Hot flashes, night sweats, decreased libido, weight gain, and fatigue; most of us are familiar with these typical signs of menopause. But fluctuating hormones and challenging symptoms can also lead to more serious side effects like depression.
This less talked about aspect of menopause affects more than 40% of women. Compare that to the national average of just over 18% for the general population, and the difference is clear to see.
But why does depression disproportionately affect menopausal women? And what changes can we make to alleviate the symptoms and reduce our risk factors for developing this mental health condition?
In this post, we’ll be taking a deep dive into the links between menopause and depression. We’ll find out why it happens and who is most at risk. Plus, we’ll also examine some of the treatments, therapies, and lifestyle changes that can help you stave off the menopausal blues.
What is Depression?
Depression is a psychiatric disorder characterized by feelings of sadness and hopelessness. It encompasses a wide variety of psychiatric and physical symptoms, including:
- Prolonged periods of low mood. Feeling sad and down without an obvious cause for more than a few days or weeks.
- Low self-esteem. A lack of confidence in your own ability and persistent negative thought patterns about your self-worth.
- A lack of motivation. Struggling to put thoughts into action, and a lack of interest in goals you once strived towards.
- Social isolation. Withdrawing from friends, family, and colleagues and craving more time alone.
- Tearfulness. Uncontrollable crying episodes and bouts of tearfulness, often at unexpected moments throughout the day.
- Irritability. Becoming less patient and tolerant of others. You may snap or lash out at family and friends and experience disproportionate anger and agitation.
- Difficulty making decisions. Spending an excessively long time agonizing over decisions that seem inconsequential to others.
- A lack of pleasure and enjoyment. Activities you once loved no longer give you pleasure or interest like they once did.
- Anxiety or worry. Excessive and disproportionate feelings of fear, worry, or dread about the future.
- Appetite changes. Over or undereating, which can lead to unintentional weight gain or weight loss.
- Changes in sleeping patterns. Insomnia; struggling to fall asleep at night or waking up and being unable to go back to sleep. Others may develop hypersomnia and sleep more than usual, often throughout the day.
- Lack of energy. Exercise feels more laborious. Usual day-to-day tasks feel difficult or even impossible to accomplish.
- Self-harm and suicidal thoughts. Harming yourself or thinking about/making plans to end your own life is the most serious symptom of depression. If you or a loved one is experiencing this symptom, seek help immediately. Call 911, go to the nearest hospital emergency room, or call the 24-hour Suicide and Crisis Lifeline on 988.
How is Depression Linked to Menopause?
If you’re approaching menopause and you’re feeling low, you’re not alone. Many women notice a change in their mood and happiness levels during perimenopause. Mood swings are a common and well-documented symptom.
However, clinical depression can be much more serious. Some women with a historic or pre-existing diagnosis find that their symptoms return or become more exaggerated and pronounced as they go through this transitional time.
Hormonal shifts are the driving force behind both the physical and physiological symptoms of menopause. They are the reason why so many women experience hot flashes, night sweats, insomnia, and mood swings. And while the evidence isn’t definitive, some research suggests that fluctuations in hormones are also a major cause of perimenopausal depression.
Lower levels of estrogen are linked to feelings of fatigue, sadness, and irritability. Plus, a decline in estrogen levels can lead to a decline in serotonin, the so-called ‘happiness hormone’ that helps to balance our moods.
Besides the obvious hormonal shifts, there are a variety of other factors at play that can contribute to depression or depressive episodes.
Menopause is a challenging time for many women. The changes in our bodies and psyche can cause us to change the way we see ourselves and disengage with those closest to us. All these things can make us more vulnerable to developing depression.
What to Do If You Think You Have Depression
If the symptoms listed above are familiar to you, visit your doctor or a mental health professional.
They can evaluate the stage of your menopausal journey and your psychiatric condition.
Remember, depression is treatable, no matter what the cause. There is light at the end of the tunnel and a whole range of treatments, therapies, and interventions that can help.
Lifestyle Changes for Perimenopausal Depression
Small lifestyle changes can make a big difference to pre-existing symptoms of depression. Following a healthy lifestyle can also lower the risk of developing perimenopausal depression in the first place.
So, before turning to prescription medications, consider the following:
Eat a Balanced and Nutritious Diet
A diet laden with sugar and refined carbohydrates puts you in the danger zone of developing depression. Overconsumption of sugar will also increase symptoms in women with preexisting perimenopausal depression.
So, cut back on the sweet stuff and instead opt for healthy fats, proteins, complex carbs, and fresh vegetables.
Other dietary elements to consider are
- omega-3 fatty acids (found in oily fish, nuts, and seeds)
- tryptophan (found in turkey, eggs, salmon, and spinach)
- probiotics (found in fermented foods and yogurt)
All these compounds are proven to have beneficial effects on mood and reduce the symptoms associated with clinical depression.
