A multi-institutional panel of clinicians and scientists 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 published the first-ever guidelines for the evaluation and treatment of perimenopausal depression simultaneously in the journal 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.”
“There has been a need for expert consensus as well as clear clinical guidance regarding how to evaluate and treat depression in women during the perimenopause,” said Dr. Susan Kornstein, professor of psychiatry and obstetrics & gynecology at Virginia Commonwealth University and co-lead author of the guidelines. “These new clinical recommendations address this gap and offer much-needed information and guidance to health care practitioners so that they can provide optimal care and treatment for midlife women.” Kornstein is also executive director of the Institute for Women’s Health at Virginia Commonwealth University.
The task force, co-chaired by Maki and Kornstein, reviewed the scientific literature on depressive disorders and symptoms in perimenopausal women and focused on five areas: epidemiology, clinical presentation, therapeutic effects of antidepressants, effects of hormone therapy, and efficacy of other therapies such as psychotherapy, exercise and natural products. Perimenopause refers to the three- to four-year period immediately prior to menopause when periods become irregular and eventually stop, as well as the first year after the final menstrual period.
Some of the findings of the panel include:
Perimenopause is a window of vulnerability for the development of both depressive symptoms and a diagnosis of major depressive disorder.
The risk for depressive symptoms is elevated during perimenopause even in women with no prior history of depression.
Several common symptoms of perimenopause (hot flashes, night sweats, sleep and sexual disturbances, weight/energy changes, cognitive changes) complicate, co-occur and overlap with the presentation of depression during this stage.
Life stressors including caring for children and parents, career and relationship shifts, aging and body changes and family illness can adversely affect mood.
Proven therapeutic options for depression (antidepressants, cognitive behavioral therapy and other psychotherapies) should remain as front-line antidepressive treatments for major depressive episodes during perimenopause.
Clinicians should consider treating co-occurring sleep disturbance and night sweats as part of treatment for menopause-related depression.
Estrogen therapy is ineffective as a treatment for depressive disorders in postmenopausal women.
Hormonal contraceptives may improve depressive symptoms in women approaching menopause.
Evidence is insufficient for the recommendation of botanical or alternative approaches for treating depression related to perimenopause.
“Perimenopause is a window of vulnerability for the development of both depressive symptoms and major depressive episodes,” Maki said. “The recent suicide of Kate Spade at 55 years of age shows the seriousness of mental health issues in midlife women, a group that has shown a 45 percent increase in suicide rates over the past 15 years,” said Maki.
REFERENCE: Maki et al: Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. Journal of Women’s Health, 2018; https://www.liebertpub.com/doi/10.1089/jwh.2018.27099.mensocrec