A recent review written by three Finnish psychiatrists supports the use of estrogens, perhaps together with antidepressants, for depression and anxiety in perimenopausal women [1]. Depressive symptoms are experienced by 15–50% of women during the menopausal transition and up to 30% of perimenopausal depression is severe enough to be regarded as a depressive disorder. This problem, described as ‘reproductive depression’ [2] occurs with fluctuations of gonadal hormones in the form of premenstrual depression, postnatal depression and climacteric depression. In the menopausal age group, the depression, anxiety and loss of self-confidence are at their worst in the 2–3 years of the transition period before the cessation of periods. Toffol and colleagues, in their review of the literature, have come to the conclusion that hormone therapy may contribute to the alleviation of menopause-related depressive symptoms. They claim that the administration can be followed across time and should be specifically individualized. In cases of more severe depressive disorders, a combination of antidepressants and hormone therapy should be considered. This view has also been proposed by others [3,4].
Author(s)
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John Studd
London PMS and Menopause Centre, London, UK
Citations
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Toffol E, Heikinheimo O, Partonen T. Hormone therapy and mood in perimenopausal and postmenopausal women: a narrative review. Menopause 2014 September 8. Epub ahead of print
http://www.ncbi.nlm.nih.gov/pubmed/25203891 -
Studd W, Nappi RE. Reproductive depression. Gynecol Endocrinol 2012;28(Suppl 1):42-5
http://www.ncbi.nlm.nih.gov/pubmed/22394303 -
Graziottin A, Serafini A. Depression and the menopause: why antidepressants are not enough? Menopause Int 2009;15:76-81
http://www.ncbi.nlm.nih.gov/pubmed/19465674 -
Studd JW. A guide to treatment of depression in women by estrogens. Climacteric 2011;14:637-42
http://www.ncbi.nlm.nih.gov/pubmed/21878053 -
Campbell S, Whitehead M. Oestrogen therapy and the menopausal syndrome. Clin Obstet Gynaecol 1977;4:31-47
http://www.ncbi.nlm.nih.gov/pubmed/322905 -
Panay N, Studd J. Progestogen intolerance and compliance with hormone replacement therapy in menopausal women. Hum Reprod Update 1997;3:159-71
http://www.ncbi.nlm.nih.gov/pubmed/9286739 -
Craig MC. Should psychiatrists be prescribing oestrogen therapy to their female patients? Br J Psychiatry 2013;202:9-13
http://www.ncbi.nlm.nih.gov/pubmed/23284147 -
Studd J. Severe premenstrual syndrome and bipolar disorder: a tragic confusion. Menopause Int 2012;18:82-6
http://www.ncbi.nlm.nih.gov/pubmed/22611228
