Many people think it is a myth that it is a normal phenomenon to have depression during the menopausal years. Mild depression can happen to just about every woman in menopause, but severe depression is not normal and should be treated like any other kind of depression.  

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Depression affects up to ¼ of all women at some time in their lives. This is a much higher number than is seen in men. Depression can be extremely debilitating, interfering with activities of daily living, like other physical disorders like depression and heart disease.  

While depression usually begins during a woman’s 20s, some women will develop their first episode of depression during menopause or even after menopausal symptoms have passed. This means that a woman can have depression at any point in her life.   

In some cases, the symptoms are more progressive and can lead to major depression, which is a more severe mood disorder. This is defined as having low mood, guilt, and other depressive symptoms that last for a minimum of two weeks.  

Women with premenstrual dysphoric disorder are at a higher risk of having an episode of major depression in the premenopausal years. Women with postpartum depression also carry a higher risk of menopause-related depression.   

Some women will have an episode of depression for the first time in perimenopause. There are several theories that have been identified that explain the increases in depressive symptoms during menopause. Traditional psychologists blame the increase in depression things like “empty nest syndrome” or other changes that occur in the middle age years.   

In recent times, researchers have changed their focus to include the biological effects of the fluctuation of emotions that occur when the ovaries begin to make less of the hormones estrogen and depression.  

Estrogen interacts with neurochemical in the brain that affect a woman’s mood. This decrease in estrogen in the premenopausal years can result in depression. Things like insomnia and hot flashes may also contribute to emotional distress.   

There have been many depression treatments proposed for depression during menopause but many of the research studies have not been done or have not been done correctly. Even so, many experts have their own methods of treating depression during menopause that work for most women. 

What is Major Depression? 

Major depression is a mood disorder that negatively affects an individual’s ability to have a normal mood. Mood disorders are generally not considered to be psychological but are believed to be changes in brain chemistry.  

Basically, there are biological illnesses. Heredity can play a big role in who gets depression in menopause and who does not. It can also be related to emotional stressors or to physical illnesses. Hormonal changes are a part of menopause that can similarly affect the mood.  

The primary symptoms of major depression include the following: 

  • Lack of pleasure or interest in activities of daily living or in those things usually enjoyed. 
  • A depressed mood on nearly every day for at least two weeks or more. 
  • Lack of energy or fatigue 
  • Feeling slower than normal or sped up and restless 
  • Feeling guilty or worthless 
  • Having problems with concentration 
  • Sleeping too much or suffering from insomnia 
  • Thoughts of suicide or death 

These mood disorders, such as major depression, are not a part of having a weak personality or being unstable. Instead, they are treatable illnesses for which psychotherapy and medication scan be prescribed.   

How is Depression Identified during Menopause? 

If you find yourself feeling depressed during the premenopausal or menopausal years, you should fist consider seeing a gynecologist to see whether your symptoms are related to hormonal changes during menopause.  

You may also need to see a mental health professional, such as a psychiatrist (or even your own family doctor); especially if you think you are suffering from a severe depression.   

As a part of the evaluation process, the doctor will likely do the following:  

  • He or she will take a careful history of any past depressive episodes you have had in the past and any symptoms you are currently happening. This includes physical and emotional symptoms.  
  • Do a physical examination and possibly run blood tests to see if the ovaries are working. Other blood tests, such as those of the thyroid gland, may also be taken.   
  • Ask you about life stressors that may be causing the depressive symptoms to be worse. 

Treatments of Depression in Menopause

The treatments used for depression depend on the severity of your symptoms and whether or not you have had previous depressive episodes. If the symptoms are found to be severe, antidepressant medications may be prescribed with or without the use of hormone replacement therapy. You may end up on an SSRI antidepressant (selective serotonin reuptake inhibitor) as well as on estrogen and possibly progesterone (depending on the status of your uterus).   

If your symptoms are somewhat mild and you have not been depressed before, there may be several treatment options. Hormones alone or antidepressants alone may be used to control the symptoms and relieve depression. Hormone replacement therapy has the added advantage of being able to control hot flashes as well as treating the depression.

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