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By Mindy Bilgrey, HealthAtoZ contributing writer
As some women get older, they feel depressed and wonder if it's because they've reached menopause. There is no scientific evidence that diminishing hormone levels during menopause are the actual cause of emotional difficulties or depression. However, experts recognize that some women do suffer from depression as they reach that stage in their lives.
Depression during menopause
"Some women may experience depression at any age. Clinical depression is not more common at menopause than at other stages of a woman's life," says Margery L. S. Gass, M.D., former president of the North American Menopause Society, professor of clinical obstetrics and gynecology at the University of Cincinnati College of Medicine, and director of the University Hospital Menopause and Osteoporosis Center in Ohio.
She adds that while some women experience moodiness and irritability during menopause, the cause remains elusive. Some experts think such emotional disturbances may be hormone-related while some think they're depressed because of the situation a woman feels she's caught in. Some say that having one's sleep interrupted by hot flashes may worsen the problems.
Symptoms of depression
Depressed menopausal women have the same feelings as non-menopausal depressed people, which include:
- Persistent sadness, anxiety, despair, pessimism and guilt, as well as feelings of emptiness, worthlessness and helplessness.
- Lack of interest in or no longer enjoying activities and hobbies.
- Loss of interest in sex.
- Feeling tired or having no energy.
- Trouble concentrating and remembering, and with making decisions.
- Changes in sleeping patterns, such as insomnia, waking up too early or sleeping too much.
- Appetite and weight changes.
- Preoccupation with death and suicide and perhaps attempting suicide.
- Restlessness and irritability.
- Nagging physical ailments, such as headaches, stomach problems and chronic pain, that don't respond to treatment.
Causes of menopausal depression
"Triggers may be midlife issues - problems of aging parents, children leaving home, facing personal issues of aging, career issues for self or partner, health concerns and loss of fertility," Gass says, adding that there is evidence that depression runs in families.
Many women find midlife not only a time of physical changes but also a time when they feel additional stresses, such as:
- Uncertainty in close relationships
- Change in marital status through death or divorce
- Dealing with teenage children or grandchildren, or with grown children who are still living at home
- Accepting, for some women, that they will never have children
- Taking care of aging parents
- Making career choices or deciding whether to retire
- Physical changes that occur as women age
Although a woman may not be able to change the pressures she faces, she can learn to cope with stressful situations. The North American Menopause Society offers several suggestions:
- Participate in activities that you enjoy.
- Spend time with your friends.
- Exercise daily.
- Find hobbies or activities that you find mentally or spiritually fulfilling.
- Take time for yourself, such as getting a manicure or massage.
- Eat well-balanced meals and snack on healthy foods.
- Learn stress-reduction and relaxation exercises.
- Get enough sleep.
- Laugh whenever you can.
- Find a support group.
- Seek counseling.
Treatment for menopausal depression
Many menopausal women feel irritable or "blue." Often, changing one's lifestyle can relieve these feelings. Stress-reducing techniques and relaxation exercises have been found to be very helpful in reducing depression in some women.
Gass suggests that women become more involved in activities such as exercise, working outside the home and exploring new interests. If the feelings of depression persist, a woman should speak with her physician regarding medication or counseling, or both.
Gass says antidepressants are commonly prescribed to menopausal women who are fighting depression. The ones most often prescribed include:
- Prozac®
- Zoloft®
- Paxil®
- Effexor®
- Celexa®
- Lexapro®
 Anyone being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with your doctor.
Emotional difficulties can be due to sleep deprivation from hot flashes during the night. Be sure to talk to your doctor if hot flashes are problematic.
This article was reviewed and updated June 2007.
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