Abstract
The relationship between the perimenopause and mood disturbances is the source of myth and polemic. Our current lack of understanding of this relationship reflects the variable or inadequate definitions employed for both the perimenopause and depression. As well, it reflects the belief that if the perimenopause is not associated with mood changes in everyone, it must be relevant in no one. The literature is, nonetheless, replete with reports attributing mood and behavioral disturbances to the changes in reproductive hormones occurring during the perimenopause. In addition to early descriptions of perimenopausal neurasthenia (fatigue, insomnia, decreased concentration, anxiety, sadness), Maudsley and Kraepelin described a severe perimenopausal or involutional melancholia (1–4). In the ensuing decades, controversy raged regarding the existence of a perimenopausal depression that was distinct from depression occurring outside the context of the perimenopause. Influential studies by Weissman (5) and Winokur and Cadoret (6) provided arguments against involutional melancholia as a distinct entity. Largely as a consequence of these studies, involutional melancholia was eliminated from subsequent editions of the Diagnostic and Statistical Manual of Mental Disorders. As reviewed elsewhere (and in brief below), both conceptual and and methodologic problems underlie the certainty with which a relationship between the perimenopause and mood disturbances has been dismissed. In this chapter we pose several questions that may help define the possible relationship between mood changes and the perimenopause.
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Schmidt, P.J., Roca, C.A., Rubinow, D.R. (1997). Perimenopausal Depression. In: Lobo, R.A. (eds) Perimenopause. Serono Symposia USA. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-2288-0_18
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DOI: https://doi.org/10.1007/978-1-4612-2288-0_18
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