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Depression

Depression is defined as persistent negative emotions that affect one’s ability to feel, think, or act.  An increase in depressive feelings may result in extreme tiredness; lack of energy; loss of interest in normal activities; sadness or an “empty” feeling; a sense of helplessness or hopelessness; feelings of guilt; or, difficulty in decision-making. In severe cases, symptoms may result in chronic insomnia or persistent thoughts about death. To be clinical in nature, depression will cause emotional or physical problems affecting daily life functions for a sustained period of time.

During menopause, up to 20% of women experience periodic depression.

The onset of depression tends to be more common during peri-menopause than post-menopause, and women who have a previous history of mental health troubles or clinical depression are at higher risk to developing depression during peri-menopause. The good news is that, as estrogen levels stabilize in post-menopause, mood related disorders experienced during the peri-menopausal stage normally recede in the absence of an underlying major depressive disorder.  It is important to recognize that peri-menopause is a time of vulnerability to depression for many women and it is important to seek help if you are suffering from any of these feelings.

The Lowdown on Depression

Why does this happen, how does it impact you, how is it diagnoses and common triggers/ risk profiles.

Depression and the mood-regulating aspects of a woman’s physiology is affected by hormonal fluctuations. A woman’s endocrine system (the system that regulates biological processes through hormone releasing glands) works with her nervous system (hypothalamic-pituitary system) to create physiological wellness. Any imbalance can result in physical and mental effects, and we know that peri-menopause alters the levels of estrogen, progesterone, and serotonin in a woman’s body.

Additional hormones affected by menopause that may cause troubles regarding neurotransmission, resulting in mood-based dysfunction, are progesterone and GABA. During peri-menopause, progesterone levels are declining and can lead to changes in a woman’s sense of emotional stability. When progesterone is metabolized, it produces GABA (a receptor agonist called Gamma-Aminobutyric acid) in order to regulate emotions, moods, and sleep. During times of lowered progesterone and GABA, anxiety, depression, and sleep disorders may increase.

Depression is linked to an increased risk of self-harm and social isolation

That’s why it is important that early indicators are assessed for an accurate diagnosis. If behavioral symptoms are interfering with normal daily activities, cognitive functions, or are disrupting relationships, it is important to seek a healthcare evaluation.Particularly if you are having suicidal thoughts or persistent thoughts about death, you may be experiencing the effects of depression and will benefit from early and accurate diagnosis and possible treatment alternatives. Depression is a common by-product of hormonal fluctuations and should not be associated with negative feelings of shame or deficiency. With compassionate medical treatment, clinical depression is manageable.

There are a few behavioral changes that may be triggered by, or positively correlated with, depression: Changes in appetite, slowed movements or speech, feelings of lack of worth or guilt. This is in addition to  other general menopausal symptoms that are often inter-related with depression are:

  • Mood swings
  • Anxiety
  • Irritability
  • Fatigue and/or lack of energy
  • Sleep disturbance, particularly difficulty falling asleep and oversleeping
  • “Brain fog” & difficulty concentrating
  • Decreased libido

Medical professionals have accurate diagnostic tests to evaluate self-reported symptoms. Doctors and therapists use a scale-of-severity testing method to determine if symptoms are chronic or temporary. 

Clinical diagnosis of depression, prior to or during menopause, involves the assessment of key characteristics. The DSM-V diagnostic assessment involves a series of self-reported answers to standardized questions. If a woman reports more than a threshold number of affirmative answers for a duration of longer than two weeks, she may be diagnosed with clinical depression requiring treatment. The existence of occasional depressive thoughts or cyclical (hormonal related) depressive episodes is not sufficient evidence to prove clinical depression, but you can still receive treatment.

The strongest predictor for depression during menopause is a prior depressive episode or period, particularly if it was related to your hormonal cycle. However, any women with a history of mental health diagnoses is at higher risk for developing menopausal depression. Vasomotor symptoms and anxiety are also known to modulate the risk for menopausal depression.

Mental health

Will this emotional rollercoaster ever end?

You might feel that PMS or menopause means you're destined for a life of gloom and doom. We are not going to lie for some women these years are not going to be pretty. But there is light at the end of the tunnel: most of these mood related symptoms are due to fluctuations in your hormones. So when you go through Menopause (average age 50-52) and your hormones stabalise, so will these symptoms.

In the meantime - get the help and treatment you need to weather this storm. Do NOT let perceived stigma, embarrassment or the all too common "its not that bad, I can handle this" stop you from getting help. These symptoms are real and there is effective treatment available.

