We women often hear the word “emotional” used interchangeably with “hormonal” and it’s not usually a compliment or comment on one of our strengths. This week, we invited Dr. Julia Frank to talk to us about menopause and depression. We learn that women are likely in states of “hormonal flux” at puberty, premenstrually, postpartum, and during perimenopause and menopause. (Someone should invent a lubricant or maybe a cocktail and name it “Hormonal Flux.”) So, from as early as age 10 until our 60’s, we’re basically dealing with changing hormone levels at least once a month or for longer periods. Pun intended. Lucky us. Well, I do mean lucky. Before we talk about the happy subject of depression, let’s listen to a bit of Eve Ensler who reminds us that being an emotional creature is one of the things that make us the strong, beautiful, intuitive human beings that we are:
This is not extreme.
It’s a girl thing.
What we would all be if the big door inside us flew open.
Don’t tell me not to cry.
To calm it down.
Not to be so extreme.
To be reasonable.
I am an emotional creature.
It’s how the earth got made.
How the wind continues to pollinate.
You don’t tell the Atlantic Ocean to behave.
There are many days we won’t feel as unstoppable as the Atlantic Ocean, and that’s fine. Eve is a poet, a writer, and a woman. She was using hyperbole to remind us of our greatness. Still, sometimes our emotional states can become something more intractable. Dr. Frank says that “hormonal flux, loss, and change” are “part of normal experience,” but when we’re living for weeks on end at a 2 instead of a 10 or can’t find our joy in living, there are options that, like perimenopause and menopause, are best evaluated and treated in partnership with a knowledgeable doctor that you trust. (I have some tips on how to find a menopause specialist.) We also learn that there may be reasons to exercise other than the fact that summer and swimsuit season is here (better sleep and fewer hot flashes, anyone?). Read on …
Menopause and Depression: Interview with Dr. Julia Frank
Q: Why are women at greater risk of depression as they approach menopause?
A: Menopause is one of the several times in a woman’s life in which levels of estrogen and progesterone are in flux. (Puberty, premenstrually and postpartum are the others). Because these hormones are also neuromodulators, rapid changes can trigger mood symptoms. In addition, women who are in the later stages of mid-life face many changes that can lead to depression–loss of the members of the older generation, dealing either with not ever having children or having children leave home, reaching a plateau at work or other workplace stresses, and the sexual changes that may occur in intimate relationships all may trigger depression. All of these factors–hormonal flux, loss, and change–are part of normal experience, so the association with depression usually involves either prior personal depression, experiencing more than one stressor or factor, or having one that is unduly severe.
Q: Do antidepressants help for menopause symptoms? Can you take antidepressants at the same time as hormone replacement therapy?
A: Yes. In particular, the serotonin reuptake inhibiting antidepressants work as well for depression in menopause as at other times–they also may relieve hot flashes, even in the absence of depression. In some women, the combination of hormones (estradiol in particular) and antidepressants seems to be more effective than antidepressants alone.
Q: Are some antidepressants more effective and/or safer than others?
A: The selective serotonin reuptake inhibitors (SSRI) (fluoxetine (Prozac) and its cousins), and the dual-acting antidepressants that inhibit the reuptake of both serotonin and norepinephrine [SNRIs] (venlafaxine (Effexor) and duloxetine (Cymbalta) and desvenlafaxine (Pristiq) are all safer than the older classes of antidepressants (the tricyclics (amitriptyline (Elavil) and monoamine oxidase inhibitors (tranylcypromine (Parnate). Very few studies directly compare antidepressants to each other, so it is not really possible to say that one group clearly works better than another. However, the SSRI and dual acting agents both clearly help with depression in menopause. Some women will respond better to one than another, but that has to be determined on an individual basis–it isn’t predictable from large studies.
Q: What are some natural ways women can fight depression?
A: EXERCISE, EXERCISE, EXERCISE is the best proven “natural method” for fighting depression. 30 minutes of vigorous aerobic exercise three to four times a week is necessary to experience this effect, but you don’t need to sign up for a marathon or a boot camp–walking, biking, swimming all work fine if you do enough of them. Exercise also helps with sleep, bone health, and even hot flashes. Exposure to very bright light in the winter (not tanning, just a bright light in the visible spectrum) helps many women, especially those with “winter blues”. The equipment for this is not terribly expensive and does not require a prescription, but you do need to use it correctly–30-40 minutes, every day. Psychotherapies of many kinds also help with depression–often just a few sessions are enough to get people back on track. Interpersonal therapy, which involves focusing on important relationships, or cognitive behavioral therapy, which involves changing patterns of thinking and activity, are both well-proven methods of relieving depression without medication. Attending to spiritual concerns–resolving conflicts with others, looking for meaningful activities and a supportive community–is another important aspect of self-care for depression. Various herbal remedies are much less clearly effective than these methods.
Thank you, Dr. Frank! Her advice almost makes perimenopause and menopause sound like an opportunity to learn more about ourselves, improve our relationships, and stay healthy. She may be on to something.
Remember: Suffering in silence is OUT! Reaching out is IN!