Depression During Menopause Is More Common Than You Think

It’s normal to feel blue sometimes. But when sadness becomes your daily default, you might be experiencing depression.

Depression is common for women during midlife—potentially up to three times more common than in premenopausal women. In fact, the menopausal transition may be one of the highest-risk periods for depression in your entire life.

If your mood is so low that you’re struggling to get by, you don’t have to suffer alone. The first step is to identify what’s going on.

The Signs of Depression

First, let’s identify the difference between everyday sadness versus depression. While feeling sad is a normal part of life, these feelings can become a major issue if they don’t resolve and start to interfere with your daily life.

The symptom list below is a starting place, but seeing a licensed therapist, psychologist, or psychiatrist is essential for determining what’s happening and what support you might need.

You may have depression if you’ve experienced at least five of these symptoms over the past two or more weeks.

1. Depressed mood
2. Loss of pleasure or interest in most or all activities
3. Significant weight changes or poor appetite
4. Sleeping too much or too little
5. Changes in movement and activity
6. Fatigue or loss of energy
7. Feelings of worthlessness or guilt
8. Diminished ability to think or concentrate, or indecisiveness
9. Recurrent thoughts of death or suicide

Women are nearly twice as likely as men to develop depression. This might be partially due to hormonal changes that come with puberty, pregnancy, and menopause.

However, your depression risk is far more complex than just hormones. Your family history, serious illnesses, and drug and alcohol use can also be risk factors for developing depression. Life’s challenges are another major influence. While not everyone who experiences financial, work, relationship or social stress develops depression, but these difficulties can add up and take depression risk past its tipping point.

But what makes menopause such a uniquely challenging time for depression?

Does Menopause Cause Depression?

Given the prevalence of depression during perimenopause, it’s tempting to think that there is a direct causal link. However, science paints a more complicated picture.

On the one hand, research suggests that the hormonal shifts during perimenopause may affect mental health. Estrogen plays a role in brain function, and its decline during perimenopause may make the brain prone to lower mood.

A recent literature review shows that at least six different studies have found a link between declining reproductive hormones and depressive symptoms. It’s noteworthy that another phase of life with massive hormonal changes—pregnancy—is also a high-risk time for developing depression.

There is no clear evidence that the menopause transition alone increases the risk of mood disorders, except when women also have significant life stressors, severe hot flashes, and a history of mood disorders.

Many researchers call the menopausal transition a time of “vulnerability” for depression. In other words, while menopause itself does not cause depression, it’s a time when women are at higher risk for developing it.

What makes this period so vulnerable? In addition to changing hormones, it’s likely due to the additive effect of other changes happening at the same time. Struggling with hot flashes, insomnia, weight fluctuations, and other physical menopause symptoms can stir up negative feelings. The ongoing stressors of money, relationships, and taking care of aging parents and children can start to add up, as well.

Managing Depression During Menopause

There’s no one solution for managing depression. Most people try a combination of these options to find relief, and you may have to change your approach over time.

Talk Therapy

“Talk therapy” is one of the primary strategies for treating depression. A range of professionals are qualified to provide talk therapy. Here are the titles and credentials that you might see:

• Psychotherapists (MA, PhD, PsyD, EdD)
• Marriage & Family Therapists (MFT)
• Social Workers (MSW, LCSW)
• Psychiatrist (MD, DO)

Therapists use different frameworks and tools to help their clients. Common therapy frameworks include cognitive behavioral therapy (CBT), trauma-focused therapy, or dialectical behavioral therapy (DBT).

The “right” kind of therapy depends on you and your needs. A lot of your success in therapy also depends on your relationship with your therapist. If you don’t click after a couple of sessions, don’t be afraid to keep looking to find someone who you feel you can trust and who understands your needs.

Medication

Prescription medications are another primary strategy for managing depression. Surveys estimate that about 17% of women in the US were taking antidepressants between 2015-2018.

Antidepressant medications like these are typically prescribed by a psychiatrist or primary care provider—therapy providers are typically not licensed to prescribe any medication. If a therapist thinks you may benefit from meditation, they will refer you to a prescribing provider.

Just like therapy, antidepressant medications come in a wide variety. You should expect some trial and error to find the right medication and the right dose, but your prescribing provider will be able to help you determine the right prescription for you. Some anti-depressants may help with hot flashes, as well.

Exercise

A recent review of over 1,000 research studies showed that exercise was overall 1.5 times more effective than medication or counseling in treating mental health issues. Researchers found that greater benefits came from consistently engaging in higher-intensity exercises.

Exercise releases “feel good” chemicals in the brain that can help turn your mood around, and keeping an exercise routine can even reduce the risk of depression and anxiety from coming back in the future.

The Centers for Disease Control recommends that all adults get at least 150 minutes per week of moderate-intensity physical activity and two days per week of strength training. Most importantly, find a routine that you can stick to consistently.

Holistic Therapies

While talk therapy and medication are the most common strategies for managing depression, they’re not a quick fix or a magic bullet. Many people find that holistic therapies like these are a helpful complement to their other efforts:

• Acupuncture and reflexology
• Meditation and mindfulness
• Yoga
• Correcting nutritional deficiencies (like vitamin D and folate)

Keep in mind that mood is complex and multi-faceted, and your life is often changing. Your approach to managing depression might need to be, as well.

If You Are In Crisis

The National Suicide & Crisis Lifeline provides 24/7 confidential support to anyone in suicidal crisis or emotional distress. Call or text 988 anywhere in the United States to connect with a trained crisis counselor.