The Evaluation and Management of Depression in Women Across the Life Span

Depression is more common in women than in men, particularly during the childbearing years.Women may present with different depressive symptoms than men and may respond differently to antidepressanttreatment. In addition, depression in women can surface in association with specific pointsin the reproductive cycle, such as during the premenstrual period, during pregnancy and the postpartumperiod, and during the perimenopausal years. Antidepressant medications may be used effectivelyat all stages in a woman’s life. In the case of premenstrual dysphoric disorder, serotonergic agents havedemonstrated efficacy in both full-cycle and luteal-phase dosing strategies. For depressed women whoare pregnant or breastfeeding, the limited safety data available on antidepressants suggest minimaldanger to the fetus or infant, and the risks and benefits to both mother and child must be weighedagainst the risks of untreated illness. Treatment of depression in middle-aged and elderly womenshould take into account the possible influence of both menopausal status and hormone replacementtherapy on antidepressant response. This article will focus on special considerations in the evaluationand management of depression in women across the life span.