Depression and menopause
The symptoms of menopause include the loss of fertility along with other physical changes, such as an increase in blood pressure, changes in cholesterol levels, and weakening of the bones (osteoporosis). Other symptoms can include weight gain, hot flushes, night sweats, irritability, poor concentration, headaches, and irregular or heavy periods. Menopausal symptoms are mainly due to falling oestrogen levels. Oestrogen is a hormone that is produced and released by the ovaries – as you go into menopause the ovaries naturally cease to produce both oestrogen and progesterone, as there are very few remaining eggs in the ovaries. Symptoms of menopause may last for just a few months or for several years. You may get all the symptoms or very few, and you may find some affect you more than they affect your friends: it is different for everyone.
Depression is very common during menopause. It is probably less talked about as a symptom, and as less people are aware of it, you may be left feeling very alone. But in fact, it has been found that up to 80% of women going through menopause can develop mild depressive symptoms, beyond the general malaise that may be attributed to insomnia and other symptoms.
Symptoms of depression include continuous low mood or sadness, feeling hopeless and helpless, a lack of motivation, a loss of interest in things you previously enjoyed, changes in appetite, and changes in your sleep patterns, such as finding it difficult to fall asleep at night or waking very early in the mornings.
The role of oestrogen
So why does depression occur during this stage of life? The hormone oestrogen, which declines during the menopause, increases the concentration of neurotransmitters in the brain. These neurotransmitters are responsible for our mood, among other things. You may have heard of some of these neurotransmitters: serotonin, dopamine, and norepinephrine – all of these are associated with depression. Depression during menopause may occur because areas of the brain involved in emotion and mood are rich in oestrogen receptors, and oestrogen directly influences the amounts of these neurotransmitters in the brain. The reduced amount of oestrogen in the body reduces the neurotransmitters involved in keeping us from being clinically depressed. Alongside the emotional changes that often occur at this stage of life, it is unsurprising that many women become depressed during menopause.
How St John’s Wort can help
St John’s Wort (Hypericum perforatum) is a herbal medicine that may be helpful in the treatment of mild or moderate depression. St John’s Wort works in a very similar way to prescribed antidepressants. It contains the active ingredients hypericin and hyperforin, as well as other substances present in the plant. Hypericin is the ingredient that may treat depression. It is thought to work in a similar way to antidepressant medicines, by affecting levels of the neurotransmitters such as serotonin in the brain. However, the exact mechanism of action is not known.
Research published in the British Medical Journal has suggested that St John's Wort extract is as effective as imipramine, a prescribed antidepressant, in controlling symptoms of mild to moderate depression over a period of 12 weeks. Other research has also shown that this herb may be as effective as selective serotonin reuptake inhibitors (SSRIs), which are prescribed in treating mild to moderate depression. St John’s Wort can work to improve mood and may alleviate many of the symptoms associated with depression, such as appetite change, disturbed sleep, anxiety and tiredness. Often people report feeling the positive effects of St John’s wort extract quickly after they start to take it, and there tend to be less unwanted side effects than with many prescription antidepressants.
It should be noted that St John’s Wort should not be taken alongside any prescribed antidepressants. It is important that you let your doctor know you are taking St John’s Wort if you take any other prescription medicine, as some unwanted interactions may occur.
Menopausal symptoms including depression may also be helped by adhering to a healthy balanced diet. This should include plenty of vegetables and fruit, whole grains and some protein and some healthy unsaturated fats. Also, more specifically for depression, omega-3 fats may be helpful. Try to include 2-4 portions of oily fish per week, such as salmon, mackerel, trout, sardines, herring and pilchards. If you don’t like eating fish, try to take a fish oil supplement with a high proportion of the active ingredients, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – up to 1g per day.
During menopause you are likely to lose calcium from your bones because of the decline in oestrogen. Many nutrients are important for bone health, so a varied, balanced diet is very important. However, you can help your bones further by aiming for 2-3 portions of calcium rich foods per day. Vitamin D is also an essential nutrient for bone health, so if you are over 65 or you do not get much sun exposure it may be worth taking a vitamin D supplement of 10 micrograms per day.
If you experience symptoms of depression for most of the day, every day for more than two weeks, you should seek help from your GP. It is especially important to speak to your GP if you have thoughts of self-harm or suicide or if you experience symptoms of depression that are not improving or your mood affects your work, other interests, and relationships with your family and friends.
Menopause can be a worrying time, and it is important that you do all you can to make the right choices, and get the support you need to make it as easy a transition as possible.
From Jennifer Low
Jennifer is a registered dietitian and a media spokesperson for the British Dietetic Association. She has written numerous articles for magazines and online media, as well as appearing on TV and radio. She owns JL Nutrition Clinic and also works for Weight Loss Surgery Kent.