Depression is a debilitating, often complicated psychological condition that can affect people of any gender, race, age, nationality, fitness level, personality type, economic status or social background. Multiple factors associated with depression, whether they are emotional, physical or behavioral in nature, can act as triggers to create a depressive state in an individual not previously suffering from the condition, just as these same contributing factors can easily worsen or extend existing symptoms in someone who is already somewhat depressed.
It is estimated that a full 25% of the population will at some point in their lifetime experience the effects of depression, measured in a range of symptoms that run the gamut from very mild and manageable to severe and extremely dangerous. Yet there is both strong statistical data and convincing anecdotal evidence to suggest that perimenopausal and menopausal women may be particularly vulnerable to developing worsening states of depression as they go through the typical mental and hormonal changes associated with this significant stage of life.
Types of Depression
Although there are certainly many types and varying degrees of depression, there are four main categories of depressive disorder most commonly diagnosed in menopausal women. Because the term “depressed” is often used in an offhand manner to describe a temporary state of sadness or general malaise, it is important to understand that clinical, diagnosed depression is a genuine and longer-term mental concern, and that identifying its severity and symptoms during each stage of menopause can significantly improve the effectiveness of addressing and treating several other concurrent menopausal conditions.
Major Depression is a serious illness that leaves its sufferers feeling despondent, sad and isolated, with repercussions that are far beyond just having a “bad day” or “going through a rough patch.” Lasting for at least two weeks and often quite a bit longer, indications include intense feelings of overwhelming despair; physical exhaustion and lack of energy; conscious withdrawal from social activities, friends and family; loss of interest in activities that once brought a sense of order and pleasure; and negative thoughts that will not easily go away.
Dysthymic Disorder is a somewhat milder of version of Major Depression, but it is also quite debilitating and perhaps even more insidious because its subtler symptoms can be harder to recognize and can linger quite a bit longer; in fact, it is not unusual for this form of depression to last for two years or more.
Adjustment Disorder may be triggered by either the sudden shock or the gradual appearance of a particularly stressful turn of events; it can be acute and last for less than six months, or it can be chronic, lasting for years. Because it is directly connected to change that is difficult to process, accommodate or accept, it is no surprise that the hormonal imbalances, mood swings and new physical realities experienced during menopause are often associated with this type of depression.
Seasonal Affective Disorder (also known as SAD) is exacerbated by the lack of sufficient natural sunlight, most commonly experienced during late autumn and winter months. Its symptoms can be more gradual than other forms of depression, yet the lack of energy and general feeling of heaviness it brings can add significantly to depressive menopausal anxiety.
Symptoms of Depression
To distinguish between temporal discomforts and more serious indications of menopausal depression, it is helpful to refer to a kind of checklist. As a rule, depressive symptoms can be separated into three main categories of an emotional, physical or behavioral nature; in order to diagnose genuine depression, you must recognize a minimum of five symptoms (from any category) as present for at least two weeks, with one of these including either a persistent sadness or a pervasive loss of interest and pleasure. Symptoms include:
- General listlessness
- Feeling lethargic or weighed-down
- A sense of hopelessness
- Inability to concentrate or difficulty in making decisions
- Significant weight swings during a single month when not dieting
- Feeling guilty or even worthless for no specific reason
- Difficulty falling asleep
- Excessive sleeping
- Severe headaches or migraines
- Neglecting responsibilities
- Failing to keep up basic grooming and physical appearance
- Feeling generally “empty” inside
Causes of Depression
Like anyone else suffering from mental unease, pre-existing conditions for depression among menopausal women can include biochemical, genetic, environmental, disease and personality disorders. But, the predominant underlying cause of depression among women undergoing menopause can usually be traced to hormonal imbalance in general and decreasing levels of estrogen in particular. Estrogen plays an important role in regulating brain chemistry, and sharp decreases in the brain’s transmission of serotonin (known to cause feelings of happiness and mood stability), combined with increased production of cortisol (known as “the stress hormone”) can have a dramatic effect. With all these changes in brain and body chemistry, it is no coincidence that women aged 45 to 55 are four times more likely to experience depression than are pre-menopausal women.
Biomedical causes for menopausal depression often go hand in hand with emotional triggers when based on the same hormonal imbalances. The uncomfortable hot flashes, insomnia and increased anxiety caused by lowered estrogen levels, for instance, mean that just as a woman’s body is undergoing dramatic and often distressing changes, her anxiety levels rise and she may have trouble getting enough sleep, making it extremely difficult mentally to cope with physical changes as effectively as she once might have.
In our youth-oriented culture, strong changes in feeling about worth, purpose and self-image can cause a huge shift in the way women view themselves, their roles, their families, their jobs and often their life partnerships, which in turn can be a source of severe and complex physical and emotional turmoil.
When to Call a Doctor
Physical and mental changes that directly and seriously impact your quality of life have a noticeable impact on you everyday, often threatening your wellbeing, lessening any enjoyment or satisfaction you may feel while increasing your levels of stress, sadness and anxiety. When at least five symptoms of depression last for more than two weeks, and if persistent feelings of sadness or loss of interest and pleasure taint your normal outlook and impede your ability to function, it’s time to seek medical advice. A doctor can help you avoid over-treatment or “one size fits all” solutions by evaluating your individual condition and symptoms, then tailoring a treatment regimen to meet your specific needs.
Of course, in more extreme cases, anyone feeling suicidal or having suicidal thoughts should get in touch with a physical and mental health specialist immediately.
