- Last edited on July 2, 2026
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mood:1-depression:perimenopausal [on July 2, 2026] (current) psychdb [Primer] |
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| + | ====== Perimenopausal Depression ====== | ||
| + | ===== Primer ===== | ||
| + | **Perimenopausal Depression** is a subtype of [[mood:1-depression:home|depression]] experienced by women during the perimenopausal period, defined as the interval when a women’s menstrual cycles become irregular, usually between ages of 45 and 49. | ||
| + | |||
| + | == Definition == | ||
| + | * The transition to menopause (or perimenopause, the beginning of ovarian failure) begins when menstrual cycles become 7 days longer or shorter than usual and extends to the early postmenopausal years.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994788/|MacQueen, G. M., Frey, B. N., Ismail, Z., Jaworska, N., Steiner, M., Lieshout, R. J., Kennedy, S. H., Lam, R. W., Milev, R. V., Parikh, S. V., Ravindran, A. V., & CANMAT Depression Work Group (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Canadian journal of psychiatry, 61(9), 588–603.]])] | ||
| + | * Menopause is defined as 12 months of amenorrhea following the final menstrual cycle, which usually occurs at an average age of 51 years.[([[https://pubmed.ncbi.nlm.nih.gov/18178752/|Parry, B. L. (2008). Perimenopausal depression. American Journal of Psychiatry, 165(1), 23-27.]])] | ||
| + | |||
| + | == Epidemiology == | ||
| + | |||
| + | == Prognosis == | ||
| + | * The perimenopause period is a time of increased risk for depression compared to the premenopausal years | ||
| + | * This period is also associated with perimenopausal symptoms, including hot flashes, night sweats, decreased libido, vaginal dryness, sleep disturbances, and memory complaints.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994788/|MacQueen, G. M., Frey, B. N., Ismail, Z., Jaworska, N., Steiner, M., Lieshout, R. J., Kennedy, S. H., Lam, R. W., Milev, R. V., Parikh, S. V., Ravindran, A. V., & CANMAT Depression Work Group (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. Canadian journal of psychiatry, 61(9), 588–603.]])] | ||
| + | * Hot flashes and night sweats in particular are independent predictors of perimenopausal depression. | ||
| + | |||
| + | == Comorbidity == | ||
| + | |||
| + | == Risk Factors == | ||
| + | * In women with no lifetime history of depression, those who enter the menopausal transition earlier have a significant risk for first onset of depression. [([[https://jamanetwork.com/journals/jamapsychiatry/fullarticle/209471|Cohen, L. S., Soares, C. N., Vitonis, A. F., Otto, M. W., & Harlow, B. L. (2006). Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Archives of general psychiatry, 63(4), 385-390.]])] | ||
| + | ===== Pathophysiology ===== | ||
| + | * Since estrogen and serotonin may modulate hypothalamic thermoregulatory function, abrupt changes in neuromodulatory function and reproductive-hormone levels during menopause are thought to contribute to mood and vasomotor symptoms seen in menopause. | ||
| + | ===== Treatment ===== | ||
| + | <panel type="info" title="Treatments for Perimenopausal Depression" subtitle="MacQueen, G. M. et al. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 6. Special populations: youth, women, and the elderly. The Canadian Journal of Psychiatry, 61(9), 588-603." no-body="true" footer="* = Women with an intact uterus should also be prescribed concomitant progesterone."> | ||
| + | ^ 1st line | **Monotherapy**: [[meds:antidepressants:snri:v-desvenlafaxine|Desvenlafaxine]], [[psychotherapy:cbt|cognitive behavioural therapy]] | | ||
