Abstract
We describe our experience with a patient who had depression triggered by socioenvironmental factors during hormone replacement therapy for climacteric disorders. Fortunately she had been diagnosed and treated expeditiously at first attempt of interview due to good communication with her doctor. A 49-year-old female office worker had undergone an abdominal total hysterectomy and right adnexectomy in March 2000 because of uterine myoma and right ovarian cyst. The patient had severe hot flashes and sweating in the spring of 2001 and presented at our menopausal clinic in July 2001. Physical examination revealed a serum estradiol level of 20pg/mL and a serum follicle-stimulating hormone level of 92.8 mIU/mL. After conjugated equine estrogen was started, her symptoms improved. And so she presented at our clinic in August 2003 and reported that she had mood disorder and decreased volition since about July 2003, when the manager at her workplace had changed. Her score on the self-rating depression scale was 55. When she was interviewed, she said that words from her new manager suddenly triggered memories of her mother, who died while still young, after suffering from the relationship between her father and his past lover. These recollections had apparently triggered the patient's symptoms. At the same time, her eldest daughter gave birth and her eldest son left the house after graduating from college. These major changes in her family environment might have had psychological effects. Antidepressant therapy with fluvoxamine maleate (50mg/day) was started immediately. Her mood disorder improved after 1 week of treatment. After 2 weeks of treatment, she could see herself objectively, similar to before the onset of depression. After 1 month of treatment, her mood disorder had generally improved.
