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Ask the Mental Health Expert Archives 2001-2004

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Menopause and Depression

Q. 24 years ago I found out that I had clinical depression and have been on medication since. Peri-menopause started 3 years ago, major depression set in and the OB/GYN says it has nothing to do with menopause. The doctor said it's menopause though.

I have been taking 300 mg of Desyrel for all these years. Now, I am taking 300 mg of Desyrel, 50 mg of Zoloft and Xanax to help me fall asleep. Sometimes the sleep still doesn't come until about 3-4 a.m. I've had 4 major depressions in the last 1 years. Do you know of any information that deals with menopause and depression that can help me?

A. I'm sorry to hear that your depression has been so frequent and intense in recent years. There are many resources for information on menopause and depression, but first, I'd like to suggest that you consider the issue from a broader perspective: for example, are there other stressors or changes in your life that could account for the worsening pattern of depression? Have relevant medical issues, such as thyroid function and levels of vitamin B12 and folate, been completely evaluated? Is there any possibility that your frequent pattern of depressive episodes in the past two years reflects undiagnosed bipolar disorder (manic-depressive illness)?

All these issues could be considered by a psychiatrist specializing in mood disorders of later life. If you have not yet seen, or been referred to, such a specialist, I would encourage you to raise this option with your primary care doctor and/or Ob-Gyn doctor.

At a minimum, a specialist in mood disorders could be consulted by your primary care physician. Regarding menopause and depression, most of the recent data suggest that menopause per se is not linked with higher rates of major depression. For example, a study conducted by Woods, Fugate, Mitchell and Sullivan (1996), set out to investigate and differentiate women who experience patterns of depressed mood with respect to their perceptions of menopause and those depressed due to the stresses of everyday life.

In depth interviews were done on 347 women and were scaled on four patterns of depressed mood: consistent depressed mood, emerging depressed mood, resolving depressed mood and absence of depressed mood. Patterns of depressed mood were related to stressful life context, past/present health status, and social learning about mid-life. Results showed that menopause did not create the onset of depression, but rather, that other mid-life stresses were attributed to the onset of depression.

In contrast, there are data showing that the peri-menopause is associated with increased risk of depression. That said, the menopause differs considerably from woman to woman--perhaps depending on her expectations, fears, and hopes for this time of life. The degree of emotional support she receives may also be important. The role of changing hormones in menopausal depression remains controversial, but there is no convincing evidence that a reduction in "female hormones" accounts for depression in most cases.

As the Mayo Clinic website states, "You may experience mood swings, be more irritable or be more prone to emotional upset as you go through menopause. In the past, these symptoms were attributed to hormonal fluctuations. There may be a connection between changes in hormone levels and your mood. But other factors that can contribute to changes in mood include stress, insomnia and life events that can occur in this stage of adulthood - such as the illness or death of a parent, grown children leaving home or retirement."

That said, there are some studies showing that estrogen replacement therapy (ERT) may be helpful as an adjunct to standard SSRI antidepressants (such as Zoloft), in some menopausal depressed women (see Schneider et al, Am J Geriatr Psychiatry 2001 Fall;9(4):393-9). You can find more information on menopause and depression on the website www.healthandage.com and by logging on to www.mayoclinic.com.

But I think it's important that a mood disorder specialist be involved with both the diagnosis and treatment of your condition. This is not a criticism of your doctors--it is merely to say that the frequency and severity of your condition may benefit from another pair of expert eyes and ears.

There are many new antidepressants and mood stabilizers now available that may be of help to you, not to mention a variety of types of psychotherapy. ERT could also be considered as an adjunctive treatment, though there are important risks and benefits to weigh very carefully. I do hope you find relief soon.

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April 2003

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