1 Department of Psychiatry and Department of Psychology, University of Illinois at Chicago, Chicago Illinois.
2 Department of Psychiatry and Institute of Women's Health, Virginia Commonwealth University, Richmond, Virginia.
J Womens Health (Larchmt). 2019 Feb;28(2):117-134. doi: 10.1089/jwh.2018.27099.mensocrec. Epub 2018 Sep 5.
There is a new appreciation of the perimenopause-defined as the early and late menopause transition stages as well as the early postmenopause-as a window of vulnerability for the development of both depressive symptoms and major depressive episodes. However, clinical recommendations on how to identify, characterize and treat clinical depression are lacking. To address this gap, an expert panel was convened to systematically review the published literature and develop guidelines on the evaluation and management of perimenopausal depression. The areas addressed included: (1) epidemiology; (2) clinical presentation; (3) therapeutic effects of antidepressants; (4) effects of hormone therapy; and (5) efficacy of other therapies (e.g., psychotherapy, exercise, and natural health products). Overall, evidence generally suggests that most midlife women who experience a major depressive episode during the perimenopause have experienced a prior episode of depression. Midlife depression presents with classic depressive symptoms commonly in combination with menopause symptoms (i.e., vasomotor symptoms, sleep disturbance), and psychosocial challenges. Menopause symptoms complicate, co-occur, and overlap with the presentation of depression. Diagnosis involves identification of menopausal stage, assessment of co-occurring psychiatric and menopause symptoms, appreciation of the psychosocial factors common in midlife, differential diagnoses, and the use of validated screening instruments. Proven therapeutic options for depression (i.e., antidepressants, psychotherapy) are the front-line treatments for perimenopausal depression. Although estrogen therapy is not approved to treat perimenopausal depression, there is evidence that it has antidepressant effects in perimenopausal women, particularly those with concomitant vasomotor symptoms. Data on estrogen plus progestin are sparse and inconclusive.
人们对围绝经期（定义为绝经前期和后期过渡阶段以及绝经早期）有了新的认识，认为这是易发生抑郁症状和重度抑郁发作的脆弱期。然而，目前缺乏关于如何识别、描述和治疗临床抑郁症的临床建议。为了解决这一差距，一个专家小组召开了会议，对已发表的文献进行了系统回顾，并制定了关于围绝经期抑郁症评估和管理的指南。所涉及的领域包括：（1）流行病学；（2）临床表现；（3）抗抑郁药的治疗效果；（4）激素治疗的效果；以及（5）其他治疗方法的疗效（如心理疗法、运动和天然保健品）。总体而言，证据普遍表明，大多数在围绝经期经历重度抑郁发作的中年女性此前曾经历过抑郁发作。中年抑郁症表现为典型的抑郁症状，通常与绝经症状（即血管舒缩症状、睡眠障碍）和心理社会挑战共同出现。绝经症状使抑郁的表现变得复杂、同时发生和重叠。诊断包括确定绝经阶段、评估同时存在的精神疾病和绝经症状、了解中年常见的心理社会因素、鉴别诊断以及使用经过验证的筛查工具。经证实的抑郁症治疗选择（即抗抑郁药、心理疗法）是围绝经期抑郁症的一线治疗方法。尽管雌激素治疗未被批准用于治疗围绝经期抑郁症，但有证据表明，它对围绝经期妇女具有抗抑郁作用，特别是那些同时存在血管舒缩症状的妇女。关于雌孕激素联合治疗的数据很少且不确定。
