ABSTRACT
The relationship of mood changes and the menopause/perimenopause continues to be a controversial topic that has been the subject of a number of recent reviews and commentaries1-4. While in the past, clinical experience had led physicians to recognize that the time of perimenopause/menopause was a period of increased susceptibility to depression and other affective disorders5, over the last two to three decades a number of epidemiological, correlational and therapeutic studies have cast doubt on this association. Since ‘involutional melancholia’ was dropped from the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification of psychiatric diseases in 1980, the view has prevailed that the climacteric and depression are not associated; that emotive symptoms associated with the climacteric are more likely to be due to psychosocial than biological causes; and that hormonal treatment of affective disturbances experienced by women during the climacteric is, with the possible exception of postsurgical menopause, ineffective1,2. To quote two recent reviews, ‘involutional melancholia seems to be of vanishing interest to psychiatry’6 because ‘there is no substantial evidence that a natural menopause causes depression’7. Instead, depressed mood during the climacteric has been attributed to middle age-related life events and associated psychosocial changes such as the departure of children from home, illness and death of parents, and marital separation/divorce.
