Perimenopause depression. I don’t know if it’s the worst complaint from women in perimenopause, but it’s up there. Usually right behind the rages.
During the worst of my own perimenopause symptoms, when those mood swings hit, it almost always began with depression. A depression so heavy and oppressive that I literally could not get out of the bed for days.
A depression so dark and so sad that I would sob and cry until my eyes swelled shut. It would not be a stretch to say that it was completely debilitating.
From what I’ve read, it has been suggested that if a woman is predisposed to depression prior to perimenopause, she will likely have a tougher time with the mood swings, and particularly depression, when she is perimenopausal. This may or may not be true.
I cannot help but think though, that this attitude is a bit dismissive from male physicians who really have no clue what a woman’s perimenopausal experience is like. And to my many male readers, please know that I’m saying this as gently as I possibly can. I have no desire to alienate anyone. I just find these types of attitudes frustrating because I know from experience how difficult perimenopause is for so many women.
The last thing we need to be told is that if we’re already predisposed to something, then perhaps we’re exaggerating our present condition. Or worse, that we’re hysterical. Whether one is predisposed or not is really irrelevant, in my opinion. The facts are, perimenopausal mood swings and depression are real and what women really need are solutions, not suggestions that they are over-reacting.
The Chemical Roller Coaster
In one of my previous posts on depression, I discussed the effects fluctuating estrogen levels during perimenopause have on serotonin and norepinephrine levels in the brain. Which, as you may know, play a very direct role in our moods. Particularly, depression.
Serotonin and norepinephrine along with another chemical, dopamine, work in synergy in our brain. When all things are equal and chemically balanced between these mood power players, we experience a general state of calm and well being. Serotonin, norepinephrine and dopamine can also reduce anxiety, improve sleep, and generally take us to a happy place.
Serotonin and norepinephrine are also neurotransmitters . Neurotransmitters act as messengers, if you will, transmitting information via neural pathways throughout our brain. If there is some type of disruption in those neural pathways or in the ability of serotonin and norepinephrine to act effectively as neurotransmitters, then the result will usually be a difficult time with moods, depression, anxiety and insomnia. Sound familiar?
Keepers of the Biological Gate
We also have these things called receptors in the brain. There are many different types of receptors throughout our body, but all of them act as biological traffic cops, if you will, receiving, directing and modulating the many types of chemical transmissions that are carried out by the neurotransmitters, which include the aforementioned serotonin, norepinephrine and dopamine.
One type of receptor for women, the estrogen receptor, is heavily concentrated in the cortex and the limbic system part of our brain. The limbic system is the major regulating center for your mood, memory, sleep, sex drive, appetite and pain. As you might expect, if the receptors are having a bad day (like, say, your estrogen is rising & your progesterone is falling) you’re going to have all kinds of biological road rage and chemical smash-ups. (Mood swings anyone?)
In the book Screaming to be Heard: Hormonal Connections Women Suspect, and Doctors Still Ignore by Dr. ElizabethVliet, which I referenced in a previous post here, it is explained like this: (emphasis mine)
There are multiple connections between the limbic system and all the other parts of the brain….which carries messages to all parts of the body. The rise and fall of estrogen alters serotonin, which affects pathways in the limbic system, which then produces changes in mood, sleep, memory, pain appetite and many other mind-body functions. Changes in hormone levels, in turn, affect the amountof neurotransmitters produced as well as the sensitivity of the neurotransmitter receptors to the chemical messengers. No wonder changing hormone levels at puberty, in pregnancy, after delivery and at menopause can produce such a wide variety of physical and emotional changes!
What to Do?
Okay, so, if you’re anything like me, the first thing that went through my head was, “Well, if the key to keeping ourselves out of the “crappy place” and in the “happy place” is dependent (to some degree) upon managing the levels of serotonin, norepinephrine and dopamine in our brain, then, sign me up and tell me how do we do that!”
One possible solution would be antidepressants. Also called SSRI’s (serotonin reuptake inhibitors). Briefly, antidepressants work this way:
Neurotransmitters, such as, serotonin, norepinephrine & dopamine, that are released from nerve cells into the brain only have a short time to relay their message to another cell before enzymes destroy them or they are taken back up by the cell. This process is called reuptake. Once reuptake occurs, the neurotransmitters cease to have any affect on the brain.
In people suffering from depression (such as women with perimenopause) fewer of these neurotransmitters (due to our estrogen receptors being wacky, remember?) are being produced. Therefore antidepressants delay the reuptake of these neurotransmitters, particularly, serotonin, thus raising levels in the brain. With more natural levels of serotonin in the brain, mood is elevated from the depressed state to a more normal state of mind.
As I’ve shared here before, I took Prozac, which at the time, was marketed as Sarafem, to help with my mood swings. I will say that it certainly took the edge off and gave me the ability to relax a little bit so that I could at least “talk myself down” when they occurred. It did not cure all of my perimenopausal ills and they came with a set of side-effects that I was not too thrilled about, particularly teeth and jaw-grinding (which is common) and insomnia (which is also common).
