Abstract
Studies of depressive symptoms in menopausal women indicate that menopause is not associated with increased rates of depression, although mild mood and anxiety symptoms may occur in the few years prior to menopause. Women with previous affective disorders that are cyclic or that are associated with reproductive events may be at increased risk for depression at menopause. Because women presenting to menopause clinics are more likely to have affective disorders, the efficacy of estrogen for enhancing mood is an important question. Although some researchers suggest that estrogens have proven mood-elevating and antidepressant properties, others caution that the psychologic benefits of HRT deserve more systematic study before conclusions can be made. It has been suggested that minor psychologic symptoms at menopause or psychologic symptoms accompanied by vasomotor symptoms warrant a trial of HRT before considering psychotropic medication. If the psychologic symptoms do not respond to HRT, are not accompanied by vasomotor symptoms, or are clinically severe, antidepressant medication should be considered first or in addition to HRT. The psychologic effects of progesterone and androgens are less extensively studied than those of estrogen, and further research is needed.
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