Sunday, April 20, 2014

Depression During Menopause

Many women go through menopause without any emotional changes at all. Some women experience a sense of relief or even elation at the new freedom that menopause presents: freedom from pregnancy and monthly menses. For others though, menopause is associated with symptoms that are similar to the emotional changes seen prior to their menstrual cycle: fatigue, insomnia, nervousness, irritability, or mild depression. These symptoms are similar to those of PMS. The emotional changes seen in menopause are often associated with hot flashes and insomnia (an interruption of REM sleep).

The number of women afflicted with depression during the menopausal years is not more than the 8 to 10 percent prevalence that is seen throughout the reproductive years. Two groups of women are at increased risk: those experiencing surgical menopause (surgical removal of the ovaries) and those with a previous history of depression. In surgical menopause, the sudden drop in the level of both estrogen and androgen (male hormone) is associated with a greater incidence of emotional changes and depression.

Stressful events are also known to trigger emotional changes and depression. Stressful life events coincide with menopause, which may make it harder to determine the cause of the mood changes. Family or work situations may fuel fatigue, sadness, or low energy level, all of which are symptoms that may be profound in a clinical depression. When a woman has an underlying depression, the low levels of estrogen seen in menopause, or perimenopause, may accentuate the depression.

Many women require no treatment for symptoms associated with menopause. Others prefer to try dietary changes (phytoestrogens), exercise and psychotherapy before considering a trial of medication. Helpful medications include estrogen, which alleviates hot flashes and therefore helps promote restful sleep. Some women feel better on estrogen even if they are not suffering from hot flashes. Women who have undergone surgical menopause may benefit from the addition of testosterone (androgen) if they suffer significant emotional symptoms that are not relieved by estrogen alone. In certain cases, antidepressant medication, such as Prozac, Zoloft, Paxil, or cyclic antidepressants, is warranted. These medications affect the uptake of brain neurotransmitters linked to clinical depression.

I hope this gives you some insight into the emotional changes that occur during menopause. Is it wise to stop the antidepressants and see how she does on the hormones alone? No. Treating her depression is crucial and continuing the antidepressants is appropriate. When she feels well, it may be possible to taper her off the antidepressants. But even then, it should only be done with the support and guidance of her psychiatrist. I hope she feels better soon.

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