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Menopause and Depression

Menopause is referred to as “the change” for a reason. While we often associate menopause with the physical transformation that occurs after a woman’s child-bearing years, the transition can also be a time of emotional turmoil.. Irritability, mood swings and other non-physical symptoms are not uncommon.  In fact, menopause can raise the risk for clinical depression, a mental health disorder that robs you of joy and can make you feel so sad, helpless, or hopeless that it’s impossible to live a normal life. Depression during menopause makes what is often a challenging transition even more difficult. 

Depression can make you feel emotionally unable to handle your regular responsibilities or cope with even the smallest setbacks.  You may find that you’ve lost interest in or obtain little to no please from the things you once enjoyed.  Low energy, fatigue  and poor concentration are frequent symptoms.

Depression typically manifests in physical symptoms as well.  For example, you may find yourself struggling with insomnia or waking up earlier than planned and unable to fall back asleep.  You may also feel like sleeping all the time. Appetite changes are also common – some women with depression have to force themselves to eat due to a low appetite, while others find themselves eating more than usual – and struggling with subsequent unwanted weight gain.  Headaches, muscle or joint pain, and digestive upset may also accompany depression.

Fluctuating Hormones

The transition the body goes through to reach menopause is called perimenopause. During this time, your body experiences hormonal fluctuations. Estrogen levels decline while levels of other hormones, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH), rise. This hormonal flux triggers the physical symptoms with which you may already be familiar.  These include  menstrual irregularities, insomnia and hot flashes, as well as the decreasing ability to get pregnant.

These shifting hormones may also be responsible for depression symptoms in some women. While researchers aren’t exactly sure how the process works, some believe the fluctuations disturb the equilibrium in the chemical balance of the brain, leading to depression.

The physical discomfort of perimenopause may play a role in depression symptoms as well. Insomnia is common, making it very difficult to get through busy days. Hot flashes are uncomfortable and, when they happen in public places, can make you feel embarrassed or conspicuous.

Other Factors

Hormonal imbalances are rarely the only culprit to blame when depression develops during menopause. Researchers have found that other factors also increase the risk of depression during this transitional phase of life.

For instance, one study found that women who reported negative stressful events were more likely to have depression during perimenopause, especially during its later stages [1]. Studies also show that women are more likely to have depression in perimenopause if they had previous bouts of depression or postpartum depression. Genetics can also play a role.  Women with a family history of depression may also be more prone to developing it during menopause[2].

Depression during menopause may also have its roots in the life changes that often occur around the same time. For example, you may feel sad that you’re no longer able to bear children. Perhaps you’re experiencing feelings of hopelessness due to the realization that you are aging – that your youthfulness is slowly becoming a thing of the past.  Not only do you see signs of aging every time you look in the mirror, you also have to cope with the media’s constant emphasis on maintaining a youthful appearance.  Like many women your age, you may have taken on a stressful new role, such as caring for a sick, elderly parent. These are significant factors that can impact any woman’s emotional health.

Treating Depression

If symptoms of depression are interfering with your life or causing significant distress, it’s important to consider treatment. Depression is not a sign of weakness.  And even if you don’t have a prior history, don’t assume you have to “power through” it all alone.  Following are several options to consider that can help alleviate symptoms:

Psychotherapy.  Talk therapy is a critical part of treating depression at any stage of life. Working with a psychologist, clinical social worker, or other qualified mental health professional can be very beneficial.  While there are many different types of therapy, cognitive behavioral therapy (CBT) has consistently been shown to be one of the most effective types for treating depression.  A cognitive behavioral therapist can help  identify negative and irrational beliefs and thought patterns that play a significant role in depression.  For example, a negative belief for some menopausal women is “I’m old and undesirable now – my good years are over.”  Once identified, you can begin to replace these thoughts with ones that are more rational and empowering.

Antidepressant medication.  For some women, psychotherapy isn’t enough, especially if symptoms are severe.  While medication is not recommended as the sole treatment for depression, it can be a helpful adjunct to therapy.  Antidepressants like Zoloft, Paxil and others work by restoring the balance of certain brain chemicals (neurotransmitters) that are believed to be depleted in people with depression. The key to successful antidepressant treatment is to take them exactly as prescribed, which allows your brain to gradually achieve and maintain a consistent balance that helps improve your mood. If a specific medication doesn’t work for you, don’t give up. You may need to try several before discovering the one that’s right for you. Remember that antidepressants are intended to work in conjunction with therapy, not in place of it.

Hormone replacement therapy. Also called HRT, this treatment is used to relieve the physical symptoms of perimenopause. These drugs raise estrogen levels to treat hot flashes, night sweats, and other symptoms that can make menopause especially challenging for some women. Research suggests that low-dose oral or patch HRT improves depression symptoms as well [3]. HRT is considered a short-term therapy and is often only prescribed for 2-5 years. There are side effects, so this treatment is not right for every woman. Speak with your gynecologist and a mental health professional to learn if HRT is something you should consider.

Treat physical symptoms. Treating physical symptoms will help you feel more comfortable, and in turn boost your emotional well-being. To battle hot flashes, keep a fan at your desk or workstation, wear layers you can remove during the day, sleep in little or no clothing, and / or lower the room temperature. If you’re struggling with insomnia, talk with your physician about options for relief. Prescription sleep aids may help in the short-term, but they should always be used with caution.  Changing your sleep habits will provide longer-term relief, and without unwanted side effects.

Exercise regularly. Research has shown that regular exercise – particularly aerobic exercise like brisk walking, jogging, or swimming laps, is just as effective for alleviating symptoms of depression as taking antidepressants.  Regular exercise can significantly improve mood during the transition into menopause. In one study, women who exercised had more positive moods and fewer cognitive difficulties than those who did not work out [4].

Expand your world. The life changes that sometimes coincide with menopause can create feelings of emptiness. For example, if you’re feeling overwhelmingly sad about your children “leaving the nest,” seek out activities that add positive “busy-ness” to your life. Consider boosting on-the-job skills by taking a relevant class, or take up a hobby you’ve always wanted to try.

Consider couples or family therapy. Menopause often coincides with changes in significant relationships. For instance, you may suddenly find the house empty of the children you had raised or charged with full-time care of an elderly parent. Couples who stayed together for their children or who’ve grown apart over the years may choose to separate or divorce at this stage of life.  These kinds of situations can strain your connection with a partner or other family members. Therapy can help you pinpoint the underlying issues and help you deal with them in a healthy manner.  As a result, you’ll feel more positive about life.

Menopause doesn’t have to be a dreaded transition.  Rather, it can be the beginning of a wonderful and exciting new chapter in your life.  If you’re struggling with symptoms of depression, don’t hesitate to get help.  You deserve to be physically comfortable and emotionally healthy. Consult your gynecologist and a mental health professional to discuss  the best options for getting your life back on track.

 

 

There is still hope.

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