Abstract：
There is a new appreciation of the perimenopause-defined as the early and late menopause transition stages as well as the early postmenopause-as a window of vulnerability for the development of both depressive symptoms and major depressive episodes. However, clinical recommendations on how to identify, characterize and treat clinical depression are lacking. To address this gap, an expert panel was convened to systematically review the published literature and develop guidelines on the evaluation and management of perimenopausal depression. The areas addressed included: (1) epidemiology; (2) clinical presentation; (3) therapeutic effects of antidepressants; (4) effects of hormone therapy; and (5) efficacy of other therapies (e.g., psychotherapy, exercise, and natural health products). Overall, evidence generally suggests that most midlife women who experience a major depressive episode during the perimenopause have experienced a prior episode of depression. Midlife depression presents with classic depressive symptoms commonly in combination with menopause symptoms (i.e., vasomotor symptoms, sleep disturbance), and psychosocial challenges. Menopause symptoms complicate, co-occur, and overlap with the presentation of depression. Diagnosis involves identification of menopausal stage, assessment of co-occurring psychiatric and menopause symptoms, appreciation of the psychosocial factors common in midlife, differential diagnoses, and the use of validated screening instruments. Proven therapeutic options for depression (i.e., antidepressants, psychotherapy) are the front-line treatments for perimenopausal depression. Although estrogen therapy is not approved to treat perimenopausal depression, there is evidence that it has antidepressant effects in perimenopausal women, particularly those with concomitant vasomotor symptoms. Data on estrogen plus progestin are sparse and inconclusive.
摘要：
对围绝经期有了新的认识，将围绝经期定义为绝经早期和绝经后期过渡阶段以及绝经后早期，这是抑郁症状和重度抑郁发作发展的脆弱性窗口。然而,关于如何识别的临床建议，缺乏临床抑郁症的特征和治疗。为了解决这个差距，我们召集了一个专家小组,对已发表的文献进行系统回顾,并制定围绝经期抑郁症的评估和治疗指南.涉及的领域包括：（1）流行病学；（2）临床表现；（3）抗抑郁药的治疗效果；（4）激素疗法的效果；（5）其他疗法的疗效（例如，心理治疗,锻炼,和天然保健品)。总的来说,证据通常表明，大多数在围绝经期期间经历重度抑郁发作的中年女性都曾经历过抑郁症发作。中年抑郁症表现为典型的抑郁症状，通常与更年期症状相结合(即，血管舒缩症状,睡眠障碍)，和心理社会挑战。更年期症状复杂，共同发生，与抑郁症的表现重叠。诊断包括确定绝经阶段，评估同时发生的精神病和更年期症状，欣赏中年常见的社会心理因素，鉴别诊断，以及使用经过验证的筛查仪器。经证明的抑郁症治疗选择(即，抗抑郁药,心理治疗）是围绝经期抑郁症的一线治疗方法。虽然雌激素疗法未被批准用于治疗围绝经期抑郁症，有证据表明它对围绝经期妇女有抗抑郁作用，特别是那些伴有血管舒缩症状的患者。雌激素加孕激素的数据很少且尚无定论。
