"Perimenopausal Depression: Underrecognised and Underrated"

Many women with no past psychiatric history experience severe mood symptoms for the first time in their life during the menopausal transition, having serious and debilitating long-term consequences. Moreover, women with a history of depression can experience a relapse or worsening of symptoms. Traditional antidepressant approaches are commonly administered for the management of these symptoms including selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs), as the first line response. However, such treatment has shown only small improvements at best and at worst, is associated with severe side effects. Newer therapies directly targeting the fluctuations in reproductive hormonal systems (in particular estrogen, progesterone and testosterone) through the administration of such compounds as tibolone, have shown significant potential to treat depression with the added benefit of fewer adverse side effects.

Our current study investigates the potential of adjunctive 2.5 mg daily oral tibolone, a selective Hormone Replacement Therapy (HRT), to ameliorate de-novo or relapsing depression occurring in the peri-menopausal period. Preliminary results show that in 23 women, tibolone treatment produced a significant reduction in depression ratings across time (F(4,76)=2.68, p = 0.038, η² 0.12), compared to placebo. The use of tibolone and other hormone treatments in perimenopausal depression significantly reduce depressive symptoms.