Get Regular Exercise
When you’re suffering from depression, exercise might be the last thing you feel like doing. But getting active is one of the most effective ways to boost your mood and beat the perimenopausal blues.
If getting started feels impossible, take baby steps at first. Go for short walks, and gradually build up the time and intensity as your mental and physical health improves.
According to the American Heart Association, adults should aim for at least 150 minutes of moderate-level aerobic exercise, or 75 minutes of vigorous aerobic exercise, each week. This will keep your endorphins flowing and serotonin and dopamine levels high. Plus, your physical health will greatly improve too.
Pick Up a Stress-Relieving Hobby
Stress and depression go hand in hand. Being chronically stressed is one of the leading risk factors for developing clinical depression, not just during menopause but at any time in your life. So, consider picking up a stress-busting hobby or practice, for example, tai chi, yoga, or meditation. All three of these disciplines are proven to promote relaxation and help you feel more grounded and connected in the present.
Plus, these practices can balance your levels of cortisol. So, you won’t just de-stress. You’ll sleep better, too.
Cut Out Unhealthy Habits
Smoking cigarettes, drinking alcohol, and overconsumption of caffeine are all risk factors for developing depression. Plus, these habits can make a pre-existing case of mild depression much worse.
So consider limiting your daily coffee intake. And if excess alcohol and tobacco are part of your life, talk to your doctor to find programs and treatments that can help you quit.
Get in Touch With Nature
Studies show that spending time in the great outdoors has a hugely positive impact on our mental health. The scientific consensus is unanimous; a connection with nature is a powerful antidote to depression. It makes us happier and gives us a sense of purpose and well-being.
Of course, we’re not all lucky enough to have a forest right on our doorstep. But even if you live in a busy city, nature is never far away. Consider taking a regular stroll around your local park or volunteering with a community gardening group.
Menopause is a time of change. But for many women, it’s not just physical and psychological changes that fluctuating hormones bring. Menopause often coincides with other major life changes, such as children flying the nest or parents passing away. All of these stressors can trigger feelings of isolation, disconnect and leave us questioning our place in the world.
As human beings, we all need community and a sense of belonging. Feeling connected is integral to our well-being. But in our busy 21st century lives, it has become easier than ever to become disconnected.
So, it’s important to reach out to others. Consider joining a community group of like-minded people, or volunteer your time at a local soup kitchen. Activities like this can help you to heal your heart and remind you that you’re not alone.
Alternative Medicine for Perimenopausal Depression
Over-the-counter herbal supplements are safer and gentler than prescription medications. However, they can still carry risks, especially when combined with other medications. So, always speak to your doctor before adding a new supplement to your routine.
Several over-the-counter herbal supplements are thought to help treat depression, including:
When taken daily for 6-12 weeks, Rhodiola has been shown to reduce symptoms of depression and increase stress tolerance. It works by activating neurotransmitter receptors in the brain and calming the hypothalamic-pituitary-adrenocortical (HPA) axis.
N-acetylcysteine (NAC) is the supplement form of cysteine, an amino acid that occurs naturally in the body.
When NAC bonds with glutamine and glycine, it forms a powerful antioxidant that is essential to both our physical and mental health. Regular supplementation of NAC can help to reduce inflammatory markers and ease many of the symptoms of depression.
S-Adenosylmethionine (SAMe) is a naturally occurring, sulfur-rich molecule produced in the body that contributes to healthy brain function.
Recent studies show that regular supplementation of SAMe can significantly improve symptoms of major depressive disorder (MDD), both when used alone and in conjunction with prescription antidepressant medications.
St. John’s Wort
St. John’s wort is a medicinal plant native to Europe and Asia that has long been used to treat the symptoms of depression. Its chemical compounds act in a similar way to pharmaceutical antidepressants. It works by boosting neurotransmitters such as serotonin, dopamine, and noradrenaline. Some research suggests this powerful herb could be as effective as prescription medication. Plus, it has far fewer side effects.
Phytoestrogen Foods and Supplements
Phytoestrogens are estrogenic compounds found in plants. They mimic the role of naturally occurring estrogen in the body.
So, phytoestrogens can play an important role in alleviating the symptoms of perimenopausal depression linked to low estrogen levels.
Thanks to their hormone-balancing properties, phytoestrogens can also aid with other symptoms of menopause. These include hot flashes, night sweats, and insomnia.
You can find phytoestrogens in herbal supplements. These include black cohosh, chaste berry, and dong quai. It’s also available in certain foods, including soy, flaxseeds, lentils, and oats.
Medical Treatments for Perimenopausal Depression
If lifestyle changes and natural supplementation aren’t enough, visit your doctor. They can refer you for therapy or prescribe prescription medication, or both.
