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Menopause is not medically considered a major risk for depression. However, hormone fluctuations which begin in the perimenopause years can influence the neurotransmitters in the brain. Those transmitters, including dopamine, serotonin and norepinephrine, are responsible for mood, feeling of well being, appetite, sleep and sexual interest. Estrogen in particular plays a major role in emotional fluctuations; you only need to consider the effects it has when levels are low during certain times of the menstrual cycle. There is no doubt that major changes in hormone levels can throw a woman's emotions out of synch. In fact some even claim it’s like going through puberty again. Nearly one in three women will experience major depression at some time in their life. This is most likely to occur after having a baby (postpartum depression) or in the years approaching menopause. Then again, other women experience very few emotional problems during perimenopause. It is rather like premenstrual syndrome (PMS) - some experience more severe symptoms than others.
Which Comes First - Menopause or Depression?
Research seems to indicate that a woman is more prone to the effects of depression in the transition phase (perimenopause) leading up to menopause. Women with no history of depression in the family, who are normally healthy and happy can suddenly feel hopelessly down. They start to suffer severe mood swings which are compounded by lack of sleep due to night sweats and hot flashes. They wake up stressed and irritable and this feeling carries through the day. In fact some mornings they look in the mirror and wonder what has happened to the happy go lucky woman they used to be. Naturally they wonder -am I depressed? It is important to note that there are different types of depression, ranging from feeling 'blue' to bi-polar or manic, and different treatments are applied. Working with a sympathetic gynecologist for diagnosis and treatment is important.
Common Emotional Symptoms Of Menopause
The following is a list of common changes you may feel approaching menopause (but don't miss our more in depth article, the effects of menopause on the body):
A sudden panic wave hits you out of the blue. Palpitations along with butterflies in the stomach are a typical sign of an anxiety attack. This is common during perimenopause and menopause.
Women who experienced postpartum depression or severe mood swings related to PMS, are more likely to develop depression approaching menopause. The reasons are not yet clear, but it suggests that they are more sensitive to hormone fluxes.
You may feel extra sensitive, over analyzing conversations and looking for slights. You may cry for no reason, or cry more easily in situations you would not have before.
In the morning you feel great, but by the afternoon you feel down and gloomy. Situations in the home or work may trigger these feelings.
Not sure if you are menopausal? See about having a menopause test at home.
Am I Depressed?
Feeling down or just not quite yourself is not depression. Feeling sad because you have been fired is quite normal. Or feeling down after the death of a loved one for weeks or even months is not major depression (also known as clinical depression). The continuity and severity of emotions is normally an indicator of depression. No two women will experience the same symptoms when it comes to depression, but the following are some questions to ask yourself. It will help differentiate between just feeling 'blue' and actual depression.
• Have you lost interest in hobbies or activities that used to give you pleasure?
• Have your sleep patterns changed? Are you having difficulties falling asleep and are you tired all the time, regardless of how much sleep you have?
• Have you lost interest in sexual intercourse with your partner?
• Does everything seem more difficult to do then it used to?
• Do you feel unattractive and worthless?
• Are you feeling angry and resentful? Do you have outbursts of shouting?
• Do you cry more than you used to, or on other hand, feel less than you used to?
• Do you think about self harming or suicide?
• Do you often feel anxious?
• Have you problems concentrating and are your thoughts a bit hazy?
• Have your body movements and speech slowed down?
If you answer yes to most of these descriptions, you may be suffering clinical depression. Talk to your doctor immediately. They can recommend a treatment plan that will help you feel like yourself again.
What Are The Treatment Options?
Depression is treated much the same way in menopause as it would be at any other time in a woman's life. Treatment usually involves antidepressants and behavioral therapy, with the addition of HRT to help improve mood. Which exact therapy is recommended, will depend on the severity of symptoms presented.
