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Depression & Menopause

Women appear to be particularly vulnerable to depression during the perimenopause years and in the years immediately after menopause. Theories exist as to why women have double the rates of depression during this period. One theory is that there is a “window of vulnerability” such that some women are more sensitive to the hormone shifts that occur during perimenopause and puts them at greater risk for depression. In addition, women at greatest risk are those with a history of depressed mood earlier in life.

Menopause and depression: what's the relationship?

Emotional health during perimenopause requires a balance between self-nurturing and the obligations of work and caring for others. Many women are able to identify and describe sources of tension and symptoms of stress but may still find it difficult to take time for themselves. Recognizing a problem is the first step to finding ways to cope. Although many stressors cannot be altered, coping skills can enable women to meet life’s challenges and create a renewed sense of self-confidence, balance, and harmony.

Some women also may benefit from adjustments to their lifestyles, including eating a balanced diet and getting regular exercise.

It’s important that a healthcare provider helps a woman decide whether she is just feeling stressed or blue or whether she is clinically depressed (major depression). Major depression is a condition associated with a chemical imbalance in the brain, and changing hormones during perimenopause may be associated with that imbalance. It’s marked by symptoms such as prolonged tiredness, low energy, loss of interest in normal activities, sadness, irritability, sleep disturbances, agitation, weight changes, and decreased sex drive. Although most people will experience these symptoms from time to time, they have to last for more than 2 weeks to suggest major depression.

Signs of Major Depression

If you have been experiencing some of these signs and symptoms most of the day, nearly every day, for at least 2 weeks, you may be experiencing major depression and should see a healthcare provider.

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

For major depression, antidepressants and/or cognitive behavior psychotherapy can correct the chemical imbalance. Most women will show a noticeable improvement with antidepressants and have relatively few adverse events, although it may take several weeks to experience the drug’s full effects. Common adverse events include weight gain and difficulty with sexual desire and arousal. Cognitive-behavior therapy also has been shown to effectively treat depression in some women. Antidepressants are most effective when used in combination with psychotherapy. For some people, psychotherapy without medication may not be as effective.

Estrogen also has been shown to significantly improve mood in some women during perimenopause. A healthcare provider may recommend a trial of systemic estrogen therapy for women with symptoms of depression along with bothersome menopause symptoms. This may be recommended for women who are unable or unwilling to take antidepressants, or the two therapies can be used in combination if antidepressants alone are insufficient.

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