By Wendy Klein, M.D., and Staness Jonekos
Q: I am perimenopausal and feeling extremely depressed. I feel blue for no reason at all and I can’t snap out of it. Is depression a symptom of menopause?
A: Most perimenopausal women do not experience major depression, but many have symptoms of feeling depressed, stressed, and anxious. If you are experiencing menopausal symptoms such as severe hot flashes and lack of sleep from night sweats, they may be causing you to feel depressed.
The most common signs of depression are feeling sad, feeling worthless, and losing interest in whatever normally engages you. Other symptoms include the loss of libido, changes in appetite – too much or too little – feeling very sleepy and fatigued, or having insomnia and not being able to sleep. A common sign of depression is a change in your normal habits.
A more serious symptom of depression is a sustained loss of interest in activities that you normally enjoy. This is called dysthymia. Life seems really bleak. If the condition lingers or if you have thoughts that are scary, such as wanting to give up or wanting to hurt yourself or even suicidal thoughts, you must talk to your clinician because there are treatments and strategies that can help you.
There are many factors that can cause an increased risk for depression. If you have depression in your family, a prior history of depression, or you're taking certain medications, you may be prone to depression. Some endocrine disorders such as hypothyroidism, or other illnesses such as chronic fatigue syndrome are also associated with depression.
Depression is an illness that can be triggered by the chemicals in your brain. Serotonin regulates your moods. It is the “feel good” hormone. When serotonin levels drop, you can experience extreme episodes of depression.
You also want to look at lifestyle stressors – a change in relationship, finances, loss of a loved one, caring for parents – and consider the many modalities of treatment that are available to help you.
Your approach to depression in menopause is the same as it would be at any other time. First you want to rule out medical causes or medications that might be contributing to your low moon.
A number of options are available including psychotherapy and antidepressants to assist you if you are suffering from depression. There are degrees of depression. Mild depression, feeling blue or sad, can be dealt with through cognitive therapy, psychotherapy, meditation, yoga, healthy eating, and exercise. An active lifestyle boosts your endorphins and lifts your mood. Also, engaging in new activities may help. Try making yourself take classes and getting out and doing interesting activities. Also, enlist the support of your family and friends.
If you have continuing or worsening symptoms, you may need medication because we know that depression can be a malfunction of your neurotransmitters, particularly serotonin, which is the feel good neurotransmitter. Medicines can be enormously helpful although you will want to incorporate lifestyle changes as well. If you need medication, in the broader context of menopausal symptoms, there is some evidence that hormone therapy can augment treatment and help people who are on anti-depressants feel even better. That is a decision for you and your clinician.
Wendy Klein, M.D., is co-author of the book "The Menopause Makeover" and a national leader in women’s health. She is Associate Professor Emeritus of Medicine, Obstetrics & Gynecology at Virginia Commonwealth University School of Medicine. Dr. Klein cofounded the VCU Institute for Women’s Health and created their Women’s Health Residency Program which is lauded as one of the best such programs in the United States.
Staness Jonekos is an advocate for women's health, wellness and empowerment. An award-winning television writer, producer, and director, she was one of the original executive producers who launched the television network Oxygen Media, cofounded by Oprah Winfrey. She is also the co-author of "The Menopause Makeover." For more information, visit www.MenopauseMakeover.com. You can also follow her on www.twitter.com/staness.