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. 

What is Depression?

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.

What Causes It?

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 sleepnessness (and insomnia itself is also symptom of menopause), which increases the likelihood of depression.

What’s Happening Inside Your Body?

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.

What Does the Research Say?

  • A 2018 review published in the journal Obstetrics and Gynecology Clinics of North America showed that women are up to five times more likely to experience a depressive disorder during perimenopause than during the period immediately before perimenopause.
  • Up to 40 percent of women going through perimenopause experience depression, suggested a study on Turkish women published in the journal Menopause in 2010.
  • Despite reported high rates of depression, a 2020 study also published in Menopause found that 34.1% of OB-GYNs don’t typically screen perimenopausal patients for this illness. 

How Is Depression Diagnosed?

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.

What Are Effective Treatments?

A number of effective medications are available for treating depression, and they sometimes go hand in hand with psychotherapy. A few common ones include:

  • Antidepressants: There are many types of antidepressants commonly prescribed to treat depression. A common one is a class of drugs called selective serotonin reuptake inhibitors (SSRIs), which work by increasing levels of the neurotransmitter serotonin in the brain. These drugs usually alleviate some symptoms in 3-4 weeks but it may take four to eight weeks to feel their full effects. Some experts recommend choosing SSRIs as the first line of treatment for depression in menopause. Another common class of antidepressants called SNRIs act on the neurotransmitters dopamine, norepinephrine, and serotonin.
  • Hormone replacement therapy: This form of therapy is designed to restore hormone levels that drop during menopause. Some evidence suggests that estrogen can help alleviate depression in some women who are going through perimenopause, especially those with mild or moderate symptoms who haven’t had depression before. HRT may be more effective in tandem with other treatments, such as antidepressants and talk therapy. 

What Are Some Non-Medical Treatments?

  • Psychotherapy: This type of treatment involves talking with a licensed mental health specialist one-on-one or in a group setting. It often goes hand in hand with medication. There are many forms of psychotherapy: A common one is cognitive behavioral therapy, which helps patients identify and correct the negative thought patterns that may underlie depression. Another is interpersonal therapy, which focuses on helping patients improve relationships with people.
  • Mindfulness: This form of meditation teaches people to respond non-judgmentally to their thoughts and feelings and accept them as they are. A growing body of evidence shows that mindfulness can not only help alleviate depression but also rewire the brain.
  • Exercise: Regularly engaging in physical activity can directly improve mood through the release of hormones called endorphins, which trigger positive feelings. It can also boost self-esteem. 

What To Do Next

  • Make an appointment with a mental health specialist or a trusted PCP: Talking with a specialist can help you understand the symptoms you’re experiencing and, if necessary, provide a depression diagnosis and help you develop a treatment plan.
  • Find treatments that work for you: People respond differently to medications for depression. While it’s important to give both medical and non-medical treatments enough time to start working, pay attention to whether your treatment is working for you. If it doesn’t, your mental health specialist can help you find alternatives
  • Take care of your mind and body: Depression treatments work best when your mind and body are well cared for. Getting enough sleep, exercise, and healthy food and reducing stress can help make the most of your treatment. 

Learn More

Are you experiencing other symptoms that you want to better understand and learn how to treat and manage them? 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.