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This is not a benign transitional state. When unrecognised, perimenopausal depression leads to:.– Chronic affective disorders.– Relationship and occupational dysfunction.– Increased suicide risk in midlife women. Timely diagnosis is essential for both symptom relief and.

Lifestyle modification remains essential. Structured exercise, sleep hygiene, and dietary interventions show benefit in mild to moderate presentations, particularly when integrated with pharmacotherapy or psychotherapy. 12/14🧵.

Non-pharmacological treatments are also effective. CBT has demonstrated:. – ≥50% symptom reduction in ~50% of patients. – Full remission in 25%. – Significant benefit in sleep and cognitive domains (Brandon et al., 2013). 11/14🧵.

Hormonal treatment is not universally effective, but it has a role. Transdermal estradiol (0.05–0.1 mg/day) shows antidepressant effects in perimenopausal women, especially when vasomotor symptoms are prominent (Schmidt et al., 2000; Soares et al., 2001). Combination therapy.

Desvenlafaxine is currently the most evidence-based agent. It improves both depressive and vasomotor symptoms and has demonstrated efficacy in longitudinal perimenopausal studies. Other agents (e.g. fluoxetine) may worsen anxiety and insomnia in this population. 9/14🧵.

Vasomotor symptoms are not benign. Nocturnal hot flashes and night sweats disrupt REM architecture, elevate cortisol, and worsen mood, even in those without baseline MDD. Their presence should prompt a proactive psychiatric evaluation. 8/14🧵

Risk is elevated even in psychiatrically well women. Prospective cohort data show that women with no prior psychiatric history are nearly twice as likely to develop depression upon entering perimenopause (Cohen et al., 2006). 7/14🧵.

This is a nosologically neglected disorder. Despite its unique symptom structure and neuroendocrine underpinnings, perimenopausal depression remains unrecognised in both ICD and DSM frameworks (Maki et al., 2018). 6/14🧵.

A distinct neurobiological trajectory underlies this presentation. Estradiol fluctuations destabilise serotonin, dopamine, and HPA axis activity. This hormonal volatility, not absolute deficiency, drives symptom onset during the transition. 5/14 🧵.

Clinically, the syndrome precedes the stereotype. Psychiatric symptoms, particularly insomnia, irritability, and affective instability, often manifest several years before vasomotor or menstrual symptoms. This temporal disconnect delays diagnostic formulation. 4/14 🧵.

Commonly used screening tools lack sensitivity. Scales such as the PHQ-9 or HAM-D often underrepresent the somatic and cognitive domains prominent in this population. The MENO-D scale, developed by Kulkarni et al., improves detection by incorporating physical and vasomotor.

The diagnostic profile diverges from classic MDD. Perimenopausal depression is associated with:. – Paranoid ideation. – Irritability or hostility. – Cognitive slowing. – Somatic complaints (e.g. joint pain, headaches). – Decreased libido and sleep disturbance. These features.

Up to 68% of perimenopausal women report clinically significant depressive symptoms, yet most are never formally diagnosed. Their symptoms are somatised, cyclical, and hormonally modulated, often falling outside DSM-5 criteria and undetected by conventional tools like the PHQ-9

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Integrating this knowledge may enhance therapeutic precision. Understanding how framing, delivery, and patient characteristics interact with treatment response could support more individualised care. 13/14 🧵.