GUIDELINES relating to the diagnosis and treatment of perimenopausal depression have been published for the first time by a multi-institutional panel of clinicians and scientists, including academics from the University of Illinois at Chicago (UIC), Illinois, USA. It is hoped the new recommendations will enable doctors to be better able to identify the signs and symptoms of depression in these women as well as select the most appropriate form of treatment.
Much Needed Guidance
Perimenopause, which occurs 3–4 years directly before menopause, is when a woman’s periods become irregular and eventually stop. During this time, women are particularly vulnerable to depression. In addition to experiencing symptoms such as hot flashes and sleep disturbances, they tend to hold multiple responsibilities at this point in their lives, such as caring for their children and helping ageing parents, and face increasing workplace demands, leading to high levels of stress.
“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, UIC, who was co-lead author of the guidelines.
Accounting for Individual Circumstances
The authors believe that the individual circumstances of perimenopausal woman experiencing depressive symptoms should be looked at to decide upon the most appropriate action. “Are women experiencing low energy because they are having night sweats and losing sleep. If so, treating with hormones may be the best bet,” commented Dr Maki. “Alternatively, is a woman with a past history of depression having another depressive episode? In that case, antidepressant therapy might be most effective. Is the issue primarily due to family and job burden? If so, cognitive behavioural therapy with or without an antidepressant might be best.”
Treatment for sleep disturbance and night sweats taking place together should also be considered as part of treatment for menopause-related depression by clinicians, according to the guidelines.
Efficacy of Treatments
Other findings of the panel relate to the efficacy of various therapeutic options. They said that well-established antidepressive treatments, such as antidepressants and cognitive behavioural therapy, should remain as front-line therapy options for major depressive episodes during perimenopause. Additionally, depressive symptoms in these women can be improved through taking hormonal contraceptives. However, they found that in postmenopausal women, oestrogen therapy was ineffective at treating depressive symptoms.
James Coker, Reporter
For the source and further information about the study, click here.