'Menopause knowledge is often siloed, and care is fragmented and not patient-centered,' Dr. Claudio N. Soares said. 'What The Menopause Society does is bring all of us together, and we should celebrate that and work together to break those silos.'
Dr. Soares is a professor in the Department of Psychiatry at Queen's University and the immediate past president of The Menopause Society. He presented 'Mood disorders and the menopause transition: what every clinician needs to know' at The Menopause Society 2026 Annual Meeting, held October 20 to 24, 2026, in San Diego, California. His talk was part of the plenary symposium, ‘Mind the gap: mood disorders, suicide risk, and the menopause transition.'
Dr. Soares reviewed who is at risk, how symptoms present, and what the evidence supports for treatment. 'It's time to really look at what is evidence and what is noise.' Most women will not have a major depressive episode during menopause, although depressive symptoms are more common. 'The threshold here is what is affecting your patient's functioning and quality of life,' he said.
Who may be at risk for depression during the menopause transition
Because recurrence is more common than new onset, prior depression is the key risk factor to ask about. During the transition, hormone fluctuations, vasomotor symptoms (VMS), sleep problems, and stressful life events add risk, particularly in late perimenopause and early postmenopause.
These symptoms rarely occur alone. In survey data from nearly 48,000 women, perimenopausal women had higher depression and anxiety scores than postmenopausal women. Sleep disturbances, with or without vasomotor symptoms (VMS), were associated with higher scores than VMS alone. 'If your patients tell you that they have VMS, ask about sleep and anxiety,' Dr. Soares suggested.
How evidence-based treatment may apply to mood symptoms in menopause
For major depressive disorder or significant depressive symptoms, Dr. Soares presented guidelines with antidepressants and cognitive behavioral therapy as first-line options. Hormone therapy is not first-line for depression. For an antidepressant effect, exercise needs to be supervised and structured. 'What is not here is walking your dog, taking your dog to the park', he joked, pointing at the guidelines slide. 'All antidepressants are not born the same,' he added, pointing to vortioxetine, vilazodone, desvenlafaxine, and bupropion as best tolerated for weight and sexual function. Transdermal estradiol is a second-line option for perimenopausal depression but appears ineffective after menopause.
He then illustrated how this information changed his practice in menopause care with two patients. The first, a woman in her early 50s with moderate to severe VMS, disrupted sleep, and mood changes, had no history of depression. Because her mood changes may have stemmed from VMS and poor sleep, he suggested treating those first and reassessing mood after a few weeks. The second, a woman in her early 60s with significant depressive symptoms, had a history of major depression, which pointed to a recurrent episode. For her, he recommended first-line depression treatment, separate from other menopause care.
Dr. Soares closed with open questions about the timing and sequence of treatment and the understudied role of anxiety, which would bridge the knowledge gap we have.