The first-ever guidelines for perimenopausal depression have been developed by The North American Menopause Society and the National Network on Depression Centers Women and Mood Disorders Task Group. Co-published in The Journal of Women’s Health and Menopause: The Journal of the North American Menopause Society, the document represents the work of an 11-member expert panel of clinicians and scientists.
The conclusions in the document are based on a systematic review of literature published in English between 1980 and 2015. The guidelines address five topics relevant to symptoms of depression and depressive disorders in perimenopause: 1. epidemiology; 2. clinical presentation; 3. therapeutic effects of antidepressants; 4. effects of hormone therapy (HT); and 5. efficacy of other treatments such as psychotherapy, exercise, and natural health products.
According to the panel’s report, a review of the literature on the relationship between perimenopause stage and depressive symptoms showed that in cross-sectional studies, “45% to 68% of perimenopausal women report elevated depressive symptoms compared with 28% to 31% of premenopausal women.” Six of 11 longitudinal studies reviewed suggested an increased risk of depressive symptoms during the transition. Regarding major depressive episodes, the panel noted that they tend to occur in midlife women with a history of depression.
Risk factors for depressive symptoms in menopause cited in the guidelines include prior major depressive disorder, sociodemographic and psychosocial factors, menopause and anxiety symptoms, and reproductive-related disturbance. The panel found that hot flashes, night sweats, sleep and sexual disturbances, weight/energy changes, and cognitive changes overlap with depression in perimenopause. “Empty nest” and “revolving door” syndromes, they said, have “little enduring effect” on mood.
To evaluate mood disorders in perimenopausal women, the guidelines recommend that clinicians use a validated screening measure such as the PHQ-9, the Menopause Rating Scale, the Menopause-Specific Quality-of-Life Scale, the Greene Climacteric Scale or the Utian Quality-of-Life Scale.
Antidepressants, cognitive-behavioral therapy and other psychotherapies are recommended as first-line options. Regarding antidepressants, the panel noted that “only desvenlafaxine has been studied and proven efficacious in large randomized placebo-controlled trials of well-defined peri- and postmenopausal depressed women.” Hormonal contraceptives, the guidelines said, have shown some benefits for mood regulation and while estrogen-based therapies may augment clinical response to antidepressants, “their use should be considered with caution.” Looking at HT, the panel characterized the data in depression as “sparse and inconclusive.”