Psychotherapy for Perimenopausal Depression
Psychotherapy is the preferred medical treatment for most forms of depression due to the low risk of side effects.
The main form of therapy used for perimenopausal depression is cognitive behavioral therapy (CBT). CBT is a talking therapy. It helps patients to identify patterns of thoughts and behaviors that no longer serve them and replace them with new ones which do. It’s been shown to be highly effective for treating mild to moderate depression across all adult demographics, including women with perimenopausal depression.
CBT is a relatively short-term therapy that can provide lasting results in just a few sessions.
Alongside therapy, your doctor may prescribe antidepressant medication. These include:
- Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are the most commonly prescribed antidepressants. They work by blocking serotonin reuptake via neurotransmitters in the brain. This results in increased serotonin levels.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
SNRIs are another commonly prescribed antidepressant that works in a similar way to SSRIs. However, they also block the reuptake of norepinephrine, another important hormone that regulates emotional health.
Other less commonly used antidepressant medications include tricyclic antidepressants, which increase the bioavailability of serotonin and norepinephrine, and monoamine oxidase inhibitors (MAOIs). MAOIs block a naturally occurring enzyme called monoamine oxidase which destroys the mood-boosting neurotransmitters serotonin, norepinephrine, and dopamine.
- Hormone replacement therapy (HRT)
HRT works by replacing the reproductive hormones estrogen and progesterone, which are lost during menopause. It was once the go-to medication used to treat perimenopausal symptoms, including mood swings and depression.
Yet, in recent years, new research has come to light suggesting HRT has serious side effects, including a link to strokes and certain types of cancers.
So, while some doctors still prescribe HRT to treat the physical and psychological symptoms of menopause, it is unlikely to be their first choice.
Anxiety and depression are both associated with menopause. But while the two conditions have many overlapping features, they are also distinct from one another.
Anxiety is characterized by worry, nervousness, and racing thoughts. It’s a more energetic disorder that is driven by fear or perceived danger. Depression, on the other hand, is apathetic and sluggish. It is characterized by sadness and a lack of motivation and energy.
Often, women going through menopause will present features of both anxiety and depression. But it’s important to understand the differences between the two.
Mood swings are a commonly reported side effect of menopause, and they go hand in hand with symptoms of depression.
But while menopausal mood swings are a temporary state of emotional turbulence, depression is a longer-lasting condition. Mood swings come in waves and pass quickly. They can involve feelings of sadness and despair, but they are often swiftly replaced by other emotions, such as irritation, anger, and even joy.
To really tell the difference between mood swings and depression, you need to wait a while. If feelings of sadness, hopelessness, and fatigue last for more than 2 weeks, it’s likely that they are down to depression.
Like many conditions and illnesses, research shows that depression can indeed run through multiple generations of the same family. And the same applies to menopause-related depression too.
So, if your mother struggled with depression during her menopausal transition, this puts you at an increased risk.
However, your fate is certainly not sealed. There are plenty of ways you can bolster your mental health. By keeping your mind and body as healthy as possible throughout perimenopause and beyond, you are setting yourself up for success.
Menopause is already a challenging time. But dealing with depression alongside other symptoms like hot flashes and night sweats can feel overwhelming.
Thankfully, the hormonal upheaval experienced during perimenopause is temporary. Once your periods have stopped for more than 12 months, many of the most unpleasant symptoms will begin to settle. So, if you’re a perimenopausal woman suffering from a bout of depression, rest assured that there is hope ahead.
In the meantime, try to put in place the lifestyle changes discussed in this post. Getting regular exercise, spending time in nature, eating well, and generally taking care of yourself can be even more powerful than prescription medication.
That being said, if you think you might have depression, don’t be afraid to talk to your doctor. They can diagnose the problem, help you identify the triggers, and work with you to find a treatment plan that will help.
- The prevalence of depression symptoms and influencing factors among perimenopausal and postmenopausal women – PubMed (nih.gov)
- National, State-Level, and County-Level Prevalence Estimates of Adults Aged ≥18 Years Self-Reporting a Lifetime Diagnosis of Depression — United States, 2020 | MMWR (cdc.gov)
- Perimenopause and Depression | Anxiety and Depression Association of America, ADAA
- Interactive effects of estrogen and serotonin on brain activation during working memory and affective processing in menopausal women – PubMed (nih.gov)
- Antidepressants for Menopause: Benefits, Types, Side Effects, and More (healthline.com)
- HRT and breast cancer: Risk, prevention, and alternatives (medicalnewstoday.com)
- 10 Best Herb Supplements for Depression (healthline.com)
- S-Adenosylmethionine (SAMe)
- St. John’s Wort for Depression (healthline.com)
- Sugar: What Is Its Relation to Depression? (webmd.com)
- Nurtured by nature (apa.org)