Menopause
Why
am I depressed?
Depression affects twice as many women as men. Midlife
is often considered a period of increased risk for depression
in women. It is not known why, but it may be related to having
a personal or family history of depression, life stressors,
and role changes. Menopause is often believed to be a time
when women are more likely to become depressed. Studies actually
show that depression is more likely to occur in the years
during transition to menopause, perimenopausal
years. This period is associate with gradual declines in estrogen
levels. Some studies suggest that changes in estrogen levels
are associated with onset of depression.
What are the
symptoms of depression during midlife?
The symptoms of depression in menopause or perimenopause are: two or more weeks
of depressed mood, decreased interest or pleasure in activities,
change in appetite, change in sleep patterns, fatigue or loss
of energy, difficulty concentrating, excessive feeling of
guilt or worthlessness, thoughts of suicide, extreme restlessness
and irritability. Many symptoms of menopause overlap with
symptoms of depression including problems with sleep, physical
symptoms such as hot flashes, fatigue, irritability, anxiety
and difficulty concentrating. Some women suffer needlessly
because they think these discomforts and problems are a natural
part of aging. Depression should not be dismissed as a normal
consequence of later life for women.
Depression that goes untreated can lead to more severe episodes of depression and even physical complications. For example, depression is associated with increased risk for heart attacks. A recent study suggests that depression leads to loss of bone mineral density, therefore increasing a women's risk for broken bones.
What can I do about
depression in Midlife?
You have already taken one of the most important steps in
helping your depression -- you have come for help. Fortunately,
depression is treatable. Believing one's condition is "incurable"
is part of the hopelessness that accompanies depression. This
way of thinking is a symptom of depression and will improve
with treatment. There are many treatment options available
to help depression.
Medication - There are many effective, well-tolerated antidepressant medications. Antidepressant medications are an essential part of treatment for women who are moderately to severely depressed.
Hormone Replacement Therapy - Some clinical studies indicate that estrogen may help with depression in the early stages of menopause. Although the usefulness of estrogen as an antidepressant has not been well established, it may be an important adjunct to other treatments for depression. Be sure to discuss the benefits and risks of hormone replacement therapy with your health care provider, including the potential benefits to your mood.
Get a physical examination - A thorough physical examination is important to rule out any physical illnesses that may cause depressive symptoms. As you get older, you may be more likely to develop some of these physical health problems. Certain medications can cause symptoms that mimic depression. Be sure to review all medications that you are taking with your health care provider.
Therapy - Therapy involves talking with a trained professional (psychologist, psychiatrist, clinical nurse or social worker) on a short term (12-20 weeks) or a long-term basis and can take many forms. Two types of therapy are particularly effective for depression. Cognitive Behavioral Therapy (CBT) targets negative thoughts and behaviors that tend to worsen depressed mood and teaches better ways of thinking and behaving. Interpersonal Therapy (IPT) helps a person communicate more effectively with others therefore decreasing stressors. Some studies suggest that women with depression are more likely to engage in excessive rumination. This increased pondering and brooding causes the length and severity of depression. Therapy can help you address these negative ruminations.
Alternative medicine, herbal remedies and dietary supplements -
There has been rising interest in the use of herbs and dietary supplements for the treatment of depression. St John's Wort (hypericum perforatum) has been the most common of these. However, scientific studies of these alternative forms of treatment have so far been short-term and not well controlled. There is no uniformity of dose or amounts and types of ingredients because the Food and Drug Administration does not regulate them. Be sure to tell your health care provider if you are taking an herbal or dietary supplement. Some of them may negatively interact with antidepressant medication or other medications you are taking.
Is there
anything else that I can do?
Along with professional treatment, there are several other
things that you can do to help yourself feel better.
Support - It is not uncommon for women in midlife to have double care-taking responsibilities - still caring for their own children while also caring for elderly relatives. It is very important that you get support for yourself and communicate your needs to others. Ask for help with housekeeping, preparing meals and other daily tasks. Don't feel you have to do it all yourself. The University of Michigan Turner Health Clinic offers support for those caring for the elderly.
Exercise - The benefits of exercise in depression are well documented. Be sure to discuss any changes you make in your exercise routine with your health care provider. Exercise helps treat depression by releasing the body's mood-elevating compounds, reducing the depression hormone cortisol, providing perspective on life, providing a feeling of accomplishment, enhancing self-esteem, and increasing levels of serotonin (a neurotransmitter found to be key in the development of depression). It doesn't matter what you do as long as you do something physical for 20 to 30 minutes three times a week or more. Even exercising as little as 10 minutes a day has been found to have beneficial effects. Walking is perhaps the most accessible form of exercise because it costs nothing and you can start immediately.
Stress Management - Depression can also be made worse by stress. Midlife is identified with stressors and life transitions such as children leaving home, loss of a parent, caring for a parent, occupational problems, marital changes and even death of a loved one. These life changes, particularly loss and interpersonal role transitions, have been associated with depression in women. Identify stressors that you are putting on yourself (trying to be "perfect", doing too much). Set priorities and let unnecessary tasks wait.
Promote sleep - Inadequate sleep can make depression worse. Take care to keep your sleep cycle regular by going to bed and waking around the same time. Develop relaxing bedtime rituals such as reading or a warm bath. Take time to rest during bedtime hours, even if you aren't asleep.
Dietary changes - Eating a well balanced diet and regularly scheduled meals is important. Decreasing refined sugar, caffeine, alcohol, and chocolate may help. Use of calcium, and B vitamins (B6) may also decrease symptoms.
Spend time with others - Depressed women often withdraw from others because they mistakenly feel they would not be good company. Being with others is another way to gain perspective, which helps with the symptoms of depression. If you live alone, it is especially important to establish contact with others. Consider joining a support group for others experiencing problems with depression.
Make time to do what you enjoy - Depressed women sometimes temporarily lose the ability to enjoy themselves. Avoiding enjoyable activities only makes this worse. Continue doing pleasurable activities even if you don't feel like it. You will soon find that you have come to enjoy yourself again, at least for short periods.
Give yourself a break - You will feel like yourself again and better able to handle everyday pressures. Be realistic about the demands and expectations you make on yourself.
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