137 Recent evidence indicates that estrogen can produce an antidepressant response in perimenopausal women with major or minor depression.128,129 Antidepressants are clearly effective for dysphoric mood. Although preliminary findings have suggested that the combined use of HRT and serotonergic antidepressants enhanced the antidepressant response, these observations pertained to elderly depressed women and cannot be generalized to perimenopausal women. There are no Crenolanib ic50 studies

of combined estrogen and antidepressant therapies Inhibitors,research,lifescience,medical in women identified as perimenopausal. To assess perimenopausal depression, the pattern and severity of the depressive symptoms should be determined. Perimenopausal status is suggested by the presence of vasomotor symptoms such as hot flashes or irregular menstrual cycles, although it is entirely possible

that a perimenopausal woman has neither, particularly in the early stages of the Inhibitors,research,lifescience,medical menopausal transition. Careful physical examination Inhibitors,research,lifescience,medical and medical history should be obtained to determine other coexisting conditions, previous experience of any depressive disorder, the onset of the depressive symptoms in conjunction with menstrual cycle changes, and to identify risk factors and contraindications for estrogen therapy. A follicle-stimulating hormone (FSH) level greater than 20 IU/L is a hormonal marker of the Inhibitors,research,lifescience,medical perimenopause, but single measures are considered unreliable because of sporadic follicular activity and competence.

The decline in mean estrogen levels occurs primarily in the year before menopause,138 although there is considerable individual variability. Burger et al recently reported that mean estrogen levels started to decrease about 2 years before Inhibitors,research,lifescience,medical the final menstrual period, but fell substantially only in the year before the final menses with the most rapid decrease around the time of the final menstrual period.139 Recognition that the perimenopause can extend over a number of years and that the hormonal shifts that occur in this transition may be associated with depressive symptoms is important for patient care. However, scientific data to guide treatment of depression in the perimenopause are limited and inconclusive. Estrogen therapy may be helpful for major or minor depression as well as also for depressive symptoms linked to the menopause. OCs containing estrogen are another possible option for perimenopausal women, who still require contraceptive protection, but there is no consistent evidence at this time of their antidepressant effects. The hormone doses of OCs are considerably higher than those of HRT, but only the HRT dose levels of estrogen have shown antidepressant effects in perimenopausal women at this time.