Management of depressive symptoms in peri- and postmenopausal women: EMAS position statement

Petra Stute, Areti Spyropoulou, Vasilios Karageorgiou, Antonio Cano, Johannes Bitzer, Iuliana Ceausu, Peter Chedraui, Fatih Durmusoglu, Risto Erkkola, Dimitrios G Goulis, Angelica Lindén Hirschberg, Ludwig Kiesel, Patrice Lopes, Amos Pines, Margaret Rees, Mick van Trotsenburg, Iannis Zervas, Irene Lambrinoudaki
Maturitas 2020, 131: 91-101

INTRODUCTION: Globally, the total number of people with depression exceeds 300 million, and the incidence rate is 70 % greater in women. The perimenopause is considered to be a time of increased risk for the development of depressive symptoms and major depressive episodes.

AIM: The aim of this position statement is to provide a comprehensive model of care for the management of depressive symptoms in perimenopausal and early menopausal women, including diagnosis, treatment and follow-up. The model integrates the care provided by all those involved in the management of mild or moderate depression in midlife women.

MATERIALS AND METHODS: Literature review and consensus of expert opinion.

SUMMARY RECOMMENDATIONS: Awareness of depressive symptoms, early detection, standardized diagnostic procedures, personalized treatment and a suitable follow-up schedule need to be integrated into healthcare systems worldwide. Recommended treatment comprises antidepressants, psychosocial therapies and lifestyle changes. Alternative and complementary therapies, although widely used, may help with depression, but a stronger evidence base is needed. Although not approved for this indication, menopausal hormone therapy may improve depressive symptoms in peri- but not in postmenopausal women, especially in those with vasomotor symptoms.

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