Like many aspects of depression in women, the diagnosis of climacteric depression and its treatment remains controversial. Whereas gynaecologists who deal with the menopause have no difficulty in accepting the role of oestrogens in the causation and the treatment of this common disorder, psychiatrists seem to be implacably opposed to it. This may be because there is no real evidence of an excess of depression occurring after the menopause, nor any evidence that oestrogens help postmenopausal depression or what used to be called "involutional melancholia". This is quite true and indeed many women with longstanding depression improve considerably when the periods stop. This is because the depression created by premenstrual syndrome, heavy painful periods, menstrual headaches and the exhaustion that attend excess blood loss disappears. Therefore, the longitudinal studies of depression carried out by many psychologists, particularly those as notable as Hunter(28), have shown no peak of depression in a large population of menopausal women. The depression that occurs in women around the time of the menopause is at its worst in the two or three years before the periods stop. This, of course, is perimenopausal depression and is no doubt, related to premenstrual depression as it becomes worse with age and with falling oestrogen levels.
Of the 30 or so neurotransmitters that have been identified, researchers have discovered associations between clinical depression and the function of three primary ones: serotonin, norepinephrine, and dopamine. These three neurotransmitters function within structures of the brain that regulate emotions, reactions to stress, and the physical drives of sleep, appetite, and sexuality. Structures that have received a great deal of attention from depression researchers include the limbic system and hypothalamus.