Is it depression, anxiety or hormones?

Though commonly stigmatized and all-too frequently (and wrongly) mistaken as conventional mental health disorders, anxiety and depression may show up for the first time during perimenopause due to the hormonal rollercoaster.

Women without a prior history of mental health concerns may suddenly find themselves with an onset of anxiety or depression – and often with no tangible or discernable cause or catalyst.

These materials and research uncover the many layers involved in mood changes during perimenopause. There is an inter-relationship between female reproductive hormones (namely estrogen and progesterone), key brain neurotransmitters (such as serotonin) and other hormones associated with the HPA (hypothalamus-pituitary-adrenal) axis responsible for anxiety and depression during perimenopause.

​Treatment approaches vary, from lifestyle interventions to mental health medications and menopause hormone therapy (MHT) / hormone replacement therapy (HRT).

Note: This list of resources is continually updated.

3 Common Myths about Antidepressants Debunked! – Heather Hirsch, MD, Oct. 11, 2021 - https://www.youtube.com/watch?v=DcvZGC9ME9M

Acupuncture: A Promising Approach for Comorbid Depression and Insomnia in Perimenopause – Department of Psychiatry, Shanghai Municipal Hospital of Traditional Chinese Medicine, Fei-Yi Zhao, Qiang-Qiang Fu, Sarah J. Spencer, Gerard A. Kenney, Russell Conduit, Wen-Jing Zhang, Zhen Zheng, Oct. 12, 2021 – https://www.dovepress.com/acupuncture-a-promising-approach-for-comorbid-depression-and-insomnia--peer-reviewed-fulltext-article-NSS

After Two Decades, I Decided to Go off Antidepressants – Ashley Abramson, The Paper Gown, Zoc Doc, April 11, 2019 – https://thepapergown.zocdoc.com/after-two-decades-i-decided-to-go-off-antidepressants/

Antidepressants During and After Menopausal Transition: A Systematic Review and Meta-Analysis, Scientific Reports, Ching-Kuan Wu, Ping-Tao Tseng, Ming-Kung Wu, Dian-Jeng Li, Tien-Yu Chen, Fu-Chen Kuo, Brendon Stubbs, Andre F. Carvalho, Yen-Wen Chen, Pao-Yen Lin, Yu-Shian Cheng, Cheuk-Kwan Sun, May 15, 2020 – https://www.nature.com/articles/s41598-020-64910-8

Antidepressants for Menopause – Everything You Should Know – Winona, March 3, 2021 - https://bywinona.com/journal/antidepressants-for-menopause/

Antidepressants May Not Be All They’re Cracked Up to Be – Gabrielle Glaser, The Daily Beast, March 2, 2018 – https://www.thedailybeast.com/antidepressants-may-not-be-all-theyre-cracked-up-to-be

As Menopause Nears, Be Aware It Can Trigger Depression and Anxiety, Too - NPR Morning Edition, Jan. 16, 2020 - https://www.npr.org/sections/health-shots/2020/01/16/796682276/for-some-women-nearing-menopause-depression-and-anxiety-can-spike 

Depression and Related Disorders during the Female Reproductive Cycle – Women’s Health, Future of Medicine, Ltd., Laura J. Miller; Christina Girgis; Renu Gupta, 2009 – https://journals.sagepub.com/doi/pdf/10.2217/WHE.09.44

Depression During the Menopausal Transition: An Update on Epidemiology and Biological Treatments, Luciano Minuzzi, MD, PhD., Benicio N. Frey, MD, PhD., Claudio N. Soares, MD, PhD, FRCPC, Focus: The Journal of Lifelong Learning in Psychiatry, Jan. 1, 2012 – https://focus.psychiatryonline.org/doi/10.1176/appi.focus.10.1.22

Depression or Menopause? Presentation and Management of Major Depressive Disorder in Perimenopausal and Menopausal Women, Anita H. Clayton, MD, and Philip T. Ninan, MD., Journal of Clinical Psychiatry, 2010 – https://www.psychiatrist.com/pcc/depression/depression-menopause-presentation-management-major/

Estrogen and the Brain – Jan Shephard, MD, FACOG - http://npsymposium.com/wp-content/uploads/2021/05/A4-Estrogen-and-the-Brain-Shepherd-1-up-Color.pdf

