Mental wellbeing during menopause: Finding help when you need it

We hear a lot about the changes to our bodies during perimenopause and menopause, but menopause can have a big impact on our mental wellbeing, too. In fact, studies demonstrate that women are two times more likely to have depressive symptoms during perimenopause compared to before perimenopause. Women with a history of depression, including postpartum depression, have the highest risk. 

So why this big jump in depression? Researchers aren’t completely sure. Studies suggest that decreasing estrogen levels may play a major role in its interaction with serotonin and other neurotransmitters, which contribute to mood regulation. 

The physical symptoms around menopause, such as hot flashes that make it hard to get enough sleep, can cause women to feel irritable and anxious as well. On top of that, many women face significant life changes around the time of menopause — for example, children may be getting ready to leave home while aging parents need more care. 

For women who’ve been focused on looking after others for years, it can be hard to pause and tend to their own mental health.

Is this depression? 

The symptoms of depression include feeling tired or low on energy, losing interest in your usual activities, feeling sad or irritable, struggling to sleep, and having a lower libido. If you’ve had any of these symptoms for more than two weeks, it may be a sign of clinical depression.

Please know that depression doesn’t come from weakness, and it’s not anyone’s fault. The truth is, depression is a treatable medical condition, and your healthcare team can help. If you think you may be experiencing depression, talk with your doctor. 

Medications to treat depression

If you and your healthcare provider agree that it’s time to treat depression, there are different therapies out there, and medications are one of them. Deciding what medication to choose will depend on how severe your symptoms are, and whether you’ve experienced depression before. 

If your symptoms are severe, your healthcare provider may recommend a combination of antidepressant medications and menopause hormone therapy (MHT). For milder symptoms, especially if you don’t have a history of depression, your healthcare provider may recommend trying antidepressants or MHT alone to see what works for you. 

There are many types of antidepressants to choose from. Selective serotonin reuptake inhibitors (SSRI) are often first-line therapies for depression. SSRIs work by increasing the levels of serotonin in the brain. Serotonin is a neurotransmitter that helps brain cells communicate with each other, and it’s known to stabilize mood and support feelings of wellbeing. SSRIs are the most prescribed type of antidepressant, and they come with a good safety record and few adverse effects. Common SSRIs include fluoxetine (Prozac™), sertraline (Zoloft™), and paroxetine (Paxil™). 

Your healthcare provider may suggest MHT for mild-to-moderate symptoms of depression, especially if you haven’t experienced depression before. Since MHT includes estrogen, it may help with mood changes that come with decreasing estrogen levels in your body. MHT can also ease other physical effects of menopause, which may help with mood. Progesterone will also be prescribed to protect the uterine lining, and this may help with sleep. 

While it’s rare, depression can be a side effect of MHT. If you notice an increase in your symptoms after you begin MHT, talk to your healthcare team.

How does therapy fit in?

Whether you go with an antidepressant, MHT, or both, psychotherapy is another important piece of the puzzle. Experts recommend interpersonal therapy, which helps people understand how relationships impact depression, and cognitive behavioral therapy (CBT), which helps people reframe the thoughts and beliefs that come with depression.

When will I feel better?

If you begin with MHT treatment, most patients notice a difference in two to four weeks. With antidepressants, you will likely work up to the right dose for you, so it can take one to two months to know if your antidepressant is working well. If your medication isn’t helping you feel better, or you have side effects, your healthcare provider may suggest switching to a different medication. 

Psychotherapy usually works more gradually — on its own, people notice a change after two months or more. Although therapy takes time and commitment, the benefits tend to be long-lasting. 

If you’ve noticed mood changes and you’d like to talk over the options for treatment, reach out to your provider.

Reviewed by the Ovia Health Clinical Team

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