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New guidelines for the evaluation and treatment of perimenopausal depression

New "Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations have been co-published in Journal of Women's Health and Menopause: The Journal of The North American Menopause Society. The Guidelines are published online here in Journal of Women's Health, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers, and are available to download free until October 5, 2018.

The North American Menopause Society (NAMS) expert panel was convened by NAMS and the Women and Mood Disorders Task Force of the National Network of Depression Centers (NNDC) to conduct a systematic review of the existing literature, and develop clinical guidelines for the evaluation and treatment of depression during the perimenopause.

Panel co-chairs Pauline M. Maki, PhD, University of Illinois at Chicago and Susan G. Kornstein, MD (Editor-in-Chief of Journal of Women's Health), Virginia Commonwealth University Institute for Women's Health, Richmond, VA, developed the recommendations with panel members on behalf of the Board of Trustees for NAMS and the Women and Mood Disorders Task Force of the NNDC. The panel focused on five key areas: epidemiology of depressive symptoms and depressive disorders; the clinical presentation of depression; the therapeutic effects of antidepressant medications; the effects of hormone therapy; and the efficacy of other therapies, such as psychotherapy, exercise, and natural health products.

"There has been a need for expert consensus, as well as clear clinical guidance regarding how to evaluate and treat depression in women during the perimenopause," states Dr. Kornstein. "These new clinical recommendations address this gap, and offer much-needed information and guidance to healthcare practitioners so that they can provide optimal care and treatment for midlife women."

The guidelines address 5 areas: epidemiology; clinical presentation; therapeutic effects of antidepressants; effects of hormone therapy; and efficacy of other therapies.

Among the recommendations:

  • When selecting antidepressants during perimenopause, a woman’s prior history of antidepressant use should be considered.
  • Cooccurring sleep disturbances and night sweats should be considered as part of treatment for menopause-related depression.
  • While estrogen-based therapies may help improve clinical response to antidepressants, their use in older women should be considered with caution.

Reference

Maki PM, Kornstein SG, Joffe H, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations [published online September 5, 2018]. Journal of Women’s Health. https://doi.org/10.1089/jwh.2018.27099.mensocrec.

Content updated 5 September 2018

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