First-Ever Guidelines for Detecting, Treating Perimenopausal Depression – The University of Illinois College of Medicine - https://chicago.medicine.uic.edu/first-ever-guidelines-for-detecting-treating-perimenopausal-depression/

​Help, Am I Going Mad? Mental Health and Menopause – A Meaningful Midlife, Aug. 8, 2019 – https://www.ameaningfulmidlife.com/blog/2019/8/4/help-am-i-going-mad-mental-health-and-perimenopause

Hormone Imbalances and Depression – Things You Should Know – Winona, March 29, 2021 - https://bywinona.com/journal/hormonal-imbalances-depression/

Hormones and Emotional Health – Women’s International Pharmacy, 2020 – https://www.womensinternational.com/blog/hormones-and-emotional-health/

HRT vs. Antidepressants in Perimenopausal Depression - Professor Jayashri Kulkarni, Sept. 26, 2020 – https://psychscenehub.com/video/hrt-vs-antidepressants-in-perimenopausal-depression-by-prof-jayashri-kulkarni/

The Impact of Hormones on Serotonin in Depression – The ZRT Laboratory Blog, Dr. Kate Placzek, Feb. 9, 2018 - https://www.zrtlab.com/blog/archive/impact-hormones-serotonin-depression/

“It Feels Impossible to Beat” – How I Was Floored by Menopause – Rose George, The UK Guardian, Aug. 16, 2018 – https://www.theguardian.com/news/2018/aug/16/it-feels-impossible-to-beat-how-i-was-floored-by-menopause

Low Mood and Depressive Symptoms during Perimenopause – Should General Practitioners Prescribe Hormone Replacement Therapy or Antidepressants as the First-Line Treatment? – Mandy Leonhardt, June 27, 2019, Post Reproductive Health – https://journals.sagepub.com/doi/10.1177/2053369119847867

Menopause and Mental Health – Is It Wreaking Havoc with Your Moods? – Harley Therapy Counselling Blog, Sheri Jacobson, June 17, 2021 – https://www.harleytherapy.co.uk/counselling/menopause-and-mental-health.htm

Menopause: Is It All In Your Head? – The ZRT Laboratory Blog, Dr. Kate Placzek, June 3, 2016 - https://www.zrtlab.com/blog/archive/menopause-all-in-your-head

Mental Health Issues Are the Menopausal Side Effect We’re Not Talking About – Meryl Davids Landau, Woman’s Day, March 11, 2022 – https://www.womansday.com/health-fitness/a30515712/how-menopause-affects-mental-health/

Perimenopause and Depression – Honor Health – https://www.honorhealth.com/healthy-living/perimenopause-and-depression

Perimenopausal Depression: A Review of Diagnosis and Management – Psych Scene Hub, Jan. 21, 2022 – https://psychscenehub.com/psychinsights/perimenopausal-depression-diagnosis-and-management/

Perimenopause Ups and Downs Can Last Years – Amy Burkholder, CNN, Jan. 10, 2007 – https://edition.cnn.com/2007/HEALTH/01/10/peri.menopause/

Psychiatry and the Menopausal Transition: Clinical Caveats – Psychiatric Times, Marlene P. Freeman, MD, Sept. 3, 2014 - https://www.psychiatrictimes.com/view/psychiatry-and-menopausal-transition-clinical-caveats

These Mental Health Symptoms of Menopause Don’t Get Mentioned Enough but Affect the Majority of Women – Well + Good, Kara Jillian Brown, May 22, 2021 - https://www.wellandgood.com/mental-health-symptoms-menopause/

Use of Antidepressants during Perimenopause – Deborah R. Kim and Hadine Joffe, Women’s Health, July 1, 2006 - https://journals.sagepub.com/doi/10.2217/17455057.2.4.627

When Anxiety, Insomnia Aren’t Just in Your Head – The Wall Street Journal, Melinda Beck, Oct. 12, 2010 - https://www.wsj.com/articles/SB10001424052748703794104575546072780597414

When Depression Sneaks Up on Menopause – Natasha Gilbert, Knowable Magazine, Jan. 27, 2022 – https://knowablemagazine.org/article/mind/2022/when-depression-sneaks-menopause

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