ABSTRACT
There is a new appreciation of the perimenopause-defined as the early and late menopause transition stages as well as the early postmenopause-as a window of vulnerability for the development of both depressive symptoms and major depressive episodes. However, clinical recommendations on how to identify, characterize and treat clinical depression are lacking. To address this gap, an expert panel was convened to systematically review the published literature and develop guidelines on the evaluation and management of perimenopausal depression. The areas addressed included: (1) epidemiology; (2) clinical presentation; (3) therapeutic effects of antidepressants; (4) effects of hormone therapy; and (5) efficacy of other therapies (e.g., psychotherapy, exercise, and natural health products). Overall, evidence generally suggests that most midlife women who experience a major depressive episode during the perimenopause have experienced a prior episode of depression. Midlife depression presents with classic depressive symptoms commonly in combination with menopause symptoms (i.e., vasomotor symptoms, sleep disturbance), and psychosocial challenges. Menopause symptoms complicate, co-occur, and overlap with the presentation of depression. Diagnosis involves identification of menopausal stage, assessment of co-occurring psychiatric and menopause symptoms, appreciation of the psychosocial factors common in midlife, differential diagnoses, and the use of validated screening instruments. Proven therapeutic options for depression (i.e., antidepressants, psychotherapy) are the front-line treatments for perimenopausal depression. Although estrogen therapy is not approved to treat perimenopausal depression, there is evidence that it has antidepressant effects in perimenopausal women, particularly those with concomitant vasomotor symptoms. Data on estrogen plus progestin are sparse and inconclusive.
Subject(s)
Depression , Perimenopause/psychology , Adult , Antidepressive Agents/therapeutic use , Depression/diagnosis , Depression/drug therapy , Depression/epidemiology , Estrogen Replacement Therapy , Female , Hot Flashes/drug therapy , Humans , Hysterectomy/adverse effects , Menopause/psychology , Middle Aged , Ovariectomy/adverse effects , Primary Ovarian Insufficiency/complications , Risk Factors , Sleep Wake Disorders/complicationsABSTRACT
There is a new appreciation of the perimenopause - defined as the early and late menopause transition stages as well as the early postmenopause - as a window of vulnerability for the development of both depressive symptoms and major depressive episodes. However, clinical recommendations on how to identify, characterize and treat clinical depression are lacking. To address this gap, an expert panel was convened to systematically review the published literature and develop guidelines on the evaluation and management of perimenopausal depression. The areas addressed included: 1) epidemiology; 2) clinical presentation; 3) therapeutic effects of antidepressants; 4) effects of hormone therapy; and 5) efficacy of other therapies (eg, psychotherapy, exercise, and natural health products). Overall, evidence generally suggests that most midlife women who experience a major depressive episode during the perimenopause have experienced a prior episode of depression. Midlife depression presents with classic depressive symptoms commonly in combination with menopause symptoms (ie, vasomotor symptoms, sleep disturbance), and psychosocial challenges. Menopause symptoms complicate, co-occur, and overlap with the presentation of depression. Diagnosis involves identification of menopausal stage, assessment of co-occurring psychiatric and menopause symptoms, appreciation of the psychosocial factors common in midlife, differential diagnoses, and the use of validated screening instruments. Proven therapeutic options for depression (ie, antidepressants, psychotherapy) are the front-line treatments for perimenopausal depression. Although estrogen therapy is not approved to treat perimenopausal depression, there is evidence that it has antidepressant effects in perimenopausal women, particularly those with concomitant vasomotor symptoms. Data on estrogen plus progestin are sparse and inconclusive.
Subject(s)
Antidepressive Agents/therapeutic use , Depression/drug therapy , Depression/epidemiology , Depressive Disorder/drug therapy , Depressive Disorder/epidemiology , Estrogen Replacement Therapy , Perimenopause/psychology , Adult , Cognitive Behavioral Therapy , Consensus , Depression/diagnosis , Depression/etiology , Depressive Disorder/diagnosis , Depressive Disorder/etiology , Female , Hot Flashes/complications , Humans , Hysterectomy/adverse effects , Middle Aged , Ovariectomy/adverse effects , Primary Ovarian Insufficiency/complications , Risk Factors , Sleep Wake Disorders/complications , Sleep Wake Disorders/etiology , Treatment OutcomeABSTRACT
BACKGROUND: Edema associated with quetiapine has been described in only one case report to date and represents a potentially serious adverse reaction. METHODS: We present a case series of 3 patients who developed bilateral leg edema following initiation of quetiapine. RESULTS: One of these patients had a recurrence of edema with subsequent rechallenge. Another patient developed quetiapine-induced edema following a prior episode of olanzapine-induced edema. All 3 cases present a compelling temporal relationship between the drug challenge and the adverse event. CONCLUSION: Prompt recognition and intervention with discontinuation of the offending agent is important for this potentially serious, seemingly idiosyncratic vascular complication.
