Why do I have depression during my menopausal syndrome?

Condition analysis: 

Studies of mood during Menopause have generally revealed an increased risk of depression during perimenopause, with a decrease in risk during postmenopausal years. Study found depressive symptoms to be increased during the menopausal transition and decreased after menopause. The strongest predictor of depressed mood was a prior history of depression, along with fluctuations in reproductive hormone levels associated with depressed mood.

In a cross-sectional population survey from the Netherlands, 2103 women were asked to rate their symptoms of depression before menopause and 3.5 years later, during the menopausal transition; the women experienced most symptoms of depression during the menopausal transition. A study of a community sample of women undergoing natural menopause also demonstrated an increase in depressive symptoms during perimenopause.

Investigators recruited premenopausal women aged 36-44 years with no history of major depression and followed up these women for 9 years to detect new onsets of major depression; they found that women who entered perimenopause were twice as likely to have clinically significant depressive symptoms as women who had not yet made the menopausal transition.

Research has shown that reproductive hormones produced during menopause contribute to mood alterations, such as depression. Higher testosterone levels may directly lead to higher depressive symptoms during the menopausal transition. Menopausal status, however, remains an independent predictor of depressive symptoms.

Instructions: 

Antidepressant therapy: For major depression, standard antidepressants are first-line treatments. Selective serotonin reuptake inhibitors (SSRIs) are the antidepressants most commonly used in the treatment of perimenopausal depression. These drugs act by inhibiting serotonin reuptake transporters in the presynaptic neuron, making more serotonin available at the synaptic cleft. The time to onset of action is 4-6 weeks.

SSRIs are thought to be generally safe and effective. They do pose a risk of serotonin syndrome, as well as several common adverse effects (eg, nausea, diarrhea, anorexia, excessive sweating, decreased libido or anorgasmia, headache, jitteriness, dizziness, sedation or activation, insomnia, and akathisia). Several of these medications inhibit the cytochrome P450 (CYP450) enzymes; therefore, it is prudent to check for drug interactions.