Menopause Blues: Is it Depression?

Menopausal woman sitting at table with tea cup looking depressed
Are you struggling with menopause blues or are you depressed?. Cultura RM\Steve Prezant/Cultura/Getty Images

You've probably heard that mood changes are a normal part of the change of life or menopause. So how can you know if your symptoms are normal or if, instead, you have clinical depression?

Perimenopause and Menopause

As you enter into perimenopause you may find that you are more irritable, sad, angry, negative, or restless. How can you tell whether these are just temporary blips on your emotional radar screen or symptoms of a more serious mental health problem?

After all, it's thought that upwards of 40 percent of women have at least some depression symptoms during menopause.

While most women go through menopause without becoming depressed, a significant number will experience depression either as a recurrence of previous depression, or for the first time in their lives. Depression can make coping—with menopause and with life in general—very difficult or impossible. It impacts relationships, work performance and your quality of life.

Your Menopause Calendar

The first step in distinguishing "normal" menopause from depression is to pay attention to your mood. If you (or friends or family members) notice that you seem more down, ill-tempered, apathetic or pessimistic than usual, it may help to keep track of your moods. Start a calendar or journal and track your mood, activity level, major life events, other menopause symptoms and menstrual cycle for a period of three to four months (but don't wait this long if you think you may be depressed.) This is a useful tool to track your passage through menopause, and will come in handy if you decide to talk your symptoms over with a professional.

It is also a good reality check so that you can judge whether you actually are feeling sadder or more crabby than usual.

What is Depression?

Clinical depression, also called “major depression,” is a serious condition characterized by intense sadness or despair that lasts more than two weeks, and that interferes with your daily life.

It is possible to minimize the symptoms for a long time before you realize it is stealing your enjoyment of life.

Causes of Midlife Depression

There are many reasons that women may suffer from depression after the age of forty. Some of them are biological, some are situational, and some are psychological. A few common factors in midlife depression are:

Hormone changes. Decreasing levels of estrogen and progesterone can upset the levels of neurotransmitters like serotonin (the "feel good" chemical in the brain), which in turn affects mood, sleep and appetite.

Response to loss. Loss of parents, children leaving home, divorce, friends lost to illness, loss of youth, or poor health—any one of these might trigger an extended grief response that could turn into major depression. (Learn about the similarities and differences between grief and depression.)

Medical conditions. Some medical conditions can make you more likely to suffer from depression. Women with heart disease, thyroid dysfunction, sleep disorders, seasonal affective disorder, or a previous head injury can be prone to major depression.

Drug and alcohol use. Alcohol and opiate pain medications are depressants. If you regularly use these substances, they can interfere with hormone activity, and can have the side effect of depression symptoms. Alcohol can also worsen hot flashes and night sweats, adding sleep difficulties to your list of things to cope with. Although it is tempting to ease your emotional pain with an extra glass of wine or other drugs, they can actually make your symptoms worse and make it harder to sort out whether you are depressed. If you are dependent on a daily dose of alcohol or other drugs, talk to your medical provider about getting off them safely so that you can see whether they are contributing to depression.

Age of Depression and Menopause

Studies looking at the age of menopause and depression have found that a later age at menopause and a longer reproductive period are associated with a reduced risk of depression, and it's felt that longer exposure to estrogen produced by the body is the reason. Those who go through early menopause appear to be at an increased risk of depression and should talk to their doctors about this possibility.

Symptoms of Depression

If you suspect you might be depressed, talk to your medical provider. Keep track of your symptoms for awhile and take that “Menopause Calendar” with you to your appointment. Any of the following could be signs that you are dealing with major depression:

  • Feelings of sadness, hopelessness or despair that last longer than two weeks
  • Feeling very tired, or tired all the time
  • Feeling guilty or worthless
  • An increase or decrease in appetite or weight
  • Loss of enjoyment in activities that you have enjoyed in the past
  • Loss of interest in sex
  • Feeling restless or “slowed down”
  • Trouble concentrating
  • Trouble sleeping, or sleeping too much
  • Thoughts of hurting yourself or dying

Anyone can have a day or two of feeling sad or down. And grief following a major loss is normal for up to a year. But if these symptoms become an ongoing norm for you, talk to a professional about it. You could talk to a medical provider, psychologist, counselor or other professional about whether your sadness or symptoms are normal.

Who’s at Risk?

Menopause is a vulnerable time for women. If you are one of those women who is particularly sensitive to hormone changes, or if you have suffered many losses or life changes in recent months you could be at risk for depression. Early perimenopause is a particularly vulnerable time because your body has not yet adjusted to the hormone shifts. The woman at highest risk for menopausal depression is one who:

Treatments for Depression

There are many ways you can improve depression. Talk it over with your medical provider or counselor. He or she may recommend one of the following, or a combination.

Medications. There are many medications that can be helpful to relieve depression. You may not have to be on it for a long time, but medication can offer great relief to the biochemical chaos that menopause sometimes brings. If one medication has side effects that are uncomfortable for you, there are many choices.

Therapy. Two types of therapy are often recommended for women with depression. Interpersonal therapy helps you see how relationships impact and contribute to your depression, and how changing your style of relating can change your symptoms. Cognitive behavioral therapy looks at your beliefs and perceptions, and helps you reframe them so that you see situations in a more realistic and positive way. Both types of therapy are short term, and problem oriented. They have been shown to be very effective with depression, especially when combined with medication.

Exercise. Exercise has a proven impact on mood. Regular aerobic exercise like walking, running, rowing or swimming can help elevate your mood. If you add vitamins and light (walk outside!) it is even more effective.

The Double Edged Sword of Depression

Depression can be life threatening. And at the very least it threatens your happiness and sense of well being. The irony is that sometimes depression lowers your energy so that even if you know you are depressed, you don’t have the energy to get help. If you, or a close friend or family member, suspect that you are depressed, ask someone to come along with you to your appointment. Or if even that is too much, ask a friend, partner or other family member to make the appointment for you. Then keep that appointment. When menopause is swinging your mood to the dark side, you may need help to sort through your symptoms and get back on a positive track.

Bottom Line on Menopause and Depression

It can sometimes be difficult to distinguish depression from the ups and downs of mood that goes with menopause. If you are reading this article you have taken the first step in helping you to separate the two, and find help for your symptoms either way. Treatment is possible, and with depression symptoms controlled, many women find the menopausal years to be refreshing and freeing. If you believe you may be depressed, talk to someone today.

Sources:

Georgakis, M., Thomopoulos, T., Diamantaras, A. et al. Association of Age at Menopause and Duration of Reproductive Period With Depression After Menopause: A Systematic Review and Meta-Analysis. JAMA Psychiatry. 2016. 73(2):139-49.

Green, S., Key, B., and R. McCabe. Cognitive-Behavioral, Behavioral, and Mindfulness-Based Therapies for Menopausal Depression: A Review. Maturitas. 2015. 80(1):37-47.

de Kruif, M., Spijker, A., and M. Molendijk. Depression During the Perimenopause: A Meta-Analysis. Journal of Affective Disorders. 2016. 206:174-180.

Weber, M., Maki, P., and M. McDermott. Cognition and Mood in Perimenopause: A Systematic Review and Meta-Analysis. Journal of Steroid Biochemistry and Molecular Biology. 2014. 142:90-8.

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