Some perimenopausal women with depression may benefit from short-term use of estrogen therapy, and its role for postmenopausal depressed women warrants further investigation. Antidepressant benefit associated with estrogen therapy may be independent of improvement in physical symptoms.

No abstract

Periods of intense hormonal fluctuations have been associated with heightened prevalence and exacerbation of underlying psychiatric illness, particularly the occurrence of premenstrual dysphoria, puerperal depression and depressive symptoms during perimenopause. It has been speculated that sex steroids such as estrogens, progestogens, testosterone and dehydroepiandrosterone (DHEA) exert a significant modulation of brain functioning, possibly through interactions with various neurotransmitter systems. It is therefore intuitive that abrupt alterations of these hormones would interfere with mood and behaviour. On the other hand, accumulating data suggest that hormonal interventions may also promote relief or even remission of depressive symptoms, as already demonstrated in studies with patients experiencing postpartum depression and perimenopausal depressive disorders. The extent to which perimenopause, alone, may increase the risk for depression is unclear. However, existing data strongly suggest that some women are particularly vulnerable to developing significant physical and psychological disturbances when entering perimenopause. This article reviews the effect of sex hormones and selective estrogen receptor modulators (SERMs) on mood among peri- and postmenopausal women. There are preliminary, though promising, data on the use of estradiol (particularly transdermal estradiol) to alleviate depression during perimenopause, use of a combination of estrogens and selective serotonin reuptake inhibitors for depression during the postmenopausal period, and the use of testosterone to improve psychological well-being and increase libido among women with induced menopause. Further studies would help to better delineate the usage of hormones as an antidepressant strategy (monotherapy or augmenting treatment) for peri- and postmenopausal women. A brief review of some nonhormonal interventions for the treatment of menopause-related symptoms that may significantly affect a woman's quality of life is also presented. There are some preliminary data suggesting the efficacy of antidepressants for the treatment of hot flushes; existing data on diet supplements and herbal products have shown more mixed results.

More than 1.7 million American women are expected to reach menopause each year. Recent Canadian statistics show that a 50-year-old woman can now expect to live until her mid-80s, which implies living at least one-third of her life after menopause. The menopausal transition is typically marked by intense hormonal fluctuations, accompanied by vasomotor symptoms (eg, hot flashes, night sweats), sleeps disturbance, and changes in sexual function, as well as increased risk for osteoporosis, cardiovascular disease, and cognitive decline. More importantly, recent studies have demonstrated a significant association between menopausal transition and a higher risk for developing depression. In the post-Women's Health Initiative Study era, physicians and patients are questioning the safety and efficacy of long-term hormone therapy use. This article reviews the current literature on the benefits and risks of using hormone therapy for the treatment of menopause-related mood disturbances and alternate strategies currently available for the management of menopause-related problems, including antidepressants, complementary and alternative medicine, and selective estrogen receptor modulators.

O processo de envelhecimento promove alterações significativas na produção e no equilíbrio dos níveis circulantes de diversos hormônios sexuais em homens e mulheres. Acredita-se que esses hormônios (estrógenos, progestógenos, testosterona, dehidroepiandrosterona [DHEA]) exercem papel modulador sobre diversas funções psíquicas, particularmente sobre o humor e a cognição. Alterações nesse papel modulador causadas por variações abruptas dos hormônios sexuais circulantes -- como as que ocorrem, por exemplo, durante a transição menopausal -- favorecem o surgimento de queixas depressivas. No entanto, a utilização terapêutica de hormônios sexuais pode promover alívio ou mesmo remissão de sintomas depressivos, como já foi caracterizado com o uso de estradiol em mulheres em perimenopausa e com a administração de testosterona após a menopausa. Este artigo aborda, por revisão da literatura, os diversos papéis atribuídos aos hormônios sexuais no desenvolvimento e tratamento das queixas depressivas. Estudos sobre a eficácia terapêutica de estrógenos, testosterona e DHEA nos quadros depressivos são discutidos de forma crítica. Em essência, existem resultados preliminares bastante promissores, particularmente quanto ao uso de estradiol e testosterona em subpopulações específicas para alívio de sintomas depressivos. Futuras investigações devem melhor definir a utilização de hormônios como agente depressivo monoterápico ou adjuntivo, bem como delinear os riscos e as contra-indicações associados a seu uso.

No abstract

Periods of intense hormonal fluctuations have been associated with heightened prevalence and exacerbation of underlying psychiatric illness, particularly the occurrence of premenstrual dysphoria, puerperal depression and depressive symptoms during the menopausal transition. It has been speculated that sex steroids, such as estrogens, progestogens, testosterone and dehydroepiandrosterone, exert a significant modulation of brain functioning, possibly through interactions with various neurotransmitter systems. It is therefore intuitive that abrupt alterations of these hormones would interfere with mood and behavior. On the other hand, accumulating data suggest that hormonal interventions may also promote relief or even remission of depressive symptoms, as already demonstrated in studies on perimenopausal women treated with transdermal estradiol. This article reviews the potential role of sex hormones for the treatment of depressive disorders in women. There are preliminary, but promising data on the use of estradiol and testosterone for specific subpopulations. Further studies would help to better delineate the usage of these compounds as an antidepressant strategy (monotherapy or augmenting treatment).