Evaluation And Treatment Of Perimenopausal Depression

The perimenopause is a window of vulnerability for the development of both depressive symptoms and major depressive episodes.

The risk of depressive symptoms is elevated during the perimenopause even in women with no history of major depressive disorder.

Most midlife women who experience a MDE during the perimenopause have experienced a prior episode of depression; therefore, the episode represents recurrence of their illness. First lifetime onset of MDD during this time is less common.

Data are mixed about whether women who undergo surgical menopause are at increased or decreased risk for developing depression compared with women who transition through menopause naturally. However, recent large-scale studies show an elevated risk of depression in women following hysterectomy with and without oophorectomy. Women with primary ovarian insufficiency also have shown elevated rates of depression.

Risk factors for depressive symptoms during the perimenopause include prior MDD, sociodemographic factors (e.g., younger age, black race, financial difficulties), psychosocial factors (adverse life events, low social support), menopause symptoms (VMS, sleep disturbance), anxiety symptoms, and reproductive-related mood disturbance (e.g., postpartum and/or premenstrual depressive symptoms).

Risk factors for MDD during the perimenopause include mental health factors (prior MDD, current use of antidepressants, anxiety, trait anxiety, premenstrual depressive symptoms), sociodemographic factors (black race, high BMI, younger age), psychosocial factors (upsetting life events, social isolation), and menopausal symptoms (especially sleep disturbance).