What Is Depression?
The term depression is one you hear frequently. It's not unusual for people to say they're depressed by the weather, their jobs, their haircuts, their prospects for dinner, or the night's television lineup. But there's a world of difference between these passing feelings of disappointment, dissatisfaction, or sadness, and an ongoing state of major depression.
For all of the overwrought “depressions” you hear about every day, true depression is a real problem faced by hundreds of thousands of people in our society. According to the Journal of the American Medical Association, between 5 and 10 percent of the U.S. population experiences major depression, and nearly 25 percent of all women will suffer from depression at some point during their lives.
Major depression is an illness that prevents sufferers from working, eating, sleeping, studying, and enjoying a full, normal life and range of moods. Major depression typically results from changes in brain chemistry; therefore, even though it can occur once in a lifetime, many people who suffer from major depression experience it several times.
Menopause and Depression
Many studies have shown that women first experience depression when they're in their twenties, or even younger. And although menopause doesn't automatically signal the onset of depression, women who have suffered from depression earlier in life — or women who have had postpartum depression or even severe premenstrual syndrome (PMS) — are more likely to have recurring depression during perimenopause. Women who have a family history of depression also run more risk of suffering from depression during perimenopause.
Sometimes, depression itself can be a symptom or side effect of some major life event, such as a divorce, the death of a loved one, losing a job, or dealing with a severe or ongoing medical problem — all problems that can occur to women at midlife. But these sorts of event-triggered depressions may pass with time or resolve themselves quickly, without the need for special treatment or therapy. Sometimes, however, these events can lead to depression that deepens into a more systemic, major depression that women are unlikely to overcome without some form of treatment.
Another, less severe, type of depression is known as dysthymia. The symptoms of dysthymia are similar to those of major depression and may be chronic and long term, but they aren't disabling. Finally, bipolar disorder (manic-depressive illness) is another kind of depression. People suffering from a bipolar disorder experience extreme mood shifts that swing wildly between manic highs and depressed lows.
Know the Symptoms of Depression
Though transient feelings of sadness, despair, or a general dissatisfaction with life are common during perimenopause, if these feelings are long lasting or severe, they could be signaling the onset of depression. Insomnia, fatigue, hot flashes, and other perimenopausal symptoms can trigger minor mood disorders during perimenopause.
But major depression goes well beyond the typical reaction to these symptoms and is often the result of a biological or chemical imbalance that requires careful diagnosis and treatment. The National Institute of Mental Health provides a list of common symptoms of depression (though it notes that few people suffer all of them). Here are some of those symptoms:
Feeling persistently sad, anxious, empty, hopeless, or pessimistic
A strong sense of impending doom
A loss of interest in hobbies or activities you once enjoyed (including sex)
Feeling guilty, worthless, or helpless
Losing energy and feeling fatigued and slowed down
Suffering from insomnia, early morning awakening, or oversleeping
Experiencing a dramatic change in appetite or weight
Difficulty concentrating, remembering, or making decisions
Thoughts of suicide and death, or suicide attempts
Feeling restless and irritable
Suffering from persistent physical symptoms (headache, pain, digestive disorders) that don't respond to treatment
If you suffer from low self-esteem, feel overwhelmed by stress, or have a persistently pessimistic attitude toward life, you might be at risk for developing depression. Scientists continue to study the causes of depression to determine whether these types of feelings are an indicator that you're prone to depression, or whether these feelings can actually trigger the illness.
The Causes of Depression
No one cause is at the source of every case of depression, but it usually is associated with a change in the brain's structure or functions. Sometimes a vulnerability to depression is genetically inherited, but depression can be brought on by physical changes resulting from stress, injury, an accident, or a serious emotional event.
If an individual feels at the mercy of a disease or illness, he or she can fall into depression. Severe illnesses such as heart attack, stroke, and cancer can lead to depression, as can progressive illnesses such as Parkinson's disease.
Financial problems, the death of a loved one, the loss of a job, a parent's illness, the departure of grown children, and other stressful changes to a daily routine also can push people into depression. Even a change of address or an abrupt change in a close circle of friends can trigger the onset of a depression that's been building over time. Finally, hormonal shifts, such as those women experience in pregnancy, perimenopause, and menopause, can also contribute to depression in women.
Considering all these triggers, you easily can see how some women might suffer from depression during perimenopause. Menopause itself doesn't cause depression, but the hormonal changes of perimenopause can join with other natural life events of middle age to contribute to a depressed state.
