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Very First Recommendations to Assess and Treat Perimenopausal Depression

Very First Recommendations to Assess and Treat Perimenopausal Depression

Written by Dr. Lakshmi Venkataraman, MD
Article Reviewed by 
The Medindia Medical Review Team on September 7, 2018 at 3:10 PM
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  • Perimenopause is the three- to four-year period immediately before menopause when menses become irregular and finally cease, as well as the year after the last menstrual period
  • Perimenopause is a vulnerable time in a woman’s life with increased risk of developing serious mental health issues such as depression; currently there is a lack of proper clinical recommendations
  • First ever guidelines to evaluate and treat perimenopausal depression in women drafted by the collective efforts of three clinical organizations; these have been published recently to help practising doctors diagnose and treat the condition better

Need for Guidelines to Treat Perimenopausal Depression

Mental health issues during the perimenopausal period are quite common and currently there are no established guidelines to help clinicians assess and treat women during this vulnerable phase in their life, and the condition often remains undiagnosed or under diagnosed.

To fill this gaping hole, a team of doctors convened by the North American Menopause Society and the National Network on Depression Centers Women and Mood Disorders Task Group, and endorsed by the International Menopause Society have drawn up guidelines and recommendations which are published simultaneously in two journals namely Menopause and the Journal of Women's Health.

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"The reason these guidelines are needed is because 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," said Dr. Pauline Maki, professor of psychology and psychiatry in the University of Illinois at Chicago College of Medicine and co-lead author of the new guidelines. "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."

Perimenopausal Depression - Key Observations and Recommendations

The two co-lead authors Dr. Pauline Maki, professor of psychology and psychiatry in the University of Illinois at Chicago College of Medicine and Dr. Susan Kornstein, professor of psychiatry and obstetrics & gynecology at Virginia Commonwealth University and their panel of doctors made the following important observations about perimenopausal depression.
  • Perimenopausal period is a vulnerable period when a woman can have depressive symptoms or even suffer a major depressive episode
  • The risk for depressive symptoms is increased in women during perimenopause even without a previous depression
  • Symptoms of perimenopause such as hot flashes, night sweats, sleep disturbances, weight gain, and tiredness can overlap with depressive symptoms, making the diagnosis difficult
  • Additional stressors that can affect mood include caring for aging parents as well as kids, career and relationship demands, body changes due to aging process and illness in the family
  • Major depressive episodes during perimenopause should be treated with antidepressants, cognitive behavioral therapy and other psychotherapies
  • Sleep disturbances and night sweats have to be addressed when treating menopause-related depression
  • Estrogen therapy is not helpful in treating major depressive disorders in postmenopausal women
  • Hormonal contraceptives may reduce symptoms of depression in women during perimenopause; presence of job and family stressors may benefit from psychotherapy and counseling
  • There is not enough evidence on the benefits of herbal remedies or alternative systems of medicines to treat perimenopause associated depressive symptoms
Symptoms and Signs of Depression to be Aware of

Major Depression SymptomsDepression Associated with Perimenopause
  • Tiredness and feeling listless
  • Loss of interest in activities previously enjoyed
  • Reduced alertness and slow to respond to situations
  • Lack of focus and attention
  • Feeling worthless and hopeless
  • Suicidal ideas
  • Mood swings
  • Getting irritated easily
  • Feeling sad with bouts of crying without reason
  • Highly anxious
  • Feeling of despair
  • Sleep disturbances due to hot flashes or night sweats


According to Maki, "Perimenopause is a window of vulnerability for the development of both depressive symptoms and major depressive episodes. It is important for women and their health care providers to recognize that these symptoms are common during perimenopause and can be treated."

References :
  1. First-ever guidelines for detecting, treating perimenopausal depression - (https://17ok.org/health/guidelines-detecting-treating-perimenopausal-depression-20860220)
  2. Menopausal - (https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401)

Source: Medindia

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