HRT vs Antidepressants in Perimenopausal Depression by Prof Jayashri Kulkarni

Posted on July 16, 2019

Professor Jayashri Kulkarni became a Fellow of the Royal Australian and New Zealand College of Psychiatrists in 1989. As the first Associate Professor/Director of Psychiatry to Dandenong Hospital in 1994, she founded and directed the Dandenong Psychiatry Research Centre (DPRC) and the Monash University Research Centre for Women’s Mental Health. She was Director of Psychiatry of Dandenong Area Mental Health Service (DAMHS) for  eight years and directs a large psychiatric research group in her current appointment as Professor of Psychiatry, The Alfred and Monash University.

Author Quotes  

What we’ve noted is that there is a very high incidence of first-onset depression in the perimenopausal age group.

The ABS suicide data show two groups for increased suicide; the biggest group in our country is men over 85, but the second biggest group is 42-52-year-old women.

We often talk about, what is the management strategy here, because depression is multifactorial and which way do we go? Do we go with antidepressants, or do we go with HRT?

Summary and slides  

Prof Kulkarni introduces this section of the presentation with an overview of perimenopausal depression.  

She describes the symptoms associated with the perimenopause and the changes that occur in the CNS prior to more obvious symptoms such as hot flushes and amenorrhoea. 

The MENO-D rating scale,2 has been developed to help detect depression menopause and is available to use in clinics and practices. Prof Kulkarni discusses the pros and cons of hormonal vs antidepressant treatments in this patient population, and the issues of emotional blunting, aggression, and tachyphylaxis. 

Take Home Points  

  • Depression rates increase dramatically by 16-fold in the 42-52 years age group according to the Harvard Mood Study. 
  • CNS changes occur 5 years before hot flushes and amenorrhoea between the ages of 43-55 years. 
  • It is better to start with hormonal treatments such as HRT before antidepressants due to the non-withdrawal aspect. 
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