The author postulates that depression during the perimenopausal years is a phase-specific affect related to necessary mourning of the loss of the procreative function. Initially, during the climacteric, denial is the primary defense mechanism. If there is a pathological predisposition, the woman may inhibit mourning and instead regress to primitive symptomatology such as paranoid ideation and psychotic depression. If, however, she has the capacity to tolerate the depression and work through the normal psychic pain of the climacteric process, the woman may adaptively restructure her self-image and ego ideal in a manner that promotes self-acceptance and enriched object relations. Included is a comprehensive review of the psychoanalytic literature bearing on this topic.