Is your menopause causing your depression, or is your depression making your menopause worse? For many women, their first encounter with depression will occur during perimenopause. Does this make depression an inevitable part of menopause? New findings that indicate some of the links between menopause and depression but there is more to the story. This first in a two-part series examines the basic symptoms and risk factors of depression.

Types of depression
Depression is loosely divided into two categories. The first deals with subsyndromal depression, which refers to having symptoms that are not severe enough or long-term enough to be considered for a clinical diagnosis.

Clinical depression requires meeting a set of criteria for a medical diagnosis, with symptoms lasting longer than two weeks. Doctors will often refer to the following list, looking for five or more of these conditions when assessing whether a patient is clinically depressed.
*Having periods of intense sadness
*A loss of interest in your usual favorite activities.
*Significant weight gain or weight loss
*Significant increase or decrease in appetite
*Agitation and irritability, getting upset easily
*Fatigue and loss of energy, often accompanied by sleep disturbances
*Feelings of worthlessness or hopelessness, even with no apparent ‘cause’
*Inappropriate guilt, sometimes linked to behaviors stemming from depression
*Poor concentration, forgetfulness, unable to make even small decisions
*Plans or thoughts of suicide, or ‘wanting out’ or ‘just wanting to end it all’

Is menopause making me depressed?
One of the biggest challenges facing healthcare experts is determining if menopause plays a role in depression, or if other risk factors cause or worsen both depression and menopause. Because every woman is different, there is no one-size-fits-all description of depression. The following are four areas doctors examine as a series of risk factors that will vary from patient to patient.

Demographic: Caucasian people tend to report more episodes of depression, as do those with lower levels of education, and lower incomes.

Psychiatric: Patients with a history of depression, even if several years ago, tend to experience recurring periods of depression. One study showed that 50% of patients diagnosed with clinical depression would experience at least one more episode of depression within the next two decades.

Psychosocial: Stressful life events tend to occur right around the time of menopause, including children leaving home, dealing with workplace stresses, and caring for elderly parents. Moreover, having an unhealthy lifestyle, marital concerns, and negative attitudes towards aging and menopause may play a role.

Menopausal: The fluctuation hormone levels, particularly estradiol in the brain, can lead to increased symptoms like hot flashes and insomnia. Other factors include an early or long-term menopause and sudden menopause from surgery.

So how much of an impact does menopause have on depression, or depression on menopause? In the second part of this series, we will look at what researchers are discovering to help identify and treat mid-life depression.

‘Menopause, Depression & Hormones: What’s the Connection?’ Hadine Joffe, MD, MSc. Department of Psychiatry, Division of Sleep Medicine, Massachusetts General Hospital, Boston, MA as presented at the NAMS 22nd Annual Meeting in Washington, D.C. Sept 2011.

‘Depression in Midlife Women: Identification & Treatment’ Teri Pearlstein, MD, Psychiatry & Human Behavior, Alpert Medical School at Brown University, Providence, RI as presented at the NAMS 22nd Annual Meeting in Washington, D.C. Sept 2011.

Keep track of any depression symptoms with Menopause, Your Doctor, and You