Eventually, the teeth & jaw grinding, coupled with the insomnia – that I sure didn’t need - became too much for me to deal with, so I stopped taking them. However, some women find they do actually work for them, so, please, by all means, if you think it is a viable option for you, take them! But, as always, under the care of your physician.
Incorporating better food choices into our diet is always a good idea whether you are dealing with perimenopausal mood swings or not. If you choose to go the antidepressant route, certainly eating well in tandem will increase your chances of getting the mood swings and depression under control.
Carbohydrates – Yeah, I know. Carb is one of those nasty 4-letter words that many women, particularly those of us in mid-life, try to avoid because they tend to cause us to gain weight. But we still need a certain amount of carbohydrates in a balanced diet and they also help to raise the levels of serotonin in the body.
Whole grains and high fiber cereals such as quinoa (pronounced keen-wah), steel cut oats and muesli are all excellent choices, however, and perhaps preferred over potatoes, white rice or pasta. Beans, brown rice and a multi-grain bread can also be added to the list of healthy, complex carbohydrates.
The benefits will include not only a natural mood elevation, but increased concentration, relaxation and calm and a healthier colon as well. You can’t beat that!
Protein – Protein not only gives you more energy and but it also increases alertness. The amino acid, tyrosine, found in proteins, increases dopamine, norepinephrine and epinephrine in our brain which then increases our alertness and excitement and decreases anxiety. Good protein choices could come from animal or plant sources.
Animal sources are considered high quality because they contain all of the essential amino acids our bodies need. Some animal sources are eggs, fish, poultry and red meat. Plant sources are good and often chosen by those who do not eat meat. Plant sources are considered lower quality sources, however, because they contain only some of the amino acids our bodies need. But, they do still provide protein nonetheless. Some plant sources of protein are beans, grains, nuts, and seeds. A good balance of complex carbohydrates and protein can help us achieve a simultaneous increase in energy level and a steady calm.
Vitamin B-12 and other B vitamins such as B1 (thiamine), B3 (niacin), B5 (pantothenic acid), B6 ( pyridoxine), B12 and folic acid, are essential to mental and emotional well-being. The challenge with B-vitamins is that they cannot be stored in our bodies and we depend on our daily diet to supply them. To make matters worse, B-vitamins are destroyed by alcohol, refined sugars, nicotine, and caffeine, so it is no surprise that many people may be deficient in these.
A deficiency of B-vitamins can contribute to memory problems, insomnia, depression, irritability and anxiety. In addition, shortness of breath, heart palpitations and dizziness can also be caused by a deficiency in B-vitamins. Of course, these same symptoms can be caused by many other issues, but for perimenopausal women, it is evident that B-vitamins play a crucial role in our physical and emotional well-being.
Food sources that can provide B-vitamins would include diary products like milk, cheese and yogurt, leafy green vegetables such as spinach and kale, beans, nuts, (which will also provide protein), eggs, liver and one of my personal favorites, brewer’s yeast. Brewer’s yeast can be taken in a pill supplement form or as I often do, sprinkled across a piece of multi-grain toasted bread with a little bit of butter. I personally love the flavor. Other’s don’t, so you may want to consider a pill supplement if you choose to take it.
Exercise & Attitude
If you’re anything like me, exercise is not exactly high on your list of things to do. With my joint and back issues, this proves particularly challenging. Not to mention, I’m inherently lazy and will quickly drop any exercise routine that requires more effort to accomplish it than the actual exercise itself – such as going to a gym.
Finding a good physical outlet, however, is a great way to lift mood and combat perimenopausal depression. I prefer a quieter, gentler approach and so the stretching in Yoga and Pilates is a perfect fit for me. Plus, it’s something you can do at home and never have to get out of those jammies!
The choices for physical exercise are limitless, really, so pick something that works for you and go for it. Remember – the light from the sun is helpful in lifting mood, so perhaps just stepping outside to feel the warmth on your face can provide a little pick-me-up.
Examining one’s thought life is an important part of dealing with depression, in my view. If you find that your thoughts tend to lead you to a more negative outlook on your life, perhaps a little readjusting of perceptions would be in order.
Without question, menopause is a time of reflection as much as it is a time of physical changes. How we choose to frame and define our day to day life can and does have a direct impact on our mood and how we feel.
Sometimes choosing to overlook, dismiss or simply to accept what we cannot change, can keep us out of the mental dumps. We may not be able to mentally talk ourselves out of menopause, but we can choose to have a less adversarial attitude towards our life’s circumstances.
For me, having some time where I can reflect, think, pray and quietly sort through my emotions and thoughts can help me grab the reins of my mind and make better choices in how I perceive my circumstances.
Change Brings Growth
These are just a few things we can do to combat and cope with perimenopause depression. And as I always say, ladies, menopause is a transition. It is not a permanent condition – though it certainly feels that way at times, I know.
Transitioning into a new phase of life will always come with challenges, but at the risk of sounding cliche’, challenges and changes can also be a time of personal growth and a new, fresher outlook on our life.