The evaluation and management of depression in women across the life span

Depression is more common in women than in men, particularly during the childbearing years. Women may present with different depressive symptoms than men and may respond differently to antidepressant treatment. In addition, depression in women can surface in association with specific points in the reproductive cycle, such as during the premenstrual period, during pregnancy and the postpartum period, and during the perimenopausal years. Antidepressant medications may be used effectively at all stages in a woman's life. In the case of premenstrual dysphoric disorder, serotonergic agents have demonstrated efficacy in both full-cycle and luteal-phase dosing strategies. For depressed women who are pregnant or breastfeeding, the limited safety data available on antidepressants suggest minimal danger to the fetus or infant, and the risks and benefits to both mother and child must be weighed against the risks of untreated illness. Treatment of depression in middle-aged and elderly women should take into account the possible influence of both menopausal status and hormone replacement therapy on antidepressant response. This article will focus on special considerations in the evaluation and management of depression in women across the life span.