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A Cross-Sectional Evaluation of Perimenopausal Depression

Emma M. Steinberg; David R. Rubinow, M.D.; John J. Bartko, Ph.D.; Paige M. Fortinsky, B.S.C.; Nazli Haq, M.A.; Karla Thompson, R.N., M.S.N.; and Peter J. Schmidt, M.D.

Objective: Overall, the clinical spectrum of depression during the perimenopause is not well characterized. This cross-sectional study examined the following: (1) clinical characteristics of women who presented to the National Institute of Mental Health midlife mood disorders clinic (between March 1990 and January 2004) with perimenopausal major and minor depressions and (2) the impact on these characteristics of either a prior episode of depression or the presence of hot flushes.

Method: Historical variables, reproductive status, symptom ratings, and plasma hormone measures were examined in 116 women between the ages of 40 and 55 years who met research criteria for perimenopause-related depression (a current episode of major or minor depression according to the Structured Clinical Interview for DSM-IV or Primary Care Evaluation of Mental Disorders supplemented with a past history form).

Results: Clinical characteristics did not differ in those women with first-onset (39%) versus recurrent depressions or in those with (57%) and without hot flushes. Depressive episodes clustered in the later stages of the menopause transition and the first year postmenopause. Seven women (6%) reported a past postpartum major depression, and 55% of women reported a history of premenstrual dysphoria (PMD).

Conclusions: We found no evidence that either hot flushes or a previous episode of depression conveys a distinct clinical profile in these women. The clustering of onsets of depression suggests the hormone events that characterize the late menopause transition may be relevant to the onset of this form of depression. Finally, although we observed a high rate of PMD, neither postpartum depression nor PMD are consistent accompaniments of perimenopausal depression.


(J Clin Psychiatry 2008;69:973-980. Online Ahead of Print May 20, 2008.)

Received Sept. 23, 2007; accepted Jan. 23, 2008. From the Behavioral Endocrinology Branch, National Institute of Mental Health, Bethesda, Md. (Dr. Schmidt and Mss. Steinberg, Fortinsky, and Haq); the Department of Psychiatry, University of North Carolina at Chapel Hill (Dr. Rubinow); private practice, Bethesda Md. (Dr. Bartko); and the Nursing Department, Clinical Center, National Institutes of Health, Bethesda, Md. (Ms. Thompson).

This work was written as part of Dr. Schmidt's official duties as a government employee. The views expressed in this article do not necessarily represent the views of the National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services, or the United States government.

Acknowledgments appear at the end of the article.

Dr. Schmidt has received material support from Watson Pharmaceuticals. Drs. Rubinow and Bartko and Mss. Steinberg, Fortinsky, Haq, and Thompson report no financial affiliations relevant to the subject of this article.

Corresponding author and reprints: Peter J. Schmidt, M.D., NIMH, Bldg. 10-CRC, Room 65340, 10 Center Dr. MSC 1276, Bethesda, MD 20892-1276 (e-mail: peterschmidt