Clinical Depression in Perimenopause

by Magnolia on July 7, 2014

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In her ground breaking book, The Female Brain, physician and neurobiologist, Dr. Louann Brizendine, tackles the issue of hormones and depression in women.

Intrigued by research data which shows that women suffer from depression at a ratio of 2 to 1 compared to men, Dr. Brizendine deftly outlines the different stages of a woman’s life and the effect that her hormones have on her moods.

Of course, women do not need a doctor or anyone else for that matter, to tell us that we suffer from depression more than men.  We already know that. We also know when we enter perimenopause, that many of us become completely blindsided by depression as well.

But, what we really want to know is what we can do about it. Confirming that hormones are often the source and cause of depression among women is one thing. Knowing what to do about it, however, is everything.

Perimenopause and Clinical Depression

By definition, clinical depression is an imbalance of the brain chemicals, serotonin, norepinephrine and dopamine, over an extended period of time. While both men and women can become clinically depressed, women have an especially difficult time with it during perimenopause because of hormone fluctuations. Also known as neurotransmitters, serotonin, norepinephrine and dopamine, play a key role in regulating mood.

When they are in balance, they are able to reduce anxiety, improve sleep, diminish sadness and depression and generally take us to a happy place of calm and contentment. During perimenopause, however, when women begin to experience an imbalance of their reproductive hormones, estrogen and progesterone, these mood regulators also become disrupted.

The changes in the hormone levels not only affect how much of these chemicals the brain is able to produce, but also the efficiency and effectiveness of their function in the brain as well. What this results in is what many women often complain of during perimenopause: disrupted sleep, irritability, rages, weepiness, and at times, heavy and debilitating depression.

Antidepressants and Perimenopause

Many physicians prescribe antidepressants for perimenopausal women. While antidepressants, also known as SSRIs (selective serotonin reuptake inhibitors), can provide some measure of relief from depression, they also come with a whole host of undesirable side effects and a great deal of skepticism as to their long term effectiveness.

Treating the Whole Person

Like many health issues, depression in perimenopause, is not an isolated problem that can be simply treated with antidepressants. Other factors such as diet and exercise, exposure to enough sunlight, sleep, and dealing with the mind also need to be taken into consideration as well. In fact, provided there are no underlying serious mental health issues, depression in perimenopause is much better treated with as little pharmaceutical intervention as possible.

Healthy Hormone Balance

One of the first things a woman can do to help with depression in perimenopause is to restore a healthy hormone balance back into her body, preferably with more natural, bioidentical hormones.

The good news on this front is that as a result of the Women’s Health Initiative, a 15 year study that confirmed the deleterious effect of synthetic hormones on a woman’s body, more and more physicians are recommending bioidentical hormones instead.

Diet, Exercise, Sunlight and Sleep

A healthy diet, plenty of exercise, regular exposure to sunlight and deep, restorative sleep are also essential in improving mood and breaking the cycle of depression. Complex carbohydrates, whole grains and lean proteins not only help stabilize blood sugar (which also helps to improve mood) but they naturally raise the levels of serotonin, norepinephrine and dopamine in the brain.

Cardiovascular exercise such as brisk walking increases oxygen rich blood to the brain which helps to lift the fog of depression, and if you are walking outside, you will have the added benefit of exposure to sunlight which also increases serotonin, norepinephrine and dopamine.

In addition, regular exposure to sunlight during the day will help the brain restore the body’s circadian rhythm, an internal biological clock which regulates sleep, among other bodily functions. Together with a consistent sleep schedule, diet, exercise and exposure to sunlight will help to improve and promote deep, restorative sleep. All of which will work together in synergy to help break the cycle of depression.

The Mind

Finally, taking a mental inventory of our thoughts and thinking patterns is imperative if you want to rid yourself of depression. Certainly, the change of perimenopause is a time that causes many women difficulty. The reality of middle age and a different time of life settles in.

Not surprisingly, this change is not always easy to embrace. However, how we choose to view it will have a direct impact on our moods. A gloomy outlook and chronic negativity will only serve to undermine all of efforts at health and wellness. So, it’s important to realize the power of our thoughts and how we perceive our life’s circumstances when it comes to dealing with depression.

Drug-Free Relief from Depression

It seems counter-intuitive that one should do the very things that perimenopause and depression make difficult. But, the truth is, a healthy diet, regular exercise, sunlight, good sleep and an effort at a positive outlook combined with bioidentical hormone therapy can provide drug-free and lasting relief from depression.

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{ 2 comments… read them below or add one }

Jen Johnson July 8, 2014 at 8:25 am

Great article! Thanks for introducing us to Dr. Brizendine’s work! I agree with your statement, “Finally, taking a mental inventory of our thoughts and thinking patterns is imperative if you want to rid yourself of depression.” Many women understand this concept but aren’t quite certain how to go about doing this. I’ve found that teaching my coaching and counseling clients mindfulness practice provides them with an excellent tool for dealing with difficult thoughts (and sensations and emotions) and restoring a sense of peace, well-being, and joy! Practicing mindfulness has had such a profound impact on my life that I am devoted to a daily practice and to teaching others! Thanks again for the great article!


Susan January 24, 2015 at 6:23 pm

I just found your blog and subscribed to it so am just now reading this post, which is excellent. I am 53 and have been going through perimenopause the past 3-4 years. I have just now decided to do something or a lot of things about it. I have an appointment with a certified menopause on/gun next week. The other thing I have started is yoga. This has been one of the best decisions I have ever made. The yoga itself is helpful but belonging to the yoga community has been a blessing. The focus on mindfulness and the idea of giving yourself the space and permission to not be perfect has been very helpful in addressing all of the issues that come with menopause. You have created a beautiful, balanced and factually helpful source for women. You have a new fan. Thank you!


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