Navigating the storm: Understanding and managing depression during menopause in women

Depression has a prevalence of about 280-300 million individuals globally and is more prevalent in women than in men. Hormonal changes, vasomotor changes and psychosocial factors are linked with the high risk of depression during menopausal transition. Oestrogen also acts upon serotonergic, dopaminergic and noradrenergic processes, which are involved in mood regulation, indicating a biological association between menopause and depression. Aim of this review was to examine the mechanisms underlying menopause-related depression and summarise existing management strategies. A literature review was based on published articles and clinical guidelines was conducted to investigate the relationship between menopause, hormonal changes and depression and the assessment of treatment options. Studies indicate a close relationship between menopausal transition and symptoms of depression. Factors that increase the risk of experiencing vasomotor symptoms, a negative attitude to menopause, surgical menopause and a previous history of depression are some of the risk factors. Several diagnostic tools are common, such as the Beck Depression Inventory and the Hamilton depression rating scale. There is evidence of the usefulness of menopausal hormone therapy (MHT) in the treatment of both menopausal and depressive symptoms. Adjunctive measures, such as antidepressants, phytoestrogens, B vitamins, vitamin D, magnesium and polyunsaturated fatty acids, have also been shown to have other advantages in the treatment of mood disturbances and psychosocial discomfort. Menopause-related depression is a growing issue in the population that has causes with multifactorial predictors. A combined management approach of MHT, nutritional supplements and psychosocial interventions is needed to enhance the quality of life and the psychological well-being of perimenopausal and postmenopausal women.