Depression or Menopausal 'low moods'?

The link between depression and the menopause is a tricky one, and many women are often misdiagnosed as depressed, and prescribed anti-depressants, rather than the depressive symptoms being due to the menopause itself.

The confusion is understandable. As you enter perimenopause, you may find that you're more irritable, sad, angry, negative, or restless. It may be hard to tell if these are just temporary blips on your emotional radar screen or symptoms of a more serious mental health problem.

While most women go through menopause without becoming depressed, a significant number will experience depression either as a recurrence of previous depression or for the first time in their lives. Depression can make coping—with menopause and with life in general—very difficult or impossible. It impacts relationships, work performance, and your quality of life.

Clinical depression, also called unipolar disorder, is a condition characterised by intense sadness or despair that lasts more than two weeks, and that interferes with your daily life.

You need to have 5 or more of the following symptoms that occur consistently for more than two weeks to be diagnosed with depression:-

· Feelings of sadness, hopelessness, or despair

· Feeling very tired, or tired all the time

· Feeling guilty or worthless (e.g. low self-esteem)

· An increase or decrease in appetite or weight

· Loss of enjoyment in activities that you have enjoyed in the past

· Difficulties concentrating

· Insomnia, or hypersomnia (sleeping too much)

· Thoughts of self-harm or suicide

There are many reasons that women may suffer from depression after the age of forty. Some of them are biological, some are situational, and some are psychological. A few common factors in midlife depression are:

Hormone changes: Decreasing levels of oestrogen and progesterone during the menopause can upset the levels of neurotransmitters like serotonin. Some believe serotonin levels are lower than they should be, which leads to low mood, problems with sleep and appetite.

Reacting to loss: Loss of parents, children leaving home, divorce, friends lost to illness, loss of youth, or poor health—any one of these might trigger depressive symptoms, that could turn into major depression if they persist for a long time.

Alcohol use: Alcohol is a depressant. If you regularly drink alcohol it can interfere with hormone activity and can have the side effect of depressive symptoms. Alcohol can also worsen hot flushes and night sweats, adding sleep difficulties to your list of things to cope with.

Although it's tempting to ease your mental and emotional pain with an extra glass of something, it can actually make your symptoms worse and make it harder to sort out whether or not you're depressed. If you're dependent on a daily dose of alcohol, perhaps consider talking with your GP about reducing your intake safely so that you can see whether or it is linked with your depressive feelings.

It's easy to be tempted to use alcohol to mask underlying feelings. Try drinking mindfully and ask why this might be the case for you

There are many ways you can improve your depressive symptoms. The following are just some examples. Your GP should be your first port of call if you feel your circumstance or feelings warrant it. They may suggest anti-depressants or other medical interventions - and if they do, it is likely that they believe that non-medical intervention on its own is not the answer for you. Take a look at the NHS Clinical Depression pages here for a snapshot view of what to expect.

There are other strategies you can try – especially if it is more likely that your symptoms are actually due to the menopause, rather than depression itself:-

Cognitive Behavioural Therapy (CBT) and/or Neuro-linguistic programming (NLP):

CBT can be a useful strategy, although it is best to work with a therapist. Sessions involve identifying situations where you feel/experience your depressive symptoms and what your thoughts are in these situations. Then, you will learn how to change your thoughts from negative to positive, with the aim of altering your perception. With this altered perception comes an altered (positive) response and symptoms tend to reduce dramatically.

A strategy you can do yourself relates to NLP – essentially, programming the neural pathways in your brain. One way to do this is to write down three things you are grateful for each day for 21 days – but they can never be the same thing. Initially, you may find it difficult, but you can identify the simplist of things, such as a lovely morning coffee, a bright blue sky, talking to a friend, your yoga class, etc. After 21 days of repeating this (the time taken to restructure neural pathways) you find it hard to select only three! The resulting effect is that your perception has become tuned in to positive things and you start to ignore negative things, which then affects how you feel.

As a Psychologist and Reflexologist, this is a strategy I suggest the most as it is cost free and can work wonders after a short time.

Outdoor exercise on sunny winter days is a great help

Exercise. Exercise has a proven impact on mood. Regular aerobic exercise like walking, running, rowing, or swimming can help elevate your mood. If you add natural daylight (try walking/exercising outside) it's even more effective. Due to the higher risk of experiencing Seasonal Affective Disorder (SAD) at this time of year, getting outside in the natural daylight will really help you to naturally produce more serotonin and re-balance melatonin production (linked to sleep).

Complementary therapies. I mentioned that I'm a Reflexologist as well as a Psychologist, so I'm perhaps a bit biased here - but I really believe in the power of complementary therapies: Homeopathy, Aromatherapy, Acupuncture, Massage Therapy - there are so many options to choose from and the majority can be found at reasonable prices in your local area. As a first step, and if you have a diffuser, Lavender oil is a very calming and relaxing oil to have in your house, or you can simply put a few drops on a handkerchief that you tuck into your sleeves to raise up your arm and get that relaxing aroma into your nose and brain. Similarly, Rose Geranium has wonderful uplifting qualities that can help brighten your mood. This is one of the reasons we’ve included both these essential oils into Menomagic cream. You'll need to decide for yourself if you think you're the kind of person that may benefit from a particular complementary therapy but I always believe these things are worth a shot!

There are many more coping mechanisms you can utilise, so have a read around and own your feelings at this stage of your life. Whilst it can be difficult to distinguish depression from the ups and downs of mood that go with menopause, there are things you can do to help yourself. If you’re able to get your depressive symptoms under control, you may find it much easier to cope with the other symptoms that come with the menopause.