Depression During Menopause

Did you know that the same hormones that once controlled our menstrual cycles also have influence over our serotonin levels? Serotonin is a chemical found in the brain commonly referred to as the “happiness hormone.” This is mainly because serotonin works to promote feelings of well-being and happiness when levels are balanced. But when our hormone levels decrease during the menopausal transition, our serotonin levels also fall, which can contribute to feelings of increased irritability, anxiety, and sadness¹ – which in some cases, may translate into clinical depression.

It’s not uncommon for women transitioning through menopause to be diagnosed with depression, however, it’s important to note that menopause doesn’t cause depression. Knowing that, what then are the potential connections between a depression diagnosis for women going through the menopausal transition? Keep reading to find out.

What is Depression?  

Depression is a common mood disorder, earmarked by lack of interest in day-to-day activities, and persistent feelings of sadness.² Depression affects people differently, but changes in weight, difficulty sleeping, irritability, and difficulty concentrating are some of the symptoms that may be experienced when an individual is depressed. Additionally, there isn’t one singular form of depression – there are varying levels of severity in regard to the symptoms experienced as well as the duration someone may be impacted by depression.

The most common types of depression are³:

• Major depressive disorder (MDD – clinical depression) – intense or overwhelming depression that lasts longer than two weeks, with menopausal women being more likely to develop MDD
• Dysthymia (persistent depressive disorder) – moderate to mild chronic depression that causes symptoms, including loss of interest in daily activities and diminished energy on most days, for at least two years

As mentioned, menopause and a diagnosis of depression often coincide, but depressed moods can manifest at any age. According to the CDC, depression occurs more often in women than in men, across all age groups.⁴ However, women may be particularly vulnerable to feelings of depression during the years leading up to menopause (during perimenopause). In fact, the rate of depressed moods in women have been shown to double during this specific time of their lives.⁵ Additionally, women who experienced depressed moods earlier in life may be most vulnerable to the emergence of depression during menopause.⁶

Depression can happen at any age for many reasons, such as genetic predisposition, hormonal fluctuations, monumental life events or severe stress, but the risk appears to decline two to four years after a woman has her last period (during post-menopause), seemingly when hormones level out.⁷

Data aside, being a woman and going through menopause doesn’t mean you’re destined for a depression diagnosis. While common, depression during menopause is not inevitable. It’s also treatable, with many mental health resources available, from talk therapy to prescription medications to lifestyle and relationship changes. It’s always a good idea to speak with your healthcare provider first, especially if you have concerns about depression and have not yet been formally diagnosed.

Menopause and Depression: What’s the Connection?  

As mentioned earlier, while menopause does not directly cause depression, there are several physiological and life changes which can impact your risk of developing it during menopause. These include:

Fluctuating Hormones

The hormonal seesaw caused by perimenopause appears to be strongly related to depression.⁸ This may explain why depression rates decline post-menopause, when, as mentioned earlier, reproductive hormones, such as estrogen and progesterone, stabilize.

Estrogen and other reproductive hormones also impact upon serotonin levels in the brain. Remember, serotonin is a “feel-good” chemical. A drop in serotonin production can result in increased feelings of sadness, anxiety, depression, and irritability during menopause.⁹

Hormonal fluctuations also cause disruptive menopausal symptoms, such as insomnia and night sweats, that can exacerbate depression. It’s been demonstrated that poor sleep can significantly increase the risk of depression and influence changes in mood.¹⁰

Life Stressors

Fluctuating hormones are not the only culprit for potential increased depression during menopause. The challenges and demands of day-to-day living can also play a role in depression and the onset of depressive symptoms.

“During the years when perimenopause and menopause occur, typically from the forties through the fifties, women may need to take on greater caregiving responsibilities for aging loved ones. This can also be a stressful time in terms of a career and financial goals. These years may also be a time to launch or not launch adult children from the home, as they reach adulthood, a life transition that can prove stressful for everyone involved,” explains Chicago-based therapist Iris Waichler, MSW, LCSW.

Ms. Waichler also cites common life stressors, like dealing with medical issues and feelings about aging, as potential catalysts or exacerbators of depression during menopause.

