Managing Depression and Anxiety during the Menopausal Transition and Beyond: The Window of Vulnerability

It has long been recognized that women are at a higher risk than men to develop depression andanxiety and that such increased risk is particularly associated with reproductive cycle events.Moreover, recent prospective studies have demonstrated that the transition to menopause is associated with higher risk for new onset and recurrent depression. A number of biological and environmental factors are independent predictors for depression in this population, including the presenceof hot flushes, sleep disturbances, history of severe premenstrual syndrome or postpartum blues, stressful life events, history of depression, socioeconomic status and use of hormones and psycho-tropic agents. Accumulated evidence suggests that ovarian hormones modulate serotonin andnoradrenaline neurotransmission, a process that may be associated with the emergence of depressive symptoms and/or anxiety during periods of hormonal fluctuation in biologically predisposedsub-populations. Transdermal estradiol and serotonergic and noradrenergic antidepressants areefficacious in the treatment of depression and vasomotor symptoms in symptomatic, midlife women.Less is known about tailored treatment strategies for the management of anxiety in this vulnerablepopulation. In this chapter, we reviewed the existing evidence that the menopausal transition maybe associated with greater risk for anxiety and depression and the putative underlying mechanismscontributing to this increased risk or ‘window of vulnerability’. Hormonal and nonhormonal treatment strategies are critically examined, although more tailored treatment options for this population at risk are scarce.