The aim of this study is to determine if the depression in perimenopausal women is symptomatologically different than depression in premenopausal women, and if these depressive women are under more risk for depression when factors like premenstrual dysphoric syndrome, socio-economical status, vasomotor symptoms and familial inclination to depression are considered. Fifty major depressive women with hormonally established perimenopause (follicle stimulating hormone (FSH) levels over 20IU/l and estrogen levels lower than 40IU/l) and who were not taking any psychotropic or hormone replacement therapy, were enrolled in the study. In order to investigate the characteristic clinical features of perimenopausal depression, a drug free control group consisting of 48 pre-perimenopausal women with a diagnosis of major depression was formed. Another control group was formed with 53 non-depressive perimenopausal women in order to investigate the risk factors of perimenopausal depression. The depressive and non-depressive groups did not differ from each other according to level of education, marital and economical status and comorbid physical problems. No major symptomatological difference between perimenopausal depression and pre-perimenopausal depression was found. No correlation was found between the severity of vasomotor symptoms and severity of depression. Findings of our study suggest that vasomotor symptoms and socio-economical status do not predict the severity and existence of perimenopausal depression. Episodes of major depression are not necessarily the normal result of such vasomotor symptoms. Therefore, the evaluation and management of perimenopausal depression should be carried out as carefully as is done in episodes of depression seen in the rest of women's life span.