Mood swings and hormone changes tend to go hand in hand. We all know that PMS and pregnancy can cause mood swings — but what about menopause? Studies in the medical literature show that the menopausal transition increases the risk of both anxiety and depression.

How common is it?

A large 10-year study showed a 2–4 fold higher risk of depression during the menopausal transition compared to premenopause, with rates of a major depressive episode between 11% and 16%, and depressive symptoms between 16% and 28%. There's less research on anxiety, but rates of anxiety also appear to increase during the transition.

Risk factors

While anyone can experience anxiety or depression during the menopausal transition, certain things raise the risk:

  • A previous history of mood disorders — especially hormone-related ones like postpartum depression, PMDD (premenstrual dysphoric disorder), or PMS
  • Vasomotor symptoms — hot flashes and night sweats are associated with depression during this time
  • Surgical menopause — more likely to be linked to depression than natural menopause, likely due to a sharper drop in estrogen
  • Chronic medical conditions or poor health
  • A negative perception of menopause
  • Life stressors — financial strain, low socioeconomic status, and stressful life events

On the other hand, social and family support is protective. Women who have six or more close friends are much less likely to be depressed than those with fewer close relationships.

Treatment

With hormone therapy, timing matters. Systemic menopausal hormone therapy has been shown to help treat and prevent anxiety and depression caused by menopause — and to lift mood even in women without these conditions — when started during the perimenopausal period (less than 12 months after the final menstrual period). It doesn't seem to have the same effect on mood when started later (12 or more months after the final period).

Standard treatments still apply. Depression and anxiety during menopause should still be treated with appropriate medications. SSRIs are usually the first-line treatment for both. No single SSRI works better than another, though there may be reasons to choose a particular one — medicine is both a science and an art. Choose a doctor who is familiar with menopause when getting treatment for your mental health.

Some medications do double duty. In women with hot flashes and night sweats, certain SSRIs and SNRIs can help treat those symptoms too — including citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil, Brisdelle), venlafaxine (Effexor), and desvenlafaxine (Pristiq). Keep in mind that weight gain and low libido are common menopausal complaints and can also be side effects of some of these medications — worth considering when choosing or monitoring treatment.

Therapy helps too. Counseling is a great treatment for depression and anxiety, alone or alongside medication. Medication plus therapy often works better than either one by itself.

Feeling depressed or anxious? Talk to your doctor about it. If you're getting closer to menopause and suspect your hormones are involved, you could be right. Find a doctor who will listen — and get back to feeling like yourself.