It's Not Just the Blues

Depression isn't a normal symptom of menopause, but it can be directly related. “Women in the menopausal transition are at increased risk of major depressive disorder.” Says Dr. Anita Clayton and Dr. Philip Ninan in their 2008 study. The objective of the study was to examine the risk of depression onset in peri-menopausal and postmenopausal woman, to discuss screening for Major Depressive Disorder (MDD) and look for therapeutic options to manage the symptoms of MDD.

Up to 25% of all women experience depression at some point in their lives, but seldom do doctors screen for this potentially debilitating disorder when speaking to their patients about menopause. It’s easy to focus on hot flashes and night sweats and lose sight of the less obvious symptoms that can come with menopause.

This same study concluded that “routine screening for MDD along with other menopausal symptoms in this at-risk population is crucial for effective management.”

I don’t know about you ladies, but my doctor never once mentioned screening for depression on any of my visits. I have suffered from bouts of MDD off and on since I was in my 20s, but I was always able to manage it with therapy and holistic methods like aromatherapy and meditation. But in the last year or two, the depression was more severe than I had ever experienced. At first I thought it was due to the combination of a stressful work environment and the normal mood swings associated with menopause. It wasn’t until I was spending multiple days a week in tears and having trouble working up the motivation to get out of bed that I realized this was something I couldn’t handle on my own. I tried therapy and it helped a bit, but my therapist suggested that medication was in order since my symptoms were so severe. I went to see my regular doctor and when I mentioned the depression she instantly prescribed an anti-depressant but still didn’t mention that this episode and the severity could be due to menopause. I don't think she knew it could be.

Major Depressive Disorder can frequently become disabling and the risk for MDD is approximately 1.5 to 3 times higher in women than in men. One theory suggests that decrease in estrogen in peri and postmenopausal women can drive the onset or worsen the pre-exisiting mood symptoms in women at risk of depression. Supporters of this theory point out that estrogen affects the brain levels of dopamine, norepinephrine, endorphins, and serotonin, all of which affect moods.* Add to that the fact that decreased estrogen levels are believed to be the culprit behind hot flashes and night sweats; which leads to sleep problems, which leads to daytime mood changes and so on until it’s a wonder that all menopausal women don’t suffer from MDD.

If you’ve ever suffered from depression in the past, you may be at higher risk of MDD during peri-menopause. Women with a history of depression are more than twice as likely to experience symptoms and nearly 5 times as likely to have an MDD diagnosis in the menopausal transition than women with no history of depression.

If you have any of they symptoms of MDD, please talk to your doctor. Not only have anti-depressants been shown to work, but estrogen therapy may be appropriate for improving the symptoms of depression.

Symptoms of MDD:

  • Depressed mood most of the day, nearly every day for 2 weeks or longer and/or

  • Loss of interest or pleasure in activities you typically enjoy

Other symptoms of MDD that can be confused with menopausal symptoms:

  • Fatigue or lack of energy

  • Restlessness

  • Feelings of guilt

  • Difficulty concentrating

  • Trouble sleeping or sleeping to much

“The recognition of MDD during the menopausal transition can be challenging given the constellation of symptoms and the overlap between depression and the transition to menopause.”*

Ask your doctor to do a thorough assessment to determine if your symptoms might be due to MDD. A proper diagnosis one way or the other is important to keeping your quality of life as good as it can be.


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