Recognition of depression among women presenting with menopausal symptoms.

OBJECTIVE: Depression is particularly prevalent among women in the reproductive years. This article reviews research on the risk of depression during the transition to menopause and discusses screening methods and management options.
DESIGN: Systematic literature searches were conducted using MEDLINE (1966 to May 2007), and all relevant papers published in English were included.
RESULTS: During the transition to menopause, most women do not experience depression, although this period represents a time of increased vulnerability for some women. Recent studies suggest that even in women without a history of depression, the risk of a new onset of depression is double or more during the menopausal transition. Certain patient factors, such as vasomotor symptoms and depression during the reproductive years, are commonly seen in gynecologic practice and are significant and independent risk factors for developing a new or recurrent episode of depression during the menopausal transition. Identifying depression in the context of menopausal symptoms may be challenging; however, various questionnaires may facilitate diagnosis. Effective short- and long-term management of depression is critical, and treatment options include antidepressant pharmacotherapy with or without estrogen therapy. Evidence suggests that some antidepressant classes have differential efficacy depending on menopausal status.
CONCLUSIONS: Obstetricians and gynecologists are in a unique position to recognize depression in potentially at-risk patients. Proactive screening and diagnosis of depression are critical for successful treatment outcomes. Additional studies are needed to evaluate the effects of menopausal status on antidepressant response and to identify new, safe, and efficacious treatment options for depression during perimenopause.