Several forms of depression are unique to women because of their apparent association with changes in
gonadal hormones, which in turn modulate neuroregulatory systems associated with mood and behavior. This review examines the evaluation and treatment of depression that occurs premenstrually, postpartum, or in the perimenopause on the basis of current literature. The serotonergic
antidepressants consistently show efficacy for severe
premenstrual syndromes (PMSs) and
premenstrual dysphoric disorder (PMDD), and are the first-line treatment for these disorders. The use of
antidepressants for
postpartum depression is compromised by concerns for effects in the infants of breast-feeding mothers, but increasing evidence suggests the relative safety of the
antidepressant medications, and the risk calculation should be made on an individual basis.
Estradiol may be effective for
postpartum depression and for moderate-to-severe major depression in the perimenopause. In spite of its frequent use,
progesterone is not effective for the mood and behavioral symptoms of PMS/PMDD,
postpartum depression, or perimenopausal depressive symptoms.