The link between depression and menopause 

This piece was originally published on Elektra Health.

Menopause can be a tough transition that impacts many aspects of your life. Many people find this stage of life difficult to cope with — so if you’re noticing that your mood has changed lately, you aren’t alone.

Mood swings and feelings of anxiety and sadness are common during perimenopause. Like most other symptoms, they can be associated with fluctuating hormone levels, specifically estrogen, progesterone, and serotonin. However depression during this time of life can also occur for reasons other than menopause. Here’s what you need to know about the link between depression and menopause. 

How your hormones play a role 

Estrogen and serotonin

The production of estrogen is correlated with serotonin, a neurotransmitter that acts as a “happy hormone” by reducing anxiety and fostering feelings of wellbeing. So as estrogen levels fluctuate during the menopausal transition, this can disrupt serotonin pathways, which can affect mood.

Progesterone and GABA

Progesterone is the “calming hormone” that may also influence Gamma-Aminobutyric acid or GABA for short. GABA is a neurotransmitter that produces a calming effect when it binds to its receptors. Progesterone increases the effects of GABA, so lower progesterone levels during perimenopause may result in less GABA-like activity, which then increases the chances of mood swings, anxiety, and sleeplessness.

Women between the ages of 40 and 55 are more likely to report depressive symptoms than premenopausal or postmenopausal women, suggesting that the highest risk for new-onset depression is during the transition into menopause, not during postmenopause.

In addition to depressive symptoms, menopause also presents physical symptoms like hot flashes/night sweats and sleep disturbances which can overlap and complicate depression, leading some researchers to believe that there is a correlation (not causation) between the two.

Those suffering from depression also report other menopausal symptoms like:

• Brain fog and difficulty concentrating
• Decreased energy
• Increased appetite
• Decreased libido (attributed to depression and/or vaginal dryness)
• Urinary incontinence (The science behind this potential association isn’t 100% understood but it may be due to decreased serotonin levels in the central nervous system, which is correlated with symptoms of depression as well as increased urinary frequency/bladder contractions. Of course, urinary incontinence can be linked to multiple factors, including its well-established link to declining estrogen levels and physical changes of menopause.)

Keep in mind that there are so many factors at play here that are difficult to discern: socioeconomic considerations, psychological, social, and health status, among others. Plus, let’s not forget that we’re dealing with our fair share of life stressors during this transition. Maybe we’re caring for children or aging parents, navigating career shifts, or struggling with our changing bodies. All of the above can adversely impact mood and should not be discounted as “par for the course.”

If you are experiencing severe symptoms that impact your everyday life or if you have suicidal thoughts, reach out to your healthcare provider right away. There is nothing shameful about getting the help you deserve.

Lifestyle

If you’ve been having a hard time lately and think you may be struggling with depression, you aren’t alone. You’re going through so many big physical and emotional changes that impact many menopausal people. Many lifestyle interventions have been studied to assess their effect on mood disorders, including depression. Please don’t struggle through these feelings on your own — everyone deserves support. Speak to your provider about getting the proper care, and if you are interested in exploring additional methods of support, here are some recommendations from Elektra’s founding physician, Dr. Anna Barbieri, MD. 

Nutrition and diet

Focus on eating more nutrient-dense foods like fruits and veggies and try to cut back on overly sugary snacks. Lean proteins (like fish and chicken) and whole foods (like veggies and beans) are good for our brain health, mood, and overall health!

Spend time in nature

Frequent exposure has been shown to reduce anxiety and depression while improving an overall sense of well-being. Taking a walk through the park or spending an afternoon by a lazy river can help you feel better.  

Practice gratitude

Practicing gratitude has been shown to improve our mood, help reduce symptoms of depression, and even lower blood pressure! 

Prioritize high-quality sleep

A lack of sleep can impact your stress hormone levels which, in turn, impair thinking and emotional regulation. Prioritize your sleep by limiting screen time before bed, drinking a soothing cup of chamomile tea, and curbing your caffeine intake before bedtime. 

Psychotherapy 

There are two types of psychotherapy recommended for menopause-related depression: interpersonal therapy and cognitive behavioral therapy (CBT) — both of which are often used in conjunction with medication. If you are interested in seeing a therapist, be sure to ask about their particular approach and practice.

Exercise

Studies show a clear link between regular movement and an elevated mood, improved sleep, and higher self-esteem. The effect of exercise specifically on depression proves to help prevent the development of depression in adults and is a useful strategy to help manage and treat existing symptoms. And don’t worry about pushing yourself too hard —- even a brisk walk around the block is a wonderful way to get your blood pumping. 

Hormonal prescriptions

Hormone therapy is a viable treatment option for women with elevated depressive symptoms who have been screened for common risk factors. Oral contraceptive pills are typically prescribed for early-late perimenopause, while hormone replacement therapy (HRT) is prescribed for late perimenopause-menopause.

Estrogen therapy alone is not approved to treat perimenopausal depression; however, there is evidence that it has antidepressant effects, particularly for those suffering from vasomotor symptoms (e.g., hot flashes & night sweats). 

Non-hormonal prescriptions 

Antidepressants such as SSRIs and SNRIs are a helpful option for anxiety and depression in peri- and menopausal women. SSRIs are selective serotonin reuptake inhibitors and SNRIs are serotonin and norepinephrine reuptake inhibitors. These antidepressants work by regulating serotonin (the “happy hormone” that controls mood) and norepinephrine (which plays a vital role in the body’s “fight-or-flight” response to stress). Like therapy, there is still a stigma around taking these medications but for many of us who experience symptoms, they can be incredibly effective and helpful, and we have decades of research to back this up. 

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