Understanding the complexities of menopausal depression is crucial for effectively treating women experiencing menopause or perimenopause. 

Menopause, a natural phase marking the end of menstrual cycles, can bring about hormonal changes that contribute to a range of physical and emotional symptoms. While most people are aware of the physical symptoms like hot flushes, night sweats and sleep issues, the psychological symptoms - including depression - can be overlooked or written off as unrelated to perimenopause and menopause. 

Causes of Major Depression vs Menopausal Depression

While the exact neurological processes behind Major Depressive Disorder are not fully understood, it is believed to involve various factors rather than a single cause or neurotransmitter imbalance. Antidepressants, particularly SSRIs in addition to psychological intervention, can be helpful in alleviating some depressive symptoms, indicating the involvement of neurotransmitters in depression. More recently, treatment such as Transcranial Magnetic Stimulation (TMS) has shown to be effective particularly for treatment resistant depression.

In contrast, menopausal depression is linked to a decline in hormones, particularly estrogen. The hormonal imbalance during menopause can disrupt the structural and functional connectivity of brain regions involved in emotional regulation and cognitive processing. Neuroscience underscores the interconnectedness of hormonal fluctuations, brain function, and overall neurological well-being during menopause.

Menopausal Depression and Prior Mental Health Conditions

Research has long shown that the rates of mental health issues, particularly depression, are highest during midlife. It’s important to know that women can experience mental health issues for the very first time in their lives, during midlife. However, women with a history of depression, anxiety, trauma, bipolar disorder, or schizophrenia may have a more challenging time during perimenopause. Indeed, those who have experienced depression before, especially during a postpartum period (another period of marked hormonal change), are at greater risk of menopausal depression. Similarly, women with premenstrual dysphoric disorder (PMDD) are more likely to experience difficulties during perimenopause or menopause. 

Differentiating Menopausal Depression from Major Depressive Disorder

Menopausal depression often presents sufficiently different to major depressive disorder so as to be missed by health practitioners. While women who experience major depressive disorder present with sadness, tearfulness, lethargy, and withdrawal, irritability, anger, and frustration are more commonly seen in those experiencing menopausal depression. These symptoms also ‘show up’ in an inconsistent manner, with the individual experiencing both good and bad days. Again this is different to the relative ‘consistent’ symptom picture typical of major depressive disorder.

Health providers should ask patients about changes in their life and mood to help differentiate between menopausal depression and other forms of depression. If a patient reports feeling irritable, grumpy, or anxious without significant life changes, menopausal depression may be a consideration. Add to that the presence of symptoms more commonly associated with menopause (i.e. somatic symptoms, sexual interest, memory difficulties) and there would be even more reason to consider menopausal depression.

Tools such as the MENO-D can also aid in identifying menopausal depression, especially in women in the perimenopausal age range whose symptoms do not fit the typical depression profile.

Treatment for Menopausal Depression

While some medical professionals may recognise signs of depression, they may opt for the common treatment approach; antidepressants. For women who have menopausal depression, whereby the cause is hormonal, antidepressants may not be effective. As you would imagine, this can exacerbate a sense of ‘being broken’ and feelings of despair. Hormone therapy (HT) is considered the most effective treatment for perimenopausal depression and as such, best practice in these instances. 

Those who are already taking antidepressant medication prior to entering perimenopause, may find it less effective. In such instances, the doctor may encourage them to continue their antidepressants and also prescribe hormone therapy. 

Being aware of the unique challenges and symptoms of menopausal depression is crucial for health providers treating women experiencing menopause or perimenopause. By understanding the underlying causes, treatment options, and ways to differentiate menopausal depression from other forms of depression, health providers can provide more effective support and care for their patients during this important life transition.

If you are a health provider seeking support for your patients during the perimenopausal and menopausal years, All About Her is here to help. You can submit a referral or find a health practitioner to suit your patient’s needs.

If you are experiencing any of the symptoms mentioned in this article, please seek the advice and guidance of your general practitioner. Alternatively, take a look at out Peri Partners page where you will find the details of menopause-informed GP’s.