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PRI-MED WEST: Challenge of Menopausal Depression By Roberta Friedman ANAHEIM, CA -- May 14, 2004 -- Depression commonly accompanies menopause and in fact is more common in the perimenopausal years. Treatment is challenging given the new take on hormonal treatments following the early halt to the Women's Health Initiative study. In a presentation here May 13th at the Annual Pri-Med West Conference and Exhibition, Karen J. Carlson, MD, assistant professor of medicine and deputy director of the Center of Excellence in Women's Health, Harvard Medical School, and director, Women's Health Associates, Massachusetts General Hospital, Boston, Massachusetts, said that women who are at risk for depression in their menopausal years are those who have been depressed before, who have hot flashes, and who are in disrupted marriage or employment situations. Doctors are left fairly empty handed when trying to help women with approved, evidence-based therapy for menopausal depression that relies on hormones. For instance, said Dr. Carlson, a trial of transdermal estrogen gave good results compared to placebo, even independent of whether or not any hot flashes were present. Yet unopposed estrogen, she said, is "not viable in the long term, and we don't know the effect of adding progesterone." Analysis of quality of life findings in the WHI study showed no differences, but this was for the older women of the study population, who were a mean age of 64 years, Dr. Carlson said. "People use this [finding] to say we should never give women who develop depression, perimenopausally, hormone replacement," Dr. Carlson said. She added that women who are not having hot flashes should try selective serotonin reuptake inhibitors (SSRIs), and that if they are having lots of hot flashes, they should consider low dose hormones or SSRIs. [Presentation Title: Mood Disorders & Menstrual Cycle.] E-mail this page to a friend or colleague! To print, use this version