Coping with Depression During Menopause

Many, if not most people, feel sad now and then. If, however, you find that your feelings of sadness are persistent, long-lasting, or interfering with your ability to enjoy life, starting out with some proactive lifestyle changes may prove to be beneficial. Consider incorporating some small tweaks to your daily routine that are geared toward supporting your overall physical and mental health:

• Exercise and physical activity of all types can be highly beneficial for boosting serotonin levels in the brain, which can elevate your mood.¹¹
• A healthy diet can help you feel in control of your life and health, which can be empowering! Certain foods, such as pineapple, salmon, and tofu, may even work to help boost serotonin levels in the brain.¹²
• Stress reducers, such as meditation and yoga, can help you cope with the daily anxieties of life. This may help to alleviate some depressive thoughts.¹³
• Take stock of your negative habits – this may help you determine what to let go of. These may include alcohol overindulgence, which can wreak havoc on feel-good chemicals in the brain, including serotonin and dopamine.¹⁴

If you’re severely depressed, making simple yet proactive lifestyle changes can feel challenging, or even impossible. These changes may also not be enough to provide you with sufficient relief. In those instances, seeking professional support can be an important next step. You can start the ball rolling by speaking with your general practitioner or gynecologist if you’re comfortable doing so. You can also seek out the support of a mental health professional, such as a therapist or psychiatrist.

A mental health professional will take a verbal history of your symptoms, in order to determine if you meet the criteria for “clinical depression.” After establishing a proper diagnosis, your provider can work with you to determine if talk therapy, cognitive behavioral therapy, medication, or a combination of these and other treatments are good options for you. It’s important to be open and honest with your therapist and healthcare providers about your symptoms and how you’re feeling, so you can work together to determine the best treatment option for you.  And if you’re uncomfortable about the thought of physically going into an office setting for an appointment, many therapists now offer tele-health visits for both individual and group therapy.

If you’re struggling with depression or other mental health conditions, we highly recommend speaking with a mental health specialist who can help assess your symptoms and devise a specialized treatment plan.

Depression is a treatable disease and there’s no reason to put off getting help. You have many years ahead of you, and you deserve to enjoy them all. Don’t let depression stop you from living life or from happiness. You have more control over depression than you may think, and with many years left in front of you, you deserve to enjoy them all!

It can be challenging to distinguish between clinical depression and the emotional ups and downs that can be related to shifting hormones during menopause. If you’re concerned about your mental health, consider taking the first step, and make an appointment with your healthcare provider. If you are currently struggling with depression or know someone who may be, below are some additional resources that can help.

• Substance Abuse and Mental Health Services (SAMHSA) National Helpline: Visit online or call 1-800-662-4357
• National Alliance on Mental Illness (NAMI): Visit online, call 1-800-950-6264, or text NAMI to 741741
• National Suicide Prevention Lifeline: Visit online or call 1-800-273-8255
• www.Psychologytoday.com is also a great resource for finding mental health care providers specific to your needs

Resources

1. https://www.hopkinsmedicine.org/health/wellness-and-prevention/can-menopause-cause-depression
2. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
3. https://www.verywellmind.com/the-connection-between-menopause-and-depression-4767577
4. https://www.cdc.gov/nchs/products/databriefs/db379.htm
5. https://www.menopause.org/for-women/menopauseflashes/mental-health-at-menopause/depression-menopause
6. https://www.menopause.org/for-women/menopauseflashes/mental-health-at-menopause/depression-menopause
7. https://www.medicalnewstoday.com/articles/menopause-and-depression
8. https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-015-0002-y#:~:text=The%20Harvard%20Study%20of%20Moods,%E2%80%93%203.2)%20%5B36%5D .
9. https://www.hopkinsmedicine.org/health/wellness-and-prevention/can-menopause-cause-depression
10. https://www.hopkinsmedicine.org/health/wellness-and-prevention/can-menopause-cause-depression
11. https://www.health.harvard.edu/mind-and-mood/serotonin-the-natural-mood-booster
12. https://www.healthline.com/health/healthy-sleep/foods-that-could-boost-your-serotonin#pineapples
13. https://www.health.harvard.edu/mind-and-mood/how-meditation-helps-with-depression
14. https://www.alcoholrehabguide.org/resources/dual-diagnosis/alcohol-and-depression/