{
    "abstract": "There is a new appreciation of the perimenopause-defined as the early and late menopause transition stages as well as the early postmenopause-as a window of vulnerability for the development of both depressive symptoms and major depressive episodes. However, clinical recommendations on how to identify, characterize and treat clinical depression are lacking. To address this gap, an expert panel was convened to systematically review the published literature and develop guidelines on the evaluation and management of perimenopausal depression. The areas addressed included: (1) epidemiology; (2) clinical presentation; (3) therapeutic effects of antidepressants; (4) effects of hormone therapy; and (5) efficacy of other therapies (e.g., psychotherapy, exercise, and natural health products). Overall, evidence generally suggests that most midlife women who experience a major depressive episode during the perimenopause have experienced a prior episode of depression. Midlife depression presents with classic depressive symptoms commonly in combination with menopause symptoms (i.e., vasomotor symptoms, sleep disturbance), and psychosocial challenges. Menopause symptoms complicate, co-occur, and overlap with the presentation of depression. Diagnosis involves identification of menopausal stage, assessment of co-occurring psychiatric and menopause symptoms, appreciation of the psychosocial factors common in midlife, differential diagnoses, and the use of validated screening instruments. Proven therapeutic options for depression (i.e., antidepressants, psychotherapy) are the front-line treatments for perimenopausal depression. Although estrogen therapy is not approved to treat perimenopausal depression, there is evidence that it has antidepressant effects in perimenopausal women, particularly those with concomitant vasomotor symptoms. Data on estrogen plus progestin are sparse and inconclusive.",
    "authors": [
        {
            "affiliation": "1 Department of Psychiatry and Department of Psychology, University of Illinois at Chicago, Chicago Illinois.",
            "firstname": "Pauline M",
            "initials": "PM",
            "lastname": "Maki"
        },
        {
            "affiliation": "2 Department of Psychiatry and Institute of Women's Health, Virginia Commonwealth University, Richmond, Virginia.",
            "firstname": "Susan G",
            "initials": "SG",
            "lastname": "Kornstein"
        },
        {
            "affiliation": "3 Connors Center for Women's Health and Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute/Harvard Medical School, Boston, Massachusetts.",
            "firstname": "Hadine",
            "initials": "H",
            "lastname": "Joffe"
        },
        {
            "affiliation": "4 Department of Epidemiology, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.",
            "firstname": "Joyce T",
            "initials": "JT",
            "lastname": "Bromberger"
        },
        {
            "affiliation": "5 Department of Obstetrics and Gynecology and Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.",
            "firstname": "Ellen W",
            "initials": "EW",
            "lastname": "Freeman"
        },
        {
            "affiliation": "6 Edith Nourse Rogers Memorial Veterans Hospital, Bedford Massachusetts; Harvard Medical School, Boston Massachusetts.",
            "firstname": "Geena",
            "initials": "G",
            "lastname": "Athappilly"
        },
        {
            "affiliation": "7 Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.",
            "firstname": "William V",
            "initials": "WV",
            "lastname": "Bobo"
        },
        {
            "affiliation": "8 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.",
            "firstname": "Leah H",
            "initials": "LH",
            "lastname": "Rubin"
        },
        {
            "affiliation": "9 University of Iowa Carver College of Medicine, Iowa City, Iowa.",
            "firstname": "Hristina K",
            "initials": "HK",
            "lastname": "Koleva"
        },
        {
            "affiliation": "10 Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.",
            "firstname": "Lee S",
            "initials": "LS",
            "lastname": "Cohen"
        },
        {
            "affiliation": "11 Department of Psychiatry, Queen's University School of Medicine, Ontario Canada.",
            "firstname": "Claudio N",
            "initials": "CN",
            "lastname": "Soares"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1089/jwh.2018.27099.mensocrec",
    "journal": "Journal of women's health (2002)",
    "keywords": [
        "antidepressants",
        "depression",
        "depressive symptoms",
        "estrogen",
        "menopause",
        "perimenopause",
        "psychotherapy"
    ],
    "methods": null,
    "publication_date": "2018-09-06",
    "pubmed_id": "30182804",
    "results": null,
    "title": "Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations.",
    "xml": "<Element 'PubmedArticle' at 0x788503fcd170>"
}