The first thing to do is arrange a diagnosis from your primary care physician. Although many menopausal women become depressed because of hormones, there are other conditions which can mimic symptoms. Those include underactive thyroid, sleep apnea, cerebrovascular disease, multiple sclerosis and Parkinson's disease. It is important to rule out other possible causes before treating depression.
Women who are experiencing common mood shifts as a result of menopause are usually recommended estrogen replacement therapy. Make an appointment with a gynecologist to discuss the pros and cons of hormone replacement therapy. Studies show it can help reduce the episodes of hot flashes, restoring a good night’s sleep. It also helps protect the vaginal area from thinning, a contributing cause of low libido in menopause. It can also help to keep collagen and skin elasticity so that the woman is less likely to experience skin problems in menopause, helping her feel better about her looks.
Still Feeling Blue And Taking HRT
The current medical advice is to issue low dosages of hormone therapy for short periods of time as a treatment for menopause symptoms. Occasionally, if the dosage does not appear to be effective enough a doctor may increase the dose and monitor the results. Anxiety and depression can also be treated naturally, this may even be recommended in tandem with HRT. Options include counseling, massage, acupuncture, yoga, biofeedback and herbal remedies. See also: Menopause treatment options.
Taking HRT But Depressed
If the woman does not respond to an increase dosage of hormone therapy and is still feeling depressed, antidepressants are usually considered. The standard antidepressants are SSRIs and SNRIs which are not considered addictive. SSRIs include Prozac and Zoloft, as well as Sarafem which is FDA approved as a treatment for PMS. SNRIs include Effexor XR, Wellbutrin and Pristiq.
Diet And Lifestyle Treatments
Some women do not want to take antidepressant drugs. They may feel that they don't really need them, or they are reacting to a cultural stigma against mental illness. They may even try to shrug it off so they do not look weak. When you consider it, it does not really make sense. We have no problem for example seeking treatment for hot flashes or menopause skin problems, so why not look after our mental health? It probably has the biggest impact on our daily life and those people who are close to us. However if you would like to try alternative treatments, or use them in tandem with medical treatments, adopting a healthy diet and fitness regime might certainly help you feel better. Additionally, see books on depression for more useful resources.
Embrace the Low GI style of eating - the combination of 'good' carbs and protein can help reduce hormone and blood sugar fluctuations. This is suitable for everyone, young or old, overweight or healthy weight. Consider it is a lifestyle and not a 'diet'. There are lots of menu plans online or cookbooks with recipes.
Increase your intake of omega 3 fats which are found in salmon and tuna, you can also purchase omega 3 enriched eggs. Include 2 to 3 servings in your diet every week. It can help to raise your mood and increase your energy levels.
Take a vitamin B complex daily. It is a particularly important supplement for women and helps to keep our mood balanced. Our natural supplies of vitamin B are destroyed by caffeine, alcohol and smoking, so need replacing regularly. A vitamin B complex includes folic acid, which is especially important for women considering pregnancy after 35.
Regular aerobic exercise can help send endorphins, the so-called happy hormones, rushing about our body. You don't need to pay expensive gym fees, a brisk walk in the fresh air is ideal. One way to make it more fun is to buy a pedometer and aim to build up to 10,000 steps a week. Even better, it will burn 2,000 to 3,500 extra calories a week. See our section books on menopause for some useful resources on diet and fitness.
How Common Is Depression Postmenopause?
A 2011 study by Eskisehir Osmangazi University, Turkey studied 744 postmenopause women for signs of depression. The results showed that nearly 25 percent experienced depression after menopause. Significant risk factors were not having children, premature menopause (before the age of 39) and having a history of irregular periods. Research shows that as we age, signs of depression can become more prevalent. This may in fact however have less to do with hormones and more to do with environmental factors. One study showed that women who are widowed in their postmenopausal years are at higher risk for depression. Major depression has also been linked to osteoporosis in women. Increased risk of bone fractures, pain and physical deformity can impact on their personal relationships and ability to socialize.