Depression and insomnia in women.
Depression and insomnia are both significantly more prevalent in women than in men. Risks appear linked to fluctuations and transitions in gonadal hormones during various phases of women's lives, with the risk of depression greatest during the period from menarche to menopause. Increased risks of both insomnia and depression also coincide with the late luteal phase of the menstrual cycle, during and after pregnancy, and during the peri-/postmenopausal period. Gonadal hormones exert significant effects on the neurohumoral systems most intimately associated with depression and insomnia, with corresponding implications for treatment. Medications related to the serotonin system-the selective serotonin reuptake inhibitors, or SSRIs-appear to be uniquely effective in the treatment of insomnia and depression experienced by women. SSRIs and the nonbenzodiazepine receptor agonists are generally useful as first-line treatments in a number of circumstances; hormone replacement therapies can also be considered. Behavioral therapies for insomnia may be particularly relevant for postpartum patients because of safety concerns and to prevent the development of autonomous chronic insomnia, which may also increase the risk of depression. In light of the high risk of relapse and high likelihood of comorbidity, it is crucial to effectively treat both insomnia and depression in women. However, few data exist for many key areas related to the treatment of these disorders in women, and research is greatly needed.
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