Menopausal Depression Can Be Treated!

Menopausal depression has for years been the subject of controversy. Is there a connection between depression and menopause or isn't there?
Absolutely not, some vehemently insist. "The link between menopause and depression was invented," Dr. Ruth Formaneck, who was chief psychologist of the Jewish Community Services of Long Island, wrote, over a decade ago. The notion of menopausal depression as a made-up social construct has been around ever since feminists began their critique of the field of gynecology, some thirty-five years ago. The idea that menopausal depression is invented, however, is in dire need of revision.

The controversy revolves around whether menopause causes depression, not whether women become depressed at mid-life, for it's very clear that many do. The question is, does their depression have to do with social and psychological events in their lives, or with hormonal shifts as the ovaries stop producing estrogen, or both?

The subject of what actually happens to women at mid-life, and whether they experience menopausal depression, remains complicated. Certainly women do undergo tremendous hormonal changes, and sometimes--for example, after surgically induced menopause, or hysterectomy--with shocking abruptness. Having hysterectomies is hormonally disruptive to many women even when their ovaries are left intact. When the hysterectomy includes removal of the ovaries, menopausal depression is virtually predictable. The estrogen levels plummet rapidly, and this leaves women vulnerable. Serotonin, one of the hormones that's so important in maintaining good mood, needs estrogen for its production in the brain.

However, it doesn't take a hysterectomy for menopause to produce a surprisingly wide range of physical and mental symptoms, including menopausal depression. It was only when I was a year past menopause that I began to address the sleep problems I was having, as well as the loss of energy and libido. I had also been having odd lapses in memory. For period of six months or so I stumbled a lot, and in another long period I had a hard time focusing on my work. I felt depressed and anxious and needed frequent naps. I can joke, now, about the bleak fantasies on which I'd obsess as I lay awake at night, but at the time I was worried about how long I'd be able to keep on supporting myself. My freelance income had dropped as my ability to plan and think ahead was compromised. I was stuck in this pattern for over two years and it became hard not to think: Is this it, the end of my vitality and productivity?

It took far longer than it should have for me to learn that a menopausal depression, related to a drop in hormones, was causing my symptoms. No physician I saw was giving me any clues. Some doctors still think there's no point in telling women ahead of time about the possibility of menopausal depression--lest, suggestive creatures that we are, we simply imagine ourselves into a state of misery. I would far rather have learned in advance how hormone changes might affect my physical and mental wellbeing. It would have meant my getting help much sooner.

The drop-off in sex hormones can affect the quality of life both during the climacteric and long afterward. For some, the symptoms appear to be chiefly emotional. For Shirley Krohn, a midlevel manager of an international engineering firm, the main symptom was tears: abrupt and inexplicable bouts of weeping. At the age of 48, she told Fortune, for an article, "Menopause and the Working woman", "I suddenly began crying in the middle of meetings for no apparent reason."

At the time, Krohn said, she had no idea that her embarrassing weeping had anything to do with hormone loss. Eventually she had to take a seven-month leave of absence from work. Now that she understands more about menopausal depression, she counsels other women at her company, convinced that she'd have gotten "much further up the corporate ladder" if she'd been diagnosed earlier. Instead, she says, "I lost confidence." Estrogen levels begin dropping in the midthirties, making pregnancy less likely. In the early forties, menstrual cycles become shorter and FSH (follicle stimulating hormone) may be elevated; when this is the case, in the words of one gynecological researcher, "the ability to get these women pregnant, even with heroic intervention, is discouraging at best". By then, the perimenopause has begun, and while pregnancy isn't out of the question, it's unlikely. By the late forties,cycles become irregular and periods often produce heavy bleeding. Irregularity is the harbinger of menopause. Some women miss a period or two and then it's all over. For others, the irregularity goes on for a year or longer.

That is but the briefest outline of the menopausal trajectory. Things become more complicated when we contemplate the effects of hormones and other body chemicals on each individual woman. Estrogen alone doesn't act on us at midlife. Who gets hit with hot flashes, insomnia, and mood changes--and when, and how severely, and for how long--has to do, in part, with brain neurotransmitters like serotonin. A chemical that requires the presence of estrogen for its metabolism in the brain, serotonin regulates sleep, energy, mood and libido, and is central to our well-being. Women (like men) vary in the amounts of serotonin they have available in the brain. Researchers have suggested that women with low serotonin to begin with (largely a genetic matter) may become more symptomatic at menopause, when their estrogen levels drop off.

Certainly there are cultural stressors that could trigger depression in women at mid-life--poverty and the loss of friends, husbands, and children among them. The radical hormone shift that occurs when women hit mid-life, in combination with social stress, could push them into menopausal depression. What's important is that women take their moods seriously enough to seek treatment.

The hormones in the endocrine system affect one another, so that when one is off, others may go off. Midlife women who are suffering from depression should have their thyroid levels checked, since lowered estrogen can pull down thyroxine levels. A low thyroid condition (hypothyroidism) mimics, perfectly, depression, and in any event must be treated, since the thyroid gland is an important regulator of many of the body's systems.

The low serotonin levels caused by menopausal loss of estrogen can sometimes be offset by vigorous exericise,or by daily use of a lightbox that emits 10,000 lux of light. This is another example of hormone interaction, since melatonin is affected by light, and melatonin affects serotonin production. (Lightboxes can be found on the internet.)

Finally, and not least, the low serotonin levels produced by lowered estrogen can be treated with antidepressant medication. The SSRIs, the newest category of antidepressant, work directly on the serotonin in the brain. Some women still treat their menopausal depression and other symptoms with hormone replacement therapy. Such treatment should be brief indeed since estrogen has been definitively connected with breast cancer and heart disease. For this reason, antidepressant medication is the safer bet when treating menopausal depression.

When told that "menopause doesn't cause depression", women at mid-life may feel guilty about their mood changes and avoid seeking treatment. There is nothing less serious about depression at midlife than depression at any other stage of life. Medical treatment may be very helpful. Ideally, it will be combined with psychotherapy for effects that last.

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