Prevention and Treatment

Learn more about your options for prevention, management and treatment of Depression. This is not an exhaustive list of the treatment options available, but a good start.

Menopause can feel like an upside-down time of life, but it’s important to understand you are not alone, you are not going crazy and a variety of excellent treatment alternatives is available. In addition to the supplement and pharmaceutical alternatives described below, there are other therapies that have excellent efficacy rates, either in isolation or combination. Cognitive Behavior Therapy (CBT) and other forms of counseling, intentional reduction of life stressors, and engaging proactively in self-care activities are among the important alternatives to consider.

General guidelines for an optimal diet, whether experiencing menopause, clinical depression, or both, includes:

  • Adequate hydration at all times
  • Balanced foods, ideally focused on a Mediterranean diet (whole grains, fruits, vegetables, seafood, beans, nuts)
  •  Elimination of tobacco products
  • Reduction or elimination of caffeine and alcohol

Throughout menopause, a woman’s goal should be to lead a healthy and activate lifestyle to minimise the impact of menopausal symptoms. Regular aerobic exercise is a key component of this and necessary to maintain best-possible hormonal balances, body weight, muscle mass, bone density, and cardiovascular health. Exercise and a positive sense of mental wellbeing are closely related. Mood improvement has been shown to accompany even mild exercise routines such as daily walking.

‍During menopause, light-exercise (such as stretching, yoga, walking) was found to be positively correlated with a reduction in self-reporting of depression symptoms. Although moderate-to-intensive exercise may be associated with an increase in other menopausal symptoms, such as hot flashes, light-exercise did not lead to additional negative effects. 

There are many foods and nutrients that are felt to relieve feelings of depression, however they have not been adequately studied for women suffering from clinical menopausal depression. Some of these options include:

  • Ginseng (tea, powder, extract)
  • Maca root
  • Red clover (isoflavones)
  • Black cohosh 

There is limited clinical evidence that St. John’s wort (hypericum perforatum) is effective in treating mild and moderate depression. However, if you decide to take this it is imperative that you tell your doctor as St. John’s wort can interact in dangerous, sometimes life-threatening ways with a variety of  medicines.

Currently there are no scientifically proven effective over-the-counter products for the relief of depression.

For hormone related depressive symptoms, antidepressant medication in combination with lifestyle improvements, alternative therapies, and/or hormonal treatments can be effective. When speaking to your physician you should make sure s/he is fully informed regarding all prescription and non-prescription drugs being taken before an accurate and safe antidepressant regime can be prescribed.

  • The most commonly prescribed medication for anxiety and depression are SSRIs and SNRIs. Both are frequently referred to as antidepressant medication, even though they’re effective and therefore prescribed to help manage a range of mental health related symptoms. Please note that these medications take time to reach effectiveness and it is important to work closely with your doctor to establish optimal dosage. For more in depth information on how this type of medication works, the difference between SSRIs and SNRIs and side effects please refer to this article. 

It is unclear how HRT improves mood and relieves depression, but estrogen levels are related to the neurotransmitters in the brain which control everything from body temperature to sleep regulation. There are three types of hormonal treatment options that have been clinically proven to help women suffering from hormone related depressive feelings: 

  • Oral contraceptive pills - frequently prescribed to women in pre and early peri-menopause. 
  • Hormonal Replacement Therapy (HRT) - is prescribed to women that are peri-menopause or post menopausal. 

FAQs

Is (periodic) depression common during peri menopause?

During menopause, up to 20% of women experience periodic depression. The onset of depression is more common during peri-menopause than post-menopause, and women who have a previous history of mental health troubles or clinical depression are at higher risk of developing depression during peri-menopause.

Am I at risk for depression if I have another mental health disorder?

The strongest predictor for depression during menopause is a prior depressive episode or period, particularly if it was related to your hormonal cycle. However, any woman with a history of mental health diagnoses is at higher risk for developing menopausal depression. Vasomotor symptoms and anxiety are also known to modulate the risk for menopausal depression.

Is acupuncture helpful for menopausal depression?

In traditional Chinese medicine, it is believed that the body has a flow of energy or qi that regulates your health. If the flow is disrupted, you’ll feel ill. Applying needles to specific acupuncture points, called meridians, rebalances your energy flow and improves your health.

There is some research supporting the effectiveness of acupuncture as a treatment for depression, Peri-menopausal Depressive Disorder (PDD) and the strengthening of estrogen receptors.

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