Origins of Perimenopausal Depression

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