Depression in Menopause

The first signs of perimenopause may bring major changes to some women’s mental health in menopause and neurological symptoms. Often ill-prepared and unaware of the typical symptoms of menopause, we fail to join the dots and link these changes to our hormones. The British Menopause Society says that around 10% of women may experience a ‘depressed mood’ in menopause.

What causes depression during menopause?

There’s no clear consensus on the link between menopause and depression. As your essential hormone levels fall when moving into perimenopause, some brains will be more sensitive to the lower levels causing a depressive episode that affects our thoughts, our feelings and our behaviour. A 2018 study found that the risk of menopausal depression decreases 2 to 4 years after the final period.

Whilst women with a history of severe premenstrual syndrome, post-natal depression or previous episodes of clinical depression, may be more susceptible to developing depression as their hormones surge and dip, it’s important to be aware that perimenopause increases the risk of depression and perimenopause PMS symptoms. To put this in context we should remember the BMS data, which states 90% of women won’t be affected by menopause depression.

Menopause's mental health may be aggravated by external factors such as the negative view of ageing, the perceived stigma that goes with society’s view of menopause and the stress of multitasking alongside menopause; working, caring for families and parents.

We’re all allowed to feel down at times in perimenopause. The low mood should improve after a few days but menopause depression is different. It’s a continuous feeling of sadness, loneliness, loss of interest and enjoyment in life lasting weeks rather than days.

How can you manage perimenopause depression?

Although it may be a challenge, being active and eating healthily can help you feel better. CBT therapy is recommended as a tool for managing menopausal depression in the NICE national guidelines for managing menopause.

Where mood changes are a result of fluctuating hormones, levelling hormones out with the correct dose of HRT may help to prevent depression from developing. Anti-depressants have all too often been used to treat menopause depression, however women themselves report, and studies have found, that they are not appropriate for treating hormonal depression in menopause.

If the depression is impacting your mental health and your ability to function on a day to day basis, especially at work, then you need to seek menopause workplace support, discussing your hormonally driven depression with your line manager is important to ensure they can arrange suitable reasonable adjustments to your working environment, or shift patterns. Do not be embarrassed they have a duty of care for your workplace wellbeing. Many organisations have mental health first aiders who can be you first point of contact to advise your next steps.

What triggers menopause depression & what to avoid?

Cut out the caffeine

Caffeine stimulates the central nervous system and is thought to increase anxiety. As depression and anxiety often go together, cutting out caffeine may help.

Alcohol and fizzy drinks sap your fizz

The risk of depression increases for menopausal women. Drinking alcohol when you’re feeling down or stressed temporarily calms the effects of stress hormones but also depresses the nervous system. 

Sweet fizzy drinks are a no-no too. High caffeine content can give you the jitters, intensifying other menopausal symptoms including; hot flushes and insomnia. It’s time to find caffeine and alcohol-free drink! Try the alcohol-free ginger beer, Feel Good’s mocktails, Elderflower Presse, or bitters (they do contain a trace of alcohol), with tonic. Adult tastes without alcohol. Seedlip has produced a couple of spicy, herbal alcohol-free spirits, which could be a tasty alternative when you feel like an end-of-day treat.

Can diet help perimenopause depression?

There is no specific medically prescribed diet for depression. Symptoms of depression have been linked to poor eating habits and vitamin and mineral deficiencies. The Mayo Clinic in the USA noted the increased likelihood of depression being reported by people with a diet high in processed foods, sweet treats and junk food, versus those who ate a diet rich in fruits, vegetables and fish.

• Vitamin B: deficiency has been linked to depression. Eat more: sunflower seeds, pistachios, tuna, salmon, turkey and chicken, dried fruit, bananas and avocados.

• Vitamin D: deficiency has been linked to aches, pains and depression. Found in a limited number of foods (the body gets the bulk of vitamin D from the sun’s UVA rays). Eat more: eggs, oily fish, fortified cereals, margarine and spreads.

• Omega-3 fatty acids: may reduce depressive symptoms. Eat more: SMASH, (the acronym to remember which oily fish are good for us), salmon, mackerel, anchovies, sardines and herring. Also, walnuts, linseed and chia seeds.

• Minerals: calcium, magnesium, zinc, iron and selenium may all help to lessen the effects of depressive symptoms. Eat more: spinach, kale, broccoli, almonds, seafood and pumpkin seeds.

Medical Treatment for Menopause Depression

Depression is a serious mental health condition. It’s essential that you consult your doctor to help you deal with it, whatever the cause. However, it can sometimes be hard to articulate how you’re feeling when sitting in front of a doctor. Before an appointment think about your own history including your periods, any post-natal issues or any depressive episodes. Keeping a diary of moods and periods before an appointment may help. A period tracker will help you monitor your moods.

Severe cases of hormonal depression may be premenstrual dysphoric disorder (PMDD) this is a very severe form of premenstrual syndrome (PMS), which can cause many emotional and physical symptoms every month during the week or two before you start your period. It is sometimes referred to as 'severe PMS'. PMDD symptoms are much worse than PMS and could have a serious impact on your life. Experiencing PMDD can make it difficult to work, socialise and have healthy relationships. In some cases, it may also lead to suicidal thoughts. If you are suffering severe symptoms you should seek help and support. There are PMDD Facebook pages you can join to find additional help. In an emergency call the Samaritans for free on 116 123, or go to A&E.

Hormonal depression can go unrecognised. Many women don’t realise they are perimenopausal, so don’t make the hormone connection. Women struggling with low moods, tiredness and focus, may therefore be prescribed anti-depressants by their doctor when the possibility of perimenopause is not discussed. However, guidelines on menopause from The National Institute for Health and Care Excellence (NICE) say, ‘It has not been shown that antidepressant drugs called SSRIs and SNRIs can help with low mood during menopause if you haven't been diagnosed with depression.’ 

CBT to help you frame your thoughts

Talking therapy may be helpful for tackling depression in menopause, encouraging you to reframe negative thoughts and change behaviours. CBT is not an instant fix but you could see results in a short period. The National Centre for Health and Care Excellence (NICE) recommend a course of between 16-24 hours. 

Can HRT help with depression?

Where depression is caused by hormone fluctuation and you are able to take HRT, transdermal oestrogen, is an option. Results of research published in January 2018, in the American JAMA Psychiatry journal, found fewer women given HRT went on to develop symptoms of depression than those who were given a placebo. NICE guidelines recommend the use of HRT for symptoms of low mood. GPs will look at your unique risk factors to see whether or not HRT is appropriate for you.
The usual caveat here is that there are pros and cons to taking HRT. We don’t take a view. It’s for you to decide whether it’s for you or not.