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OBJECTIVE: The purpose of this review was to
examine the risk of depression onset in
perimenopausal and postmenopausal women, discuss
the importance and rationale for screening for
major depressive disorder (MDD) in women in the
menopausal transition, and review therapeutic
options for management of MDD in perimenopausal and
postmenopausal women. DATA SOURCES: PubMed was
searched (1970 to 2008) using combinations of the
following terms: major depressive disorder,
perimenopause, postmenopause, mood disorder, risk
factors, reproductive period, family practice,
differential diagnosis, hormone, estrogen
replacement therapy, reuptake inhibitors, and
neurotransmitter. STUDY SELECTION: All relevant
articles identified via the search terms reporting
original data and published in English were
considered for inclusion. Twenty-two
cross-sectional and longitudinal studies were
utilized to evaluate the relationship between the
menopausal transition and risk of mood disorders
and to formulate recommendations for screening and
management of MDD in perimenopausal and
postmenopausal women. DATA EXTRACTION: RESEARCH
STUDIES UTILIZED THE FOLLOWING MEASURES: postal
questionnaires, Women's Health Questionnaire, Beck
Depression Inventory, Center for Epidemiologic
Studies-Depression scale, Modified Menopause
Symptom Inventory, 12-item symptom questionnaire,
or Structured Clinical Interview for DSM-IV. DATA
SYNTHESIS: Menopause is a normal, and for most
women largely uneventful, part of life. For some
women, however, the menopausal transition is a
period of biologic vulnerability with noticeable
physiologic, psychological, and somatic symptoms.
The perimenopausal period is associated with a
higher vulnerability for depression, with risk
rising from early to late perimenopause and
decreasing during postmenopause. Women with a
history of depression are up to 5 times more likely
to have a MDD diagnosis during this time period.
CONCLUSIONS: Routine screening of this at-risk
population followed by careful assessment for
depressive symptoms can help identify the presence
of MDD in the menopausal transition. Recognition of
menopausal symptoms, with or without depression, is
important given their potential impact on quality
of life.
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