As you approach menopause, consider your risks for depression. Do you have a family history of depression? Have you suffered from severe PMS or postpartum depression earlier in your life? If you have a predisposition, don't ignore feelings of depression that arise as you near the age of menopause. Talk to your doctor, therapist, or other health care professional about your concerns early.
Major depression is an illness, with many options for treatment. The sooner you get help, the more quickly and effectively you can overcome the physical and emotional side effects of this devastating condition. Many women can go through months of emotional turmoil thinking, “It's just a bad day,” then “What a bad week,” to “This month has been awful,” and still believe that they're just feeling temporarily down. Often, these women are taken aback when a friend, spouse, or relative expresses concerns over their moodiness, irritability, or remoteness.
If you or those around you suspect that your emotional behavior may signal a mood disorder, you need to seek a diagnosis and, if necessary, make behavioral changes or begin treatment. Your goal is to get your life back in balance, so you can regain your sense of confidence and purpose.
Rule Out Medical Causes
Mood swings, depression, and anxiety can all be triggered or made worse by medical problems. Thyroid disorders can sometimes result in depression, as can the use of some medications used to treat high blood pressure. Some weight-loss drugs can trigger a rise in anxiety levels or even panic attacks. Begin by talking with your gynecologist or general practitioner, who can review your medications and health history to uncover any potential medical causes for your mood disorders.
Your doctor or health care provider can also uncover contributing medical conditions, such as insomnia, sleep apnea, or extreme hormonal imbalances, which may contribute to your mood swings. If your doctor uncovers specific medical causes for your condition, he or she can adjust your medication, treat the contributing medical condition, or suggest other specific treatment options to address those issues.
Explore Your Treatment Options
When medical complications have been ruled out, you have several treatment options available to you for diminishing — or even eliminating — your mood disorder symptoms. The option that's best for you is determined, in part, by the severity of your problem and your personal and family medical history.
If you suffer from major depression, your doctor is likely to prescribe an antidepressant medication. Following is a quick list of some of the most commonly prescribed antidepressant and anti-anxiety medications:
Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, sertraline, paroxetine, and citalopram (marketed as Prozac, Zoloft, Paxil, and Celexa). Though SSRIs can cause depressed sexual response and other side effects in certain individuals, they are non-addictive and work by helping your body make better use of the serotonin it naturally produces. Some of these medications are effective with anxiety as well.
Tricyclic antidepressants such as desipramine, amitriptyline, imipramine and others, have been used for many years to treat depression. While they do have some annoying side effects such as dry mouth, sleepiness, sensitivity to the sun, and low blood pressure, these medications can be very effective in treating depression. Since they interact with many other medications and may change blood sugar levels, you should tell your health provider about all other medications you are on, and any medical conditions you might have before starting these drugs.
Anti-anxiety drugs, or anxiolytics — such as buspirone and alprazolam — can lessen the effects of depression, anxiety, and sleeplessness, and they also can treat the symptoms of PMDD that many perimenopausal women experience as they move closer to menopause. Anxiolytics can have a slightly sedative effect and can be addictive, so many doctors prescribe them for short periods of time only.
Many doctors prescribe antidepressants in combination with hormone therapy for perimenopausal or menopausal women with severe depression. Though hormone therapy is rarely the first-course treatment for depression, it can alleviate symptoms such as hot flashes and insomnia that contribute to depression, and it offers other benefits for some menopausal women.
Learning to be optimistic can have real physical and emotional health benefits. Studies continue to point to the benefits of optimism, including increased feelings of well-being, better immune response, and quicker recovery from injury and disease. Best of all, it can be learned! So even if you aren't rosy by nature, you can learn techniques to have an optimistic outlook that will benefit your physical and emotional health.
Psychological counseling — psychotherapy — is a powerful treatment option for women experiencing excess anxiety, stress, or mood disturbance during perimenopause and menopause. Most studies have shown that counseling in conjunction with antidepressant medication offers more long-term and effective results than does a treatment using medication alone. Though you may not experience the benefits of psychotherapy immediately after you begin treatment, its effects can be long lasting and extensive.
The two types of psychotherapy you are most likely to receive for emotional problems associated with perimenopause are interpersonal therapy or cognitive behavioral therapy. Interpersonal therapy explores the relationships in your life and how they contribute to your emotional problems. This type of therapy also teaches you how you may use the strength and support you gain from your relationships to help deal with emotional issues.
Cognitive behavioral therapy examines your core thoughts and beliefs and how they determine your actions in response to life. If you have developed a pessimistic or negative attitude toward life, this type of therapy can help you see the world in a more balanced perspective and learn more effective ways of viewing and coping with challenges.