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Aggression

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Question : 1 / 258

A 48-year-old G4P3 woman reports irritability, frequent tearfulness, poor concentration, and poor sleep quality due to hot flashes resulting in daytime fatigue. She reports irregular menses, with her cycles coming anywhere from 24 to 34 days apart. She has a history of a prior major depressive episode with onset postpartum, and has a strong family history of depression on her paternal side. She has no history of hypomania or mania. Which of the following statements most accurately reflects the patient’s condition?

Her risk for depression may start to abate just as she reaches the average age of onset for menopause (52 years old)
Her history of postpartum depression increases her vulnerability to perimenopausal mood changes
Treating her hot flashes and sleep disturbance is unlikely to reduce her risk of developing a major depressive episode
FSH and estradiol levels may establish a diagnosis of depression related to perimenopause
Her paternal family history of depression is not a risk factor for developing perimenopausal depression

The answer is B. History of premenstrual and postpartum mood changes predicts heightened risk for perimenopausal mood changes. A is incorrect because the risk for depression does not abate until after about 2 years of postmenopause. C is incorrect because sleep disturbance may be a key modifiable risk factor for perimenopausal major depression. D is incorrect because FSH and estradiol levels vary widely from cycle to cycle during perimenopause. E is incorrect because a family history of depression (regardless of the side of the family) increases risk for perimenopausal depression.

Publication reference : Miller L, Athappilly G, Avni-Barron O, et al. Depression and gynecologic conditions. In Barsky AJ, Silbersweig DA, editors. Depression in Medical Illness. USA, New York, NY: McGraw-Hill Education; 2017

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