The Truth About Menopausal Depression

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Section: Talk to the Doctor Several friends are warning me that I'll probably get depressed when I reach menopause, like they did. I know about the hot flashes, but is depression part of this midlife surprise package too?
One of the old wives' tales surrounding menopause is that it inevitably leads to depression. Let me reassure you, however, that the majority of women do not become depressed at menopause. In fact, many women feel happier and more fulfilled at this time of their life than at any other.

But enough women complain about feeling "not themselves" or depressed during this time that some research- ers have begun to look at whether or not there's a connection between the hormone estrogen and mood changes at menopause.

What's the Estrogen Connection?
Fluctuating estrogen levels may play a role in the mood changes that some women report at menopause. They may even make certain women more susceptible to depression at this time. Although this relationship isn't completely understood, there is evidence to suggest that estrogen may have a direct or indirect effect on increasing certain chemicals or neurotransmitters in the brain that are known to regulate mood and cognitive function.

Some studies have shown that giving estrogen to women during perimenopause-the transition to menopause during which menstrual periods become irregular and hot flashes may start--has helped reduce their symptoms of depression. Other studies have suggested that estrogen improves mood in postmenopausal women who feel depressed.

Women are more likely than men to become depressed during their lifetime, leading some researchers to suggest that women are more vulnerable because of their hormones. Premenstrual syndrome and postpartum depression are examples of how hormonal changes can affect mood. Much more research needs to be done to confirm a hormonal basis for depression in women.

Get the Right Diagnosis
When a menopausal patient comes to me complaining of depression, it would be equally tragic for me to just chalk it up to rapidly changing hormone levels and prescribe estrogen as it would be to treat it with an antidepressant. Treatment must be tailored to the individual by trying to attribute the depression to the most likely cause. Here are some of the common causes:

Untreated hot flashes and night sweats can lead to sleeplessness, which results in irritability, depression, and loss of an overall sense of well-being. "Trying estrogen replacement for a month or two will often solve the problem of sleep deprivation and restore a sense of well-being in postmenopausal women," says Neill Epperson, MD, assistant professor of psychiatry at Yale University School of Medicine. Exercise, too, has well-known, positive effects on mood and can even help reduce hot flashes and improve sleep.

An underactive thyroid, or hypothyroidism, can cause feelings of depression. A simple blood test for thyroid-stimulating hormone can tell me if this is the problem. If it is, it can be easily corrected by putting the patient on thyroid medication.

Certain medications for hypertension can make a person feel depressed. If you've recently started taking a beta blocker, speak with your doctor about switching to a different medication or altering the dose.

Stressful life events, whether coping with aging parents, kids going off to school, career changes, divorce, or financial problems, often hit at midlife. Any one of these factors can be stressful, and more than one would put a crimp in even the happiest outlook. "People often have very good reasons to feel depressed, and therapy and/or antidepressive medication can help them cope," says Dr. Epperson.

Clinically significant depression goes beyond the normal feelings of sadness to include persistent low mood and energy level, decreased appetite, changes in sleep patterns, and anxiety. It's important for a physician to recognize the signs, because clinical depression is best treated with a combination of psychotherapy and medication-not with estrogen. Women with a history of depression seem to be particularly susceptible to another depression at menopause.

Quick Tip Strength training is equally as effective as aerobic exercise in relieving depression.

PHOTO (COLOR): No lie: Menopause can put a smile on your face.

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By Mary Jane Minkin, MD, board-certified obstetrician/gynecologist in New Haven, CT, clinical professor at Yale University School of Medicine, and co-author of What Every Woman Needs to Know about Menopause (Yale University Press, 1996).

Adapted by MD and EdD

with Toby Hanlon, EdD,

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