Depression is a common illness that can affect people at any stage of their lives. The menopausal transition is a particularly vulnerable time because of hormonal changes and other changes that occur at midlife.
Depression affects approximately 5 percent of people worldwide. It can affect women going through perimenopause or menopause for a number of reasons, including fluctuating levels of the hormones estrogen and progesterone and physical changes. It can also develop because of stressful life changes that happen at midlife. By one estimate, depression rates for women double during perimenopause and the period immediately after menopause.
Though depression is often characterized by feeling blue, it involves more than just sadness. With depression, feelings of sadness, anxiety, or emptiness tend to persist. Loss of interest often occurs, and guilt, helplessness, hopelessness, and pessimism can arise too. Depression can make you irritable, restless, tired, or unfocused, and it can affect sleep and appetite and cause aches and pain. Sometimes, it can lead to thoughts or attempts at suicide. Fortunately, many effective medical and non-medical treatments for depression are available.
Depression’s causes are complex and not fully understood. Research suggests that a person’s genetics, personality, life stressors, medical history, medications, and their brain biochemistry interact to cause it. One reason depression may occur at higher rates during perimenopause and menopause is because of decreasing levels of estrogen and progesterone, which can lead to changes in mood. Some researchers think that there is a “window of vulnerability” during perimenopause when some women are susceptible to the effects of fluctuating hormones, especially if they have experienced depression before. Decreased estrogen and progesterone are also linked to dips in serotonin, a neurotransmitter associated with well-being and happiness.
In addition, midlife tends to coincide with significant life changes that can be stressful, like kids growing up, parents getting older, illness, and shifts in personal and professional goals. The stress caused by these events can also lead to depression, especially if these events coincide.
Furthermore, some of the other symptoms associated with perimenopause and menopause can create conditions conducive to depression. Uncomfortable hot flashes can cause sleeplessness (and insomnia itself is also symptom of menopause), which increases the likelihood of depression.
Depression is linked to shifts in activity in different parts of the brain, including the regions associated with regulating mood and cognition, like the hippocampus, amygdala, thalamus, and prefrontal cortex. Fewer connections between neurons are also observed in these areas in people with depression.
Neurotransmitters—the molecules neurons use to talk to one another—have a major role in depression as well. Depression is associated with the disruption in communication between neurons. Neurotransmitters that are involved with mood include serotonin, epinephrine, glutamate, GABA, acetylcholine, and norepinephrine, which can further disrupt communication between neurons. Some drugs used to treat depression, like selective serotonin reuptake inhibitors (SSRIs), directly involve neurotransmitters.
A mental health professional such as a psychiatrist, psychologist, or licensed social worker can diagnose depression. They will interview you about your symptoms and how long, and how frequently, they’ve been occurring. In addition, they’ll likely ask about how those symptoms have affected your daily life. After taking into account your medical history, medications, and other factors, they will come to a diagnosis or refer you to a specialist.
A number of effective medications are available for treating depression, and they sometimes go hand in hand with psychotherapy. A few common ones include:
Are you experiencing other symptoms that you want to better understand? Check out our following guides:
Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
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