Lifestyle Changes for Depression
The first and simplest place to start addressing the symptoms of menopausal depression can be found in lifestyle changes. More than ever, it’s important during menopause that women find the time to take care of themselves by making sure they get enough sleep at night, eat healthy, well-balanced meals, keep an eye on drug and alcohol use, quit smoking if possible, engage in practices like meditation and yoga that encourage a strong mind-body connection and get regular physical exercise. Not only will including just three 30-minutes sessions a week of an aerobic activity like walking, jogging, cycling, rowing or swimming help boost mood-enhancing endorphins, but regular activity will help improve body health and image while easing some physical symptoms of menopause as well.
- Get a Full Night’s Rest – It is vital to get eight to nine hours of sleep to help reduce stress and depression and alleviate one’s mood swings.
- Stress Reduction and Relaxation - Relaxation exercises, meditation, breathing exercises, massage, hypnosis, yoga and visualization techniques are all wonderful ways to help stabilize one’s mood and minimize the effects of stress on your body during menopause.
- Get Regular Exercise – Physical activity releases endorphins, which improves one’s mood and reduces cortisol, the hormone related to stress. Exercising 20-30 minutes a day, three to four days a week, can help those suffering from mood swings forget about their emotions and focus on their energy and happiness. Studies show that exercise helps restore broken sleep patterns, which lead to anxiety, anger and irritability.
- Find a Support Group – Many women find it beneficial to talk about their feelings and issues surrounding their menopausal depression. Simply confiding in a friend, family member, therapist or a support group can be extremely helpful in improving one’s emotional health and reducing the amount of mood swings.
Treating Your Depression
Before taking prescription pharmaceuticals and hormone replacement therapies (HRT) that may cause serious side effects or even long-term consequences lasting well past menopause, many women are taking greater control of their treatment options by seeking more natural and alternative solutions to help regulate estrogen levels. This approach makes sense for a growing number of women who recognize that although up to 30% will experience some degree of depression during menopause, it is, after all, a natural and normal change in a woman’s body that may best be addressed by a combination of the least risky natural remedies, a sensible exercise program, joining a support group or online website community, and even a brief period of psychological counseling or therapy to share experiences and keep on a steady track.
- Vitamins - Changing one’s blood sugar levels can contribute greatly to emotional highs and lows. The mineral chromium (200 mcg) helps to regulate blood sugar levels and control one’s sugar cravings. Vitamin B complex (50mg) can help treat stress-related mood swings. Increasing one’s calcium intake (1000mg) and magnesium intake (500mg) can allow for the transmission of nerve impulses, which can decrease edginess and irritability.
- Tai Chi and Qigong – Tai chi and qigong exercises also help women to harmonize emotions by maintaining a better balance between yin and yang aspects of their bodies.
- Alternative Medicine – Chinese medicine (acupuncture and herbology) has been a long standing treatment for mood swings around the world. Acupuncture is a medical treatment involving the insertion of sharp sterile needles into the body at specific points according to a mapping of “energy pathways.” Acupuncture stimulates endorphins and neurotransmitters, including serotonin, which helps maintain a positive sense of well-being. Acupuncture also increases the levels of dopamine and norepinephrine, which reduces mood swing occurrences. Acupuncture removes energy blockages, stabilizes hormonal fluctuations and reduces mood fluctuations. The primary energetic imbalance that causes mood swings is liver qi stagnation.
- Black Cohosh One of the most commonly used herbal remedies is Black Cohosh, a perennial plant that is a member of the buttercup family. It provides powerful phytoestrogens that mimic the hormone’s effects and bind to hormone receptors in the uterus and other parts of the body, alleviating hot flashes. Black Cohosh is also known to relieve hot flashes efficiently and is a good alternative to HRT. It is also used effectively for treating PMS, arthritis and lowering blood pressure. Red Clover, Dong Quai, Ginseng, Kava and evening primrose oil can be used as natural therapies, although there are some risks involved. Herbal supplements are not as closely regulated as prescription drugs and the amount of the herbal product, quality and safety may vary between brands.
- Herbal Remedies – For emotional symptoms, blocking or reducing serotonin re-uptake has been proven to alleviate depression; but instead of taking prescription anti-depressants, one study found that natural licorice root derivatives inhibit re-uptake by up to 60%; St. John’s Wort is another popular, herbal remedy to regulate mood swings and mild depression. Soy isoflavones, when taken orally or via transdermal application, have been found to significantly reduce the incidences and severity of hot flashes and vaginal dryness as well. Finally, various helpful vitamin supplements can be taken to enhance the overall results of natural hormone regulating treatments, steady exercise and a healthy, fresh diet. The two different herbs for treating symptoms of depression are phytoestrogen and non-estrogenic herbs. Some of the most common phytoestrogen herbs are Saint Johns Wort, Black Cohosh and Dong Quai – all which contain estrogenic components produced by plants and replace some of the missing estrogen hormones experienced as a result of menopause. Although these herbs are known to maintain the balance of key neurotransmitters in the brain, they can also make your body less responsive to producing its own hormones, causing a further decrease of one’s hormone levels. Non-estrogenic herbs are known to nourish one’s hormonal glands into producing its own natural hormones. By stimulating one’s own hormone production, non-estrogenic herbs, such as Macafem. Macafem is grown in the Andes of Peru and has achieved great success in naturally increasing one’s hormone levels.
- Hormone Therapy Treatments (HRT) - For more severe cases of depression, women may seek surgical or pharmaceutical treatments, although it is important to keep in mind that there are many studies showing hormone replacement therapy (HRT) increases a woman’s risk of elevated blood pressure, endometrial and breast cancers, strokes, blood clots and gallbladder disease. It is advised to speak with your doctor or healthcare professional regarding the negative side effects before you begin treatment.