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.