135 Overall, these preliminary findings suggest that menstrual status is an important consideration in selecting an antidepressant for women, and that the estrogen status (which differs in pre-, peri-, and postmenopausal

women) may be associated with the response to antidepressants. Management of depression in perimenopausal women Inhibitors,research,lifescience,medical Current consensus guidelines for treatment of depression in perimenopausal women recommend an antidepressant for severe depression.58 Data indicate that an SSRI may be preferred to a tricyclic antidepressant for women who are not postmenopausal. For women with previous episodes of depression, the general guideline is to prescribe the antidepressant used in the previous episode if the patient had a satisfactory response. Transdermal estradiol (0.05-0.10 mg/day) may be of benefit for perimenopausal women with major or minor depression, based on preliminary but consistent findings of two new studies.128,129 Minor mood symptoms

associated with the perimenopause Inhibitors,research,lifescience,medical are also improved with estrogen therapy.116 Inhibitors,research,lifescience,medical A progestin must also be prescribed for women with a uterus and may reduce the improvement of depressed mood in some women. Estrogen therapy is generally contraindicated for women with FK506 datasheet breast cancer, any potentially estrogen-dependent malignancy, active liver disease, Inhibitors,research,lifescience,medical and active thrombosis. Speroff et al indicate close surveillance for women with seizure disorders, familial hyperlipidemias, and migraine headaches.136 Other considerations include a history of breast disease, history of stroke, myocardial

infarction or thrombosis, and active gall bladder disease or gallstones. The estradiol dose of hormone replacement therapy (HRT) does not suppress ovulation or provide contraception for perimenopausal women, Inhibitors,research,lifescience,medical who continue to be at risk of pregnancy until the menopause.137 For contraceptive protection and for estrogen-related symptoms such as hot flashes, an OC with estrogen rather than HRT may be preferred for perimenopausal women. However, there is no evidence nearly at this time that OCs effectively treat major or minor depression in perimenopausal women. Recent studies suggested that reducing the placebo interval of OCs and extending estradiol through the cycle improved depressive symptoms, but these findings do not extend to women diagnosed with depressive illness. The association of cardiovascular events with estrogen is dose-related and the current low-dose OCs (<50 μg ethinyl estradiol) can be used by perimenopausal women with normal blood pressure.137 Smokers over age 35 should not use OCs. A frequently asked question is whether estrogen and antidepressant therapies can be combined. The strongest rationale for using both medications is the known benefits of each.