[Climacteric depression and anxiety]

Climacteric depression and anxiety Abstract. Women of all ages have a higher incidence of depression than men. The lifetime prevalence of depressive disorders in women is twice the prevalence in males and amounts to 18 - 21 %. The menopausal transition is a "window of increased vulnerability" and might trigger a depressive disorder. In this period, the risk to get depressive is 1.5 - 4 times higher than in the premenopause, particularly in women suffering from vasomotor symptoms and presenting additional risk factors for mood disorders and depression. Depression in climacteric women is still underestimated and has to be actively looked for by family doctors and gynaecologists. Oestrogens modulate the metabolism of serotonin and noradrenalin, as do SSRI / SNRI and antidepressants, and influence therefore mood, mental function and cognition. In the menopausal transition, there is suggestive evidence that Oestrogen therapy can improve mood, anxiety and depression. In peri- and early postmenopausal women with climacteric vasomotor symptoms, Oestrogens might be considered as a first-line treatment for depressive symptoms. However, Oestrogens do not improve depression in the late postmenopause. In depressed elderly postmenopausal women without hot flushes, SSRI / SNRI and antidepressants remain the first-line treatment. Each pharmacological treatment should always be embedded in a global therapeutic concept including among others frequently psychotherapy and social measures.