Ask Dr. Pat · Menopause

Is It Depression or Menopause?

Dear Cynthia,

I am so sorry you are going through such a difficult time. Many of the symptoms you describe – low mood, trouble sleeping, being unable to concentrate, a loss of interest in things you used to enjoy – are consistent with depression. I would encourage you to see your primary care doctor or a psychiatrist for further evaluation. For over a century, we have identified an association between menopause and depressed mood and research suggests that up to 1 in 5 women experience depression at some point during menopause. A study released by the Centers for Disease Control and Prevention showed that you are in a particularly high-risk age group – women between the ages of 40 and 59 had the highest rates of depression of those surveyed.  Many suffering from depression don’t seek the help they deserve. Only about 1 in 5 individuals with moderate depression report seeing a mental health professional in the past year.

There may be a number of factors that contribute to the onset of depression during perimenopause. Hormonal changes occurring during this time – namely a decrease in estrogen and resulting spikes in the release of follicle-stimulating hormone (FSH) – likely play a role.  Estrogen modulates the effects of many neurotransmitters in the brain, including serotonin, dopamine, and norepinephrine, thus impacting our emotional responses to life’s experiences.

Those who have experienced depressed mood at other periods of hormonal fluctuation – during and after pregnancy, when on contraceptives or at certain points of their menstrual cycle – are particularly susceptible to experiencing depression during the menopausal transition. In addition to the hormonal changes, the resulting symptoms may contribute to depression as hot flashes and night sweats lead to trouble with sleep and result in fatigue and irritability. Finally, various psychosocial stressors can contribute to the onset of depression in this age.

Your next step should be to talk to your primary care doctor for a thorough work-up to ensure that there are no other health-related causes of your low mood, because many physical issues can cause a depressed mood. Once other causes have been eliminated, the diagnosis of depression brings with it the opportunity for treatment. Your options include both pharmacological interventions and psychotherapy. There are a number of antidepressants available and, if you choose to go that route, you can work with your doctor to find the one that’s right for you. Given that hormonal fluctuations seem to be part of what is driving the depressed mood during menopause, one might assume hormone replacement could be the panacea. However, research in this area has been equivocal. While some studies have demonstrated the benefit of hormone therapy either alone or in conjunction with antidepressants, others showed no additional benefit, when depression is the diagnosis. As with all medications, it is important to discuss the risks and benefits with your physician.

Another option is to start psychotherapy, which studies have shown is as effective as antidepressant medications, and is typically considered the first line of treatment for mild to moderate depression. In studies, no particular form of therapy has been shown to be better than others and thus it is important to find a therapist you trust and a technique you feel you can work with. An added advantage of psychotherapy is that the positive effects last long after you have stopped therapy, because you can continue to apply the skills you have learned.

Depression is a treatable illness. Please seek the treatment you deserve.

 

References
Gramann, SB.  Menopause and Mood Disorders.  Medscape. Updated Nov 9, 2015.
Brandon, AR, Shivakumar, G & Freeman, MP. Perimenopausal depression: Covering mood and vasomotor symptoms.  Current Psychiatry.2008,  7 (10).

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