Introduction

Although the prevalence of major depression decreases in aging women, there is an increased prevalence of non-major depressive disorders in women after the age of 65. These minor depressive syndromes are two to three times as common in older women as in men of the same age. The reasons for this sex difference in the prevalence of depressive symptoms are not known. Aging women experience significant changes in social role and relationships, health status, family composition and economic status, all of which may present intense psychological challenges that could contribute to depression.

Aging women also undergo distinct biological changes, the impact of which on mood remains to be clarified. These biological changes, which are the focus of this book, include decreasing levels of hormones such as estradiol, testosterone, dehydroepiandrosterone, progesterone, insulin-like growth factor, and growth hormone. Estrogen deficiency, in particular, has been suggested as one cause of the non-major depressive disorders in elderly women. Moreover, estrogen replacement, including use of the specific estrogen receptor modulators tamoxifen and raloxifene, is increasingly recommended for disease prevention after menopause. The psychological consequences of such treatments are not well understood. If we are to consider the use of estrogen and other sex hormones to prevent or treat depressive symptoms in aging women, it will be important to understand the psychological, pharmacological, and biochemical effects of these agents.

Epidemiology of depressive disorders in aging

Gender differences in the epidemiology and phenomenology of depression may be informative about the neurobiology of depressive disorders.