Estrogens and Depression in Women

Publisher Summary Although the role of estrogen in the treatment of hot flushes has been consistently documented, the relationship between perimenopause-related changes in estrogen and depression remains to be established. In contrast, a considerable literature documents the widespread and important neuroregulatory effects of estrogen in animals, suggesting a neurobiologic basis for several recent reports of the salutary effects of estrogen on mood. This chapter reviews the effects of estrogen on the central nervous system (CNS) and mood; the relationship between perimenopause/postmenopause and depression; and the clinical evaluation and management of depression during the perimenopause. The majority of women do not develop depression during the menopausal transition, and the perimenopause is not uniformly associated with changes in a woman's mood. Epidemiologic studies examining gender and age-related differences in the 6-month to 1-year prevalence of major depression report no increased prevalence of major depression in women at midlife. Nonetheless, although the postmenopause is not associated with an increased risk for developing depression in women, depressive symptoms are observed more frequently in perimenopausal women compared with postmenopausal women in several longitudinal, community-based studies as well as in women attending gynecology clinics. The timing of appearance of the depressions observed suggest an endocrine mechanism related to the perimenopause in the pathophysiology of perimenopausal depression.