Perimenopause, or transitional menopause, is defined as the early transition stages into menopause as well as the early post-menopause stage. It is a particularly vulnerable time for depressive symptoms and major depressive episodes in women. The following are the guidelines on evaluation and management of perimenopausal depression developed by NAMS in collaboration with the National Network of Depression Centers Women and Mood Disorders Task Group expert panel. The guidelines address an approach to depressive symptoms and depressive disorders in midlife women.
Epidemiology
Risk Factors for Depressive Symptoms
Risk factors for MDD
The guidelines state
Depression during midlife presents with classic depressive symptoms, commonly in combination with menopause specific symptoms (ie, VMS, sleep disturbance) and psychosocial challenges.
Diagnostic Criteria (DSM-5)
MDD aka ‘Depression’
Clinical assessment
Note: Refer women with past MDEs and severe depressive symptoms for as professional evaluation for the presence of mood disorder
Antidepressants
Estrogen-Based Therapies (ET)
ET used together to enhance antidepressants should be used with caution
Note: Studies on hormone therapy (HT) and depression focused on unopposed estrogen. Combined HT is not well studied and data is inconclusive
Alternative (supplements and non-traditional) approaches
Exercise
DSM-5 and mental disorders in older individuals: an overview
Diagnostic and Statistical Manual of Mental Disorders (DSM–5)
PHQ-9 Screening Tool (University of Michigan)
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