For most women, the perimenopause is not associated with depression. In those who do become depressed, mood symptoms tend to decrease at the end of menopause, regardless of previous history of depression. Many of the changes in brain function that affect mood are secondary to changing estrogen levels in the brain. Treatment with estrogen alone may improve mood in women with mild depressive symptoms, but those unresponsive to estrogen and women who have moderate to severe depression need antidepressant therapy.