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Guidelines Urge Evaluation, Treatment of Perimenopausal Depression

September 12, 2018

By Reuters Staff

NEW YORK—Women going through the menopausal transition should be evaluated and treated for depression, advise the first-ever clinical recommendations on evaluating and treating perimenopausal depression.

Perimenopause is a "window of vulnerability" for the development of both depressive symptoms and major depressive episodes. However, clinical recommendations on how to identify, characterize and treat clinical depression in this population are lacking, the panel notes.

Depression during the perimenopausal phase can occur along with menopausal symptoms, "and these two sets of symptoms are hard to tease apart, which makes it difficult for clinicians to appropriately treat these women," Dr. Pauline Maki of the University of Illinois at Chicago College of Medicine said in a statement.

"Many women experience a new onset of depressive symptoms. If there is underlying low-level depression to begin with, perimenopause can increase the intensity of depressive symptoms," said Dr. Maki, co-lead author of the guidelines.

"There has been a need for expert consensus as well as clear clinical guidance regarding how to evaluate and treat depression in women during the perimenopause," added Dr. Susan Kornstein of Virginia Commonwealth University in Richmond, the other co-lead author. "These new clinical recommendations address this gap and offer much-needed information and guidance to health care practitioners so that they can provide optimal care and treatment for midlife women."

The guidelines, which are endorsed by the International Menopause Society, were published online simultaneously on September 5 in the journal Menopause and the Journal of Women's Health.

The guideline panel was convened by The North American Menopause Society and the Women and Mood Disorders Task Group of the National Network of Depression Centers. It reviewed the available literature on depressive disorders and symptoms in perimenopausal women and focused on five areas: epidemiology, clinical presentation, therapeutic effects of antidepressants, effects of hormone therapy and efficacy of other therapies such as psychotherapy, exercise and natural products.

Overall, the evidence suggests that most middle-aged women who suffer a major depressive episode during the perimenopause have a history of depression, the panel notes. Depression in midlife presents with classic depressive symptoms often alongside menopause symptoms such as vasomotor symptoms and sleep disturbances, 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," the guidelines advise. As for treatment, the guidelines say:

- Proven therapeutic options for depression (antidepressants, CBT and other psychotherapies) should remain the front-line treatments for perimenopausal depression.

- Clinicians should consider treating co-occurring sleep disturbance and night sweats as part of treatment for menopause-related depression.

- Estrogen therapy is ineffective as a treatment for depressive disorders in postmenopausal women.

- Hormonal contraceptives may improve depressive symptoms in women approaching menopause.

- Evidence is insufficient for the recommendation of botanical or alternative approaches for treating depression related to perimenopause.


Menopause 2018.

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