What You Need to Know about Perimenopausal Depression
Perimenopause is the phase in any woman’s menstrual cycle which occurs before the actual menopause. This natural stage in any woman’s life is accompanied by early menopause symptoms, which include worsening premenstrual syndrome or PMS, vaginal dryness, abnormal weight gain, breast tenderness, hair loss or thinning of hair, the onset of hot flashes, and chronic fatigue. On top of all that, there is perimenopause-associated depression.
The Harvard Medical School Medical Health Guide published a finding in 2006 which linked the depression experienced during perimenopause not to hormonal fluctuations, which were normally believed to be the causes, but to factors associated with genetic mutations. The risk is higher if the woman had a history of postpartum depression or sexual abuse or if she underwent depressed moods during her menstrual periods. Moreover, women who have never borne children are also at a higher risk for perimenopause depression. The Harvard Study of Moods and Cycles recommended that the treatment course must not be just a prescription of antidepressants or hormonal replacement therapy; psychotherapy must also be included.
When symptoms are severe, treatments for perimenopause depression involve medication with antidepressants and hormone replacement therapy. Hormone replacement therapy uses estrogen and progesterone. In some cases, only estrogen is used. And whether or not the woman had a history of depression, the combination of hormone replacement therapy and antidepressant medication is strongly advised. If the symptoms are mild, then only one of the two treatment methods must be used.
The most common antidepressants prescribed for perimenopause-related depression are fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and sometimes citalopram (Celexa). The typical side effects of these drugs are restlessness, nervousness, insomnia, nausea, sexual problems, and diarrhea. To deal with these side effects, the dose is increased gradually.
Hormonal treatments are used for mild to moderate symptoms of perimenopause depression. Estrogen minimizes hot flashes and other physical symptoms. Hormones also have other health benefits like prevention of heart disease and memory problems. They also play a role in keeping the bones strong. The side effects are higher risks of stroke and breast cancer. The other hormone, progesterone, promotes bloating which is quite uncomfortable for the woman taking it. But progesterone is normally mixed with estrogen during hormonal replacement therapy to ensure that uncontrollable buildup in the uterus does not happen, since that will possibly lead to cancer.
Finally, psychotherapy is essential, most especially for women who show severe symptoms of perimenopause-related depression. Psychotherapy sessions combined with either antidepressant medication or hormonal treatment are the best solutions to treat depression during perimenopause.
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