REVIEWS   

Minerva Psichiatrica 2007 June;48(2):211-23

Copyright © 2007 EDIZIONI MINERVA MEDICA

language: Italian

Depression in menopause: therapeutic strategies

Zanardi R., Malaguti A., Rossini D., Magri L.

Dipartimento di Psichiatria Università degli Studi Vita-Salute San Raffaele, Milano

During the menopausal transition women show many physical and psychological symptoms that can cause different levels of discomfort. Symptoms that affect mood can be light or can contribute to determine a clinically relevant depressive episode. This situation is more likely to occur in subjects with a history of depressive disorders. The symptomatology can be faced, in different situations, with antidepressant drugs, estrogens also in combination with progestogens, selective estrogen receptors modulators or phytoestrogens. The reduction of estrogen levels may, indeed, be an important cause in the genesis or the worsening of the depressive episode, also considering the well known interaction among estrogens, serotonergic system and other systems of neurotransmission. For the same reason also the response to antidepressant drugs may be reduced. Different studies evaluated the efficacy of antidepressants, estrogens and their combinations. In particular, in the last years, selective serotonin reuptake inhibitors have often been the first option in the clinical practice. In this review, data up to now avalaible in the literature for each of these therapies have been described. In particular, we considered the methodological limitations of some studies (definition of menopause, inclusion criteria, diagnostic accuracy, sample size) and the most relevant therapeutic results.