, N.Y.), Vol.25(10), pp.1069-1085
10/01/2018
DOI: 10.1097/GME.0000000000001174
PMID: 30179986
Abstract
There is a new appreciation of the perimenopause - defined as the early and late menopause transition stages as well as the early postmenopause - as a windowof vulnerability for the development of both depressive symptoms and major depressive episodes. However, clinical recommendations on how to identify, characterize and treat clinical depression are lacking. To address this gap, an expert panel was convened to systematically review the published literature and develop guidelines on the evaluation and management of perimenopausal depression. The areas addressed included: 1) epidemiology; 2) clinical presentation; 3) therapeutic effects of antidepressants; 4) effects of hormone therapy; and 5) efficacy of other therapies (eg, psychotherapy, exercise, and natural health products). Overall, evidence generally suggests that most midlife women who experience a major depressive episode during the perimenopause have experienced a prior episode of depression. Midlife depression presents with classic depressive symptoms commonly in combination with menopause symptoms (ie, vasomotor symptoms, sleep disturbance), and psychosocial challenges. Menopause symptoms complicate, co-occur, and overlap with the presentation of depression. Diagnosis involves identification of menopausal stage, assessment of co-occurring psychiatric and menopause symptoms, appreciation of the psychosocial factors common in midlife, differential diagnoses, and the use of validated screening instruments. Proven therapeutic options for depression (ie, antidepressants, psychotherapy) are the front-line treatments for perimenopausal depression. Although estrogen therapy is not approved to treat perimenopausal depression, there is evidence that it has antidepressant effects in perimenopausal women, particularly those with concomitant vasomotor symptoms. Data on estrogen plus progestin are sparse and inconclusive.
Details
- Title: Subtitle
- Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations
- Creators
- Pauline M. Maki - University of Illinois at ChicagoSusan G. Kornstein - Virginia Commonwealth UniversityHadine Joffe - Harvard UniversityJoyce T. Bromberger - University of PittsburghEllen W. Freeman - University of PennsylvaniaGeena Athappilly - Edith Nourse Rogers Memorial Veterans HospitalWilliam Bobo - Mayo Clinic in FloridaLeah H. Rubin - Johns Hopkins UniversityHristina K. Koleva - University of IowaLee S. Cohen - Harvard UniversityClaudio N. Soares - Queen's UniversityWomen and Mood Disorders Task Force of the National Network of Depression CentersBoard of Trustees for The North American Menopause Society (NAMS)
- Resource Type
- Journal article
- Publication Details
- Menopause (New York, N.Y.), Vol.25(10), pp.1069-1085
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/GME.0000000000001174
- PMID
- 30179986
- ISSN
- 1072-3714
- eISSN
- 1530-0374
- Number of pages
- 17
- Language
- English
- Date published
- 10/01/2018
- Academic Unit
- Psychiatry
- Record Identifier
- 9984293654102771
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