Beating the Menopause Blues
- with Beth E. Abramson, M.D., psychiatrist with Columbia St. Mary's
Though many women associate depression with menopause, it is actually during perimenopause that some women may begin to feel emotionally unstable. Many women might say - no wonder. When a woman suffers from night sweats that deprive her of sleep, hormonal fluctuations that cause moist brows at the most inopportune times and all the other symptoms that can occur at menopause, a woman certainly has every reason to report feeling less than ideal.
However, hormone fluctuations appear to have a more direct link to some women's mental state throughout her reproductive years. The National Institute of Mental Health reports that women suffer from depression twice as frequently as men, (12% vs. 6.6%) but that the pre-adolescent and post-menopausal women have rates about equal with men.
In addition, depression during perimenopause is more likely if a woman suffered from PMS (premenstrual syndrome) or PMDD (premenstrual dysphoric disorder) when younger, depression during early adolescence or post-partum depression; that is, if she reacted to hormonal fluctuations in the past. There also is some recent data that suggests that women who suffer from depression throughout their lives are prone to early menopause.
Usually physicians say that if these symptoms persist more than two weeks or if the symptoms are accompanied by thoughts of suicide, a woman should see her doctor. Many women approach their physicians with much milder, though still troublesome, complaints and often are referred to a specialist.
"Sometimes I see women with full-blown depression but mostly they have less ambition and less sense of accomplishment," said Dr. Beth E. Abramson, a psychiatrist with Columbia St. Mary's. She added that for some women this might be due as much to stress as physical changes.
"There are all these physical aspects that are changing. Their skin. Their eyes. Their energy is down. Often there are weight or body issues. Then there is the psychological aspect. Their kids are growing up and leaving. And they are trying to manage all these things together," the doctor said.
The symptoms of depression include:
• Sad moods or tearfulness
• Fatigue
• Loss of interest in usual activities
• Altered sleep patterns such as sleeping too much or insomnia
• Difficulty concentrating
Treating depression in a changing life
Dr. Abramson noted that one of the first things she does when she suspects perimenopause is to send the patient back to her primary care physician for a full examination. "If a woman is found to be in perimenopause, the physician will usually try some sort of natural estrogens or nutritional supplements, such as black cohosh or soy, first," she said.
Some women get relief from the birth control pill but others may find their depression worsens. "For these women, we will definitely recommend anti-depressants. They will still have hot flashes but at least they will have their moods under control," the doctor added.
Typically Dr. Abramson prescribes Prozac or Zoloft. Though these are usually not believed to be effective for the first two weeks after the drug is started, they seem to have an immediate effect on menstrual depression. "They can even be used on an intermittent basis for the week before a period or during it if that is a time a woman is having problems. Some women may stay on it continuously. These really make a difference with some people," she said.
Other anti-depressants such as Paxil and Effexor need to be taken continuously as they have withdrawal symptoms. However, some women report that their hot flashes are diminished by these particular anti-depressants and some physicians prescribe these for treating both physical and emotional symptoms of menopause in women who cannot tolerate or do not wish to try HRT (hormone replacement therapy).
"Once women get through this, and it can last up to ten years, many feel much better. I've had patients come off anti-depressants and do just fine," Dr. Abramson concluded.
