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What Are the Origins of Depression in Perimenopausal Women?

Caroline Dott, PhD

Risk Factors for even Minor Depression include:

  • Being female (because of normal varying hormone levels)

  • Having a personal or family history of depression

  • Having marital problems

  • Lack of a satisfying support system

  • Substance and alcohol abuse

Psychosocial Vulnerability Model of Depression based on Stressful Life Events:

  • Loss of mother before age 15, physically or emotionally

  • Caring for 3+ children under age 14

  • Lack of marital intimacy

  • No employment outside of home

Female-Intensive Differences in Depression between Women and Men

  • Women: Higher lifetime risk for depression ESPECIALLY following reproductive events characterized by lowered circulating estrogen levels.

  • Studies consistently find 2:1 female to male ratio in incidence of depressive disorder.

  • Most of the psychiatric crises related to depression occur the day before and the first day of menstruation coinciding with lowered estrogen levels.

  • About 70% of women with seasonal affective disorder (SAD) have a history of mood changes in connection with their menstrual cycles.

  • Reproductive cycle events can stimulate emotional changes in women predisposed to affective behaviors:

    • Depression is associated with oral contraceptive use, & with late luteal phase of menstruation when estradiol & progesterone levels reach their lowest level (in an estimated 3% to 5% of women).

    • During the postpartum period, 10% to 20% of women develop a major depressive disorder following the significant decrease in estrogen & progesterone levels to 100 times less than prenatal levels.

    • At perimenopause, up to 80% of women develop mood changes.

TAKE HOME MESSAGE:

Hormonal fluctuations during certain phases of the reproductive cycle may indicate a woman=s susceptibility to affective changes. Be aware of and chart your own behavioral/emotional changes during your monthly cycles, and during pregnancy (teach this to your daughters), including:

  • Fatigue, Sleep Disturbance

  • Sadness, Depression

  • Anxiety

  • Irritability

  • Headaches

  • Confusion

  • Low Energy

  • Sexual Disinterest

  • Swelling