| + | ^ 2nd line | **Monotherapy** or **Adjunctive therapy**: Transdermal estradiol* (level 2) \\ **Monotherapy**: [[meds:antidepressants:ssri:citalopram|Citalopram]], [[meds:antidepressants:snri:duloxetine|duloxetine]], [[meds:antidepressants:ssri:escitalopram|escitalopram]], [[meds:antidepressants:nassa:mirtazapine|mirtazapine]], [[meds:antipsychotics:second-gen-atypical:6-quetiapine|quetiapine]] XR, [[meds:antidepressants:snri:venlafaxine|venlafaxine]] XR (level 3) \\ **Monotherapy**: [[meds:supplements:omega-3|Omega-3]], [[meds:antidepressants:ssri:fluoxetine|fluoxetine]], [[meds:antidepressants:tca:nortriptyline|nortriptyline]], [[meds:antidepressants:ssri:paroxetine|paroxetine]], [[meds:antidepressants:ssri:sertraline|sertraline]] (level 4) | | ||
| + | ^ 3rd line | **Monotherapy**: [[psychotherapy:mindfulness|Mindfulness-based]] CBT, [[psychotherapy:supportive|supportive psychotherapy]] (level 4) | | ||
| + | </panel> | ||
| + | |||
| + | ==== Hormonal ==== | ||
| + | * There is scant evidence to suggest that hormone replacement therapy should be used to //prevent// the onset of depressive symptoms during the menopause transition.[([[https://www.ncbi.nlm.nih.gov/pubmed/29322164|Gordon, J. L., Rubinow, D. R., Eisenlohr-Moul, T. A., Xia, K., Schmidt, P. J., & Girdler, S. S. (2018). Efficacy of Transdermal Estradiol and Micronized Progesterone in the Prevention of Depressive Symptoms in the Menopause Transition: A Randomized Clinical Trial. JAMA psychiatry.]])] | ||
| + | * Additionally, the U.S. Preventive Services Task Force recently found “no net benefit” of hormone therapy for primary prevention of most chronic disorders related to menopause, but they did find “convincing evidence” of risks like breast cancer, thromboembolism, and cardiovascular disease.[([[https://jamanetwork.com/journals/jama/fullarticle/2665782|Grossman, D. C., Curry, S. J., Owens, D. K., Barry, M. J., Davidson, K. W., Doubeni, C. A., ... & Landefeld, C. S. (2017). Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: US Preventive Services Task Force Recommendation Statement. Jama, 318(22), 2224-2233.]])] | ||
| + | * However, there is evidence that transdermal estrogen therapy has antidepressant effects in diagnosed perimenopausal depression, especially in those with vasomotor symptoms.[([[https://pubmed.ncbi.nlm.nih.gov/30179986/|Maki, P. M., Kornstein, S. G., Joffe, H., Bromberger, J. T., Freeman, E. W., Athappilly, G., ... & Soares, C. N. (2018). Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause, 25(10), 1069-1085.]])][([[https://pubmed.ncbi.nlm.nih.gov/27486149/|MacQueen, G. M., Frey, B. N., Ismail, Z., Jaworska, N., Steiner, M., Lieshout, R. J. V., ... & CANMAT Depression Work Group. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 6. Special populations: youth, women, and the elderly. The Canadian Journal of Psychiatry, 61(9), 588-603.]])] | ||
| + | * The risks and benefits of using hormonal therapy should be discussed with the patient prior to use. | ||
| + | ===== Guidelines ===== | ||
| + | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success"> | ||
| + | See also: **[[teaching:clinical-practice-guidelines-cpg|]]** | ||
| + | </alert> | ||
| + | |||
| + | {{page>teaching:clinical-practice-guidelines-cpg#perimenopause&nouser&noheader&nodate&nofooter}} | ||
| + | |||
| + | |||
| + | ===== Resources ===== | ||
| + | <WRAP group> | ||
| + | <WRAP quarter column> | ||
| + | == For Patients == | ||
| + | |||
| + | </WRAP> | ||
| + | |||
| + | <WRAP quarter column> | ||
| + | == For Providers == | ||
| + | * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299176/|Kulkarni, J. (2018). Perimenopausal depression–an under-recognised entity. Australian prescriber, 41(6), 183.]] | ||
| + | * [[https://pubmed.ncbi.nlm.nih.gov/18178752/|Parry, B. L. (2008). Perimenopausal depression. American Journal of Psychiatry, 165(1), 23-27.]] | ||
| + | * [[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971729/|Parry, B. L. (2010). Optimal management of perimenopausal depression. International journal of women's health, 2, 143.]] | ||
| + | </WRAP> | ||
| + | <WRAP quarter column> | ||
| + | == Articles == | ||
| + | |||
| + | </WRAP> | ||
| + | <WRAP quarter column> | ||
| + | == Research == | ||
| + | |||
| + | </WRAP> | ||
| + | </WRAP> | ||