Perimenopausal depression has long been misunderstood and under-recognized — until now, that is. Doctors and scientists have just rolled out the first-ever guidelines for perimenopausal depression treatment and evaluation, and to say they're overdue is an understatement.
Published simultaneously in the journal Menopause and the Journal of Women’s Health, the September 2018 guidelines focus on the causes and symptoms of depression during perimenopause, the effects of antidepressants, the impact of hormone therapy, and the potential use of alternate therapies such as exercise and natural products.
As you might be aware, perimenopause is the three or four-year time period that happens just before menopause. During perimenopause, menstruation becomes irregular and eventually stops. But as any woman who’s going through perimenopause knows, it’s usually not as easy as simply saying goodbye to tampons and pads forever; it's also a time when symptoms such as hot flashes and sleep disturbances start to kick in. Multiple outside causes of stress can start to affect perimenopausal women at this time, such as the responsibility of simultaneously caring for their ailing parents and their own children. In the midst of all these big changes, perimenopausal depression can happen as well. That’s why it’s such good news that doctors are finally putting the spotlight on it for detection and treatment.
"The reason these guidelines are needed is because depression during the perimenopausal phase can occur along with menopausal symptoms, and these two sets of symptoms are hard to tease apart, which makes it difficult for clinicians to appropriately treat these women," said co-lead author Pauline Maki, PhD, in a press release. "Many women experience a new onset of depressive symptoms. If there is underlying low-level depression to begin with, perimenopause can increase the intensity of depressive symptoms.”
Dr. Maki went on to explain that the causes of perimenopausal depression might be tough to identify, especially since every woman experiences perimenopause a bit differently. That said, doctors can help find a proper treatment for women based on their personal experiences and specific symptoms.
"Are women experiencing low energy because they are having night sweats and losing sleep? If so, treating with hormones may be the best bet," Maki said. "Alternatively, is a woman with a past history of depression having another depressive episode? In that case, antidepressant therapy might be most effective. Is the issue primarily due to family and job burden? If so, cognitive behavioral therapy with or without an antidepressant might be best."
One of the most important takeaways from recent research is that there are effective treatments for perimenopausal depression. It’s simply a matter of working with your doctor to figure out which one is best for you.
Perimenopause and Depression: Key Findings
Obviously, the guidelines for detection and treatment of perimenopausal depression are very lengthy and complex; they're written for doctors, after all. If you’re interested in reading them in full, you can do so here. But here are a few highlights to keep in mind if you suspect that you’re experiencing depression and perimenopause:
- It is possible to experience depressive symptoms during perimenopause even if you’ve never had depression before.
- Perimenopausal symptoms (including hot flashes and night sweats) can happen alongside perimenopausal depression – and complicate it during this time.
- Therapeutic options for depression (such as antidepressants and cognitive behavior therapy) should be the front-line treatments for any major perimenopausal depressive episodes.
- Hormonal contraceptives might help improve symptoms of depression for women getting closer to menopause.
- Estrogen therapy, however, is ineffective as a treatment for perimenopausal depression. There is not enough evidence to recommend any alternative approaches — such as botanical treatments — for depressive symptoms.
Remember, always talk to your doctor if you think you may be suffering from perimenopausal depression and before attempting to treat it.