Perimenopausal Depression: Covering Mood and Vasomotor Symptoms; Hormones, Antidepressants, or Psychotherapy-What Would You Recommend?

By Brandon, Anna R.; Shivakumar, Geetha et al. | Current Psychiatry, October 2008 | Go to article overview

Perimenopausal Depression: Covering Mood and Vasomotor Symptoms; Hormones, Antidepressants, or Psychotherapy-What Would You Recommend?


Brandon, Anna R., Shivakumar, Geetha, Freeman, Marlene P., Current Psychiatry


Symptoms of perimenopausal depression are not inherently different from those of depression diagnosed at any other time in life, but they present in a unique context:

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

* Hormonal fluctations may persist for a long duration.

* Women experiencing hormonal fluctations may be vulnerable to mood problems.

* Psychosocial/psychodynamic stressors often complicate this life transition.

Managing perimenopausal depression has become more complicated since the Women's Health Initiative (WHI) studies found fewer benefits and greater risks with hormone replacement therapy (HRT) than had been perceived. This article discusses the clinical presentation of perimenopausal depression, its risk factors, and treatment options in post-WHI psychiatric practice.

Who is at risk?

Perimenopausal depression is diagnosed when onset of major depressive disorder (MDD) is associated with menstrual cycle irregularity and/or somatic symptoms of the menopausal transition. (1) Diagnosis is based on the overall clinical picture, and treatment requires a thoughtful exploration of the complex relationship between hormonal function and mood regulation.

Presentation. For many women, perimenopause is characterized by mild to severe vasomotor, cognitive, and mood symptoms (Table 1, page 40). Thus, in your workup of depression in midlife women, document somatic symptoms--such as hot flushes, vaginal dryness, and incontinence--and affective/behavioral symptoms such as mood and sleep disturbances.

Table 1
Vasomotor, cognitive, and mood symptoms of perimenopause

Vasomotor                       Cognitive, and mood

Hot flushes                     Decreased concentration
Sweating                        Anxiety
Heart palpitations              Irritability
Painful intercourse             Mood lability
Vaginal dryness and discomfort  Memory difficulty
Sleep disruption
Headache

Explore psychiatric and medical histories of your patient and her close relatives. Ask about depression, dysthymia, hypomania, or mood fluctations around hormonal events such as menses, pregnancy, postpartum, or starting/stopping oral contraceptives. In the differential diagnosis, consider:

* Is low mood temporally connected with hot flushes and disturbed sleep?

* Is low mood secondary to stressful life events?

* Does the patient have another medical illness (such as thyroid disorder) with symptoms similar to depression?

* Is low mood secondary to anxiety or another psychiatric disorder?

Screening. Menopause is considered to have been reached after 12 months of amenorrhea not due to another cause. Median ages for this transition in the United States are 47.5 for perimenopause and 51 for menopause, with an average of 8 years between regular cycles and amenorrhea. (2) Therefore, begin talking with women about perimenopausal symptoms when they turn 40.

Evidence supports screening perimenopausal women for depressive symptoms even when their primary complaints are vasomotor. The Greene Climacteric Scale (3) is convenient for quantifying and monitoring perimenopausal symptoms. It includes depressive symptoms plus physical and cognitive markers. The Quick Inventory of Depressive Symptomatology--Self Report (QIDS-SR) (4) questionnaire:

* takes minutes to complete

* is easy to score

* quantitates the number and severity of depressive symptoms (see Related Resources, page 50).

Table 2

Risk factors for depression in women

Predictive over lifetime              High risk during menopausal
                                              transition

History of depression                 History of PMS, perinatal
                                      depression, mood symptoms
                                      associated with contraceptives

Family history of affectiv disorders  Premature or surgical menopause

Insomnia                              Lengthy menopausal transition
                                      ([greater than or equal to] 27
                                      months)

Redued physical activities            Lengthy menopausal transition
                                      ([greater than or equal to]27
                                      months)

Weighy gain                           Persistent and/or severe
                                      vasomotor symptoms

Less education                        Negative attitudes toward
                                      menopause and aging

Perceived lower economic status

Perceived lower social support

Perceived lower health status

Smoking

Stressful life events

History of trauma

Marital dissatisfaction

PMS: Premenstrual syndrome

Figure

Biopsychosocial milieu of depression during perimenopause

          Depression

Social         Structural family changes; social support; losses in
               peers and extended family

Psychological  Personality characteristics; perceptions of menopause
               and aging

Biological     Hormonal fluctation; hot flushes and night sweats;
               disrupted sleep; painful intercourse

Psychosocial factors can predict depression at any time in life, but some are specific to the menopausal transition (Table 2).

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Perimenopausal Depression: Covering Mood and Vasomotor Symptoms; Hormones, Antidepressants, or Psychotherapy-What Would You Recommend?
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.