A Neurosteroid Intervention for Menopausal and Perimenopausal Depression

Inclusion Criteria: The participants must meet the following criteria: * Women aged 40-67 years who are perimenopausal or early postmenopausal (within 5 years of the last menstrual period if not surgically postmenopausal), including: * Women who have experienced changes in menstrual cycle frequency or duration, and/or physical symptoms indicative of menopausal transition, as determined by clinician * Women who are using hormonal IUDs (i.e. brands Mirena and Skyla), with FSH level \> 20 mIU/m (as menstrual periods are irregular with IUDs that utilize hormones, making irregular/absent periods difficult to assess as related to the menopausal transition). * Women with significant menopause-related physical symptoms, indicated by any of the following criteria: * Greene Climacteric Scale total scores \> 20 * Greene Climacteric Scale sub-score for vasomotor symptoms \>3 * 5 or more bothersome hot flashes per week (self-reported) * Women meeting DSM-5 criteria for current major depressive disorder (assessed by the SCID) * Baseline HRSD score of ≥ 18 * Subject agrees to abstain from disallowed medications for the duration of the trial Exclusion Criteria: The participants must not meet any of the following criteria: * Vulnerable populations (e.g. pregnant/nursing, severe cognitive or intellectual impairment, incarcerated) * Pregnancy (determined by urine pregnancy test), intending pregnancy or breast feeding * Psychiatric disorder other than MDD that is acute and the primary focus…