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Perimenopause and Mood Disturbance: An Update

Abstract This review characterizes perimenopause, including biologic changes, the influence of psychosocial factors, and the most common clinical manifestations. Clinic-based studies and community-based surveys addressing the prevalence of depressive symptoms in perimenopausal women are critically reviewed. Also discussed is the potentially greater vulnerability to mood disturbance during perimenopause in response to hormonal variability. A therapeutic algorithm for management of depressive symptoms in middle-aged perimenopausal women is presented. The role of estrogen in the treatment of perimenopausal depressive symptoms is addressed. In addition, the article contains a review of the existing data on the potential efficacy of estrogen as an antidepressant agent (monotherapy, augmentation strategy, or prophylaxis).