Approaching menopause and depressed? How to handle the emotional roller coaster after 40

Almost 60 percent of women with a history of depression and a quarter of women who have never been depressed will have an episode related to menopause and should be ready.

About a quarter of women will develop depression as they approach menopause, even if they have never experienced it before, and need to be ready, experts insist.

Depression is more common among women, and we have known for some time that times of fluctuating hormones dramatically increase the risks of mood disorder.

While postpartum depression is widely discussed and examined, perimenopausal depression is too often swept under the carpet.

Even if they never have children, all women living in middle age will experience menopause, and a panel of scientists led by the University of Illinois at Chicago have finally read the first guidelines on perimenopausal depression.

An expert gave Daily Mail Online her own guide on why menopause can cause depression and what women (and doctors) can do to be prepared for change.

Almost 60 percent of women with a history of depression and a quarter of women who have never been depressed will have an episode related to menopause and should be ready.

Almost 60 percent of women with a history of depression and a quarter of women who have never been depressed will have an episode related to menopause and should be ready.


Between the ages of 45 and 55, women have their final period, which marks the end of the reproductive period and the beginning of menopause.

Women experience unique periods of hormonal fluctuation during puberty, pregnancy and menopause.

Twice as many women as men develop depression at any age or stage of life, and hormones play a role in this.

Of the 12 million women who experience depression at some point in their lives, almost 60 percent who develop depression during the younger years will have another episode in the perimenopausal period.

"There are environmental and biological factors" that lend themselves to depression, says the study's lead author, Dr. Pauline Maki of the University of Illinois at Chicago, and both should be addressed.


Menopause is an inevitable bodily change that upsets the previous balance of a woman's system.

As a woman ages, she begins to deplete her egg reserve and the functionality of the ovaries decreases.

"We think of this as when the ovaries close, and that's true, but many think that there is a steady decrease in estradiol created by them, but, in fact, we see dramatic fluctuations in estrogen," says Dr. Maki.

"It turns out that through the different events of life, the fluctuations in estrogen levels are linked to the interruption in mood, not absolute levels."

You take a period of hormonal vulnerability and you add the symptoms of sleep and the events of life, and it's a kind of perfect storm

Dr. Pauline Maki, psychiatrist at the University of Illinois at Chicago and author of the study

Estrogen stimulates the production of serotonin, which in turn helps regulate mood. Then, when estrogen levels are everywhere, serotonin and mood can also be destabilized.

Knowing that this can help women prepare for the fluctuations of mood that could come.

Although the new guidelines specify that hormone replacement therapy (HRT) will not treat depression itself, it can help minimize this change in serotonin.

"There are many misunderstandings about hormone therapy, but the benefits outweigh the risks," says Dr. Maki.

& # 39; Then, for women with concurrent symptoms [of menopause and depression]I do not want to be a pill driver, but hormone therapy is an option. "

Antidepressants are also an option, says Dr. Maki, and women and their doctors can discuss if we treat you prophylactically or if we wait until the symptoms appear.


Menopause is a significant life event for women, on a personal level, says Dr. Maki.

"Women are aging, they are no longer fertile, many are at the top of their careers, balancing the needs of parents who age more children and can be a period of marital stress."

While the underlying causes of depression include genetic and hormonal factors, most research suggests that stressful life events remain the most important risk factors for mood disorder.

"Women look at all these great changes in their lives at a time when the brain is more vulnerable than at other times in life," says Dr. Maki.

There is no way to avoid the stressors of menopause, but conversation therapy can help women cope with these changes and changes.

"Cognitive-behavioral therapy is a good alternative, because a pill will not help you come to terms with your aging," says Dr. Maki.


Hot flashes and especially night sweats are among the feared symptoms characteristic of menopause, and feeling miserable does nothing for a woman's mood or sleep.

"I would add that hot flashes interrupt sleep and that you and I both know that multiple nights of disturbed sleep are not good for our mood and our thinking," says Dr. Maki.

I do not know that the knowledge is there, oh, the perimenopausal depression is one thing & # 39;

In addition to the depression itself can lead to insomnia.

"You take a period of hormonal vulnerability and add the symptoms of sleep and life events, and it's a kind of perfect storm," says Dr. Maki.

Actually, the only way to get rid of night sweats is to take estrogen to balance the hormonal decline.


Unfortunately, Dr. Maki says that women and professionals seem to lack awareness of perimenopausal depression, as well as a willingness to discuss it.

"It's a moment of vulnerability," she says.

"Women do not like to talk about menopause openly, there is still a stigma about it."

Also, when it comes to postmenopausal depression, "I do not know if the knowledge is there," oh, this is one thing. "

The guidelines aim to change that, but beyond maintaining a good diet and exercising, women and their doctors must really work together to treat perimenopausal depression.

"As a vegetarian who loves yoga, we also review alternative approaches, try botanicals and other things that we think might work, but unfortunately there was no support for that," says Dr. Maki.

But exercise helps and, depending on the nature of the factors that contribute to depression, there are different ways to treat it.

This form of depression is "very complicated because it is biological, environmental, and particularly because it involves menopausal symptoms, but we have solutions," says Dr. Maki.