Forging A New Path: Exploring Treatment For Menopause-Related Depression

A meta analysis published in JAMA Psychiatry examined 14 studies with 67,714 research subjects and found that women who experience early menopause are more likely to experience depression later in life. The data revealed that “there was a 5% decrease in the risk for severe depression with each 2-year increase in age at menopause” and that women who entered menopause before 40 were 50% more likely to experience depression. Additionally, women with past histories of depression were less likely to experience future depression if they began menopause at a later age. Perhaps most significantly, the researchers found that whether or not a woman was using hormone replacement therapy (HRT) did not affect the likelihood of developing depression. As lead author Dr. Eleni Th Petridou says, “It seems that HRT use does not offset the odds of depression.” The study highlights the importance of depression screening for menopausal women, particularly those who are at higher risk due to earlier menopause onset, as well as the need for depression treatment that goes beyond HRT.

If hormone replacement therapy doesn’t appear to effectively protect against depression, what can you do to address symptoms of menopause-related depression? While the initial trigger for this form of depression may be hormonal, the development and effects of major depression as the result of menopause are complex. For many women, menopause brings with it a host of psychological, physical, social, and behavioral changes that can contribute to your experience of depression and treatment must be designed to address your specific symptoms and underlying causes. As Patricia Nicholson of Women’s College Hospital writes:

There is a multitude of factors that can affect mood during menopause, and a vast range of symptoms different women will experience in different ways with differing severity. But in many cases, the tools for coping with mood problems will follow similar themes: managing symptoms, managing life stressors, and managing transitional issues.

By drawing on a range of evidence-based modalities and holistic therapies, you can begin to heal from both emotional and physical distress to recapture your quality of life and rejuvenate your sense of wellness.

Antidepressants

Antidepressants, including SSRIs, SNRIs, and bupropion, can be used to alleviate depressive symptoms by triggering neurotransmitter activity that elevates mood. Some antidepressants, such as Effexor, can also reduce the “number and severity of hot flashes for most women,” minimizing physical discomfort that can contribute to psychological distress and sleep disruption.  A skilled psychiatrist can create a tailored medication plan that will provide you with the greatest benefit with minimal side effects.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a goal-focused therapy that gives you emotional and practical tools for addressing sources of distress by establishing positive patterns of thought and behavior. While CBT has been found to be a remarkably effective form of depression treatment in general, until recently little research had been done specifically on the efficacy of CBT on menopause-related depression. Last year, however, a team of Canadian researchers found that half of menopausal women were significantly less depressed following 16 sessions of CBT and 25% no longer exhibited any depressive symptoms. CBT that combined psychoeducation, coping skills, and physical relaxation techniques was particularly effective. CBT has also been found to alleviate physical symptoms of menopause. A number of studies have also found that CBT significantly reduces hot flashes and night sweats, resulting in improved mood, sleeping patterns, and overall quality of life.

Holistic Therapies

Menopause can often disrupt your relationship with your body as you struggle against physical discomfort and seek to adapt to your new physical reality. Holistic therapies such as acupuncture, massage, and meditation can allow you to re-connect with your body in a positive and productive way while also enhancing your mood and ability to cope with distress. As Trisha Gura writes, yoga may be especially useful in regaining mind-body harmony and offer meaningful benefits for combatting depression:

Yoga practices may provide a source of distraction from daily life and enhancement of self-esteem, helping women to focus on the simplicity of movement and forget about work responsibility and demands, and thus reduce anxiety as well as depression.

The skills you develop through holistic approaches can be integrated in your everyday life, giving you the ability to engage in continuous self-healing and ongoing personal growth.

Therapy Groups

Connecting with others who understand your distress can be deeply nourishing and allow you to break through the isolating effects of major depression. For women in menopause, therapy groups may be a particularly comforting space to explore phase of life issues that impact your psychological state, and work through your emotions, experiences, and coping skills within a supportive, non-judgemental environment. Expressing yourself and learning alongside peers who share your struggle with depression is often a vital part of depression treatment, regardless of the initial trigger of the depression.