Life changes play their part
Although menopausal depression is primarily triggered by hormonal fluctuations, and affects your mood, it's important to be aware that it can also be compounded by the significant lifestyle changes often going on around the same time – CBT can be helpful for dealing with these changes in particular by developing coping strategies.
For many women, menopause may coincide with ‘empty nest’ syndrome: their children moving out and beginning lives of their own. It may also be a time when relationships break down, careers begin to wind down, and elderly parents pass on. These are all emotional upheavals, and with the hormonal changes your body can be undergoing as a result of menopause, it's understandably a time when you may feel a bit wobbly in your sense of self – menopausal depression can make you feel that it's all too much to cope with.
CBT works by helping you to examine the negative thought processes that can drive your low moods, and the behaviours you may have developed in response to those. Typically you'd use tools such as worksheets or mood diaries for this, to help you become more aware of what's going on for you, so that eventually you begin to catch those negative thoughts far more automatically.
Your CBT therapist will then help you to work through techniques for challenging and reframing those negative thoughts, avoiding black and white thinking (‘all or nothing’) in day-to-day situations, and changing any negative behaviours (e.g. isolating yourself or addictive behaviours) that sustain your low mood, and feed into the vicious cycle of depression.
The National Institute for Health and Care Excellence (NICE) – an independent body that provides evidence-based guidance on healthcare solutions in England and Wales – lists CBT as one of the three most effective talking therapies to treat depression, and recommends a course of around 16-24 hourly sessions, although this will vary depending on your needs. Finding a well-qualified, experienced CBT therapist who you like and trust also makes a huge difference in how effective the treatment could be for you, so don't be afraid to 'shop around' until you feel comfortable, if you have that option.
Although CBT is generally quite a short-term treatment, the aim is to develop a heightened awareness of your mental processes and a new way of thinking, equipping you with coping strategies that you will continue to use in the long-term. It can initially take a while to get used to recognising when negative thoughts are contributing to your depression – and even longer to learn how to challenge and change your unhelpful thoughts and behaviours – but CBT can, over time, effectively help you to become your own therapist.
Altering your thinking patterns and reactions through CBT you can, therefore, significantly reduce the symptoms of depression and enable you to feel better equipped to deal with any relapses or difficult periods.
CBT as a foundation to manage depression
For many women, CBT may also serve as a trigger for exploring how your lifestyle affects your mood, and whether there are any behavioural changes you could make that may help alleviate your depression independently. Exercise, for example, has been found to help tackle stress and anxiety, boost levels of feel-good chemicals serotonin and endorphins, and improve self-esteem – so taking up a more active lifestyle can be a great way of boosting your mood.
In the depths of depression, it can be extremely difficult to motivate yourself to pull on your trainers and get fit, however the awareness (understanding negative thoughts) you could gain through CBT can make it easier to get into the habit of hitting the gym or practising yoga to keep low moods at bay.
Similarly, simple changes to your diet can also help to ease depressive symptoms naturally. Omega 3 oils and vitamins B and D are particularly good for promoting positive mood, St John's Wort is commonly used as a herbal treatment for depression, and black cohosh is thought to relieve a number of menopause symptoms – including mood swings.
Consequently, CBT can form a great foundation for treating menopausal depression naturally, without pharmaceutical intervention, if you are unable to take medications for health reasons or if you simply prefer not to. Now, of course, CBT cannot be used to help rebalance the body’s hormones during menopause – the potential cause of the depression. However, it is not designed to do that in the first place: CBT can help to change the negative thinking that comes as a result of depression. Therefore, it's important to note that, like many treatments, CBT is not a one-size-fits-all solution. For some people it can work as a part of natural treatment, combined with lifestyle changes, and natural supplements that, together, can help manage depression – for others, it will work best in conjunction with medication, such as anti-depressants or HRT.
If you find that CBT doesn't seem to have much effect on your depression at all, it's worth considering a different therapist or consulting with your GP about other possible treatments, which may include alternative talking therapies like psychodynamic or interpersonal therapy.
From Sarah Graham
Sarah Graham is a freelance journalist, copywriter, editor and proofreader, specialising in women's issues and mental health. You can find her on Twitter @SarahGraham7.