Very First Recommendations to Assess and Treat Perimenopausal Depression

Highlights:

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

Perimenopause - Causes, Symptoms, Diagnosis and Treatment
Perimenopause is a transition phase that lasts until menopause. The low estrogen levels during this phase cause irregular periods and early menopause symptoms such as hot flashes. This phase may last from a few months to years.

‘Perimenopausal period is a vulnerable time with increased risk of mental health issues for a woman and it is important to recognize them and provide effective care and treatment.’

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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.

"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."

Depression - Types, Causes, Symptoms, Diagnosis, Treatment
Depression is one of the most common mental disorders affecting approximately 340 million people in the world. No one is immune from depression - it occurs in people of all social classes, all countries and all cultural settings.

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 Symptoms	Depression 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

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Conclusion

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:

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

Source-Medindia

Teen Trauma Increases Risk of Depression During Menopause
Women who have experienced adverse events during childhood and adolescence face increased risk of suffering from depression during menopause.