Special issues in the management of depression in women

Depression is more prevalent in women than in men, which may be related to biological, hormonal, and psychosocial factors. Four depressive conditions are specific to women: premenstrual dysphoric disorder (PMDD), depression in pregnancy, postpartum depression, and depression related to perimenopause or menopause. Antidepressant therapy with selective serotonin reuptake inhibitors and venlafaxine has demonstrated efficacy in PMDD. Both continuous and intermittent dosing regimens were effective at usual but not at low dosages. Despite reluctance of some women to take medication for depression during pregnancy and breastfeeding, substantial evidence suggests that antidepressants are safe and efficacious during these periods, while untreated depression has negative consequences for both mother and child. In peri- or postmenopausal women with depression, estrogen may enhance the effects of antidepressant medications, although a pooled analysis of data in women aged 50 years or over treated with venlafaxine found that remission rates were similar in those who were taking estrogen and those who were not. The management of women with depression can be done safely and effectively using antidepressants and alternative interventions throughout the life cycle.