Treatment options for depression and other mood disorders during menopause

If you feel that the descriptions of depression or other mood disorders apply to you, you’ll want to dig deeper. Gather your family history and talk with your health-care provider. You’ll want to conduct medical tests to rule out underactive thyroid, anemia, diabetes, adrenal insufficiency, or hepatitis, all of which can cause depression and, fortunately, can be treated.

What kind of treatment options exist for mood disorders during menopause?

During perimenopause and menopause, depression and other mood disorders are treated in much the same way they are at other times. Antidepressants and cognitive and behavioral therapy can all help. Hormones may also help improve minor mood disturbances.

Hormone therapy can help reduce hot flashes and night sweats, thereby restoring sleep, which in turn improves mood. Independent of its effects on hot flashes, HT may still improve mood. Hormone therapy protects the vaginal area against thinning and dryness, making sex more enjoyable. Hormones also protect skin from collagen loss, so women may feel better about themselves and the way their skin looks.

You take a low dose of estrogen orally but still feel moody and blue all the time

When a woman taking hormone therapy still feels depressed, I examine her dosage. The current trend is to prescribe lower doses of hormones for shorter periods. Logically, this may reduce side effects and risks because women are taking less medication. That’s a good thing. However, we may also be undertreating a woman’s condition, which is not such a good thing.

Your doctor recently increased your hormone therapy dosage, but you still feel anxious, panicky, or downright depressed

If a woman is receiving an adequate level of hormone therapy and still feels depressed, I consider antidepressant therapy. We may need to treat menopause and depression concurrently to achieve the best results.

What antidepressants are best for use by menopausal women?

Standard antidepressants, such as the SSRIs and the SNRIs (serotonin-norepinephrine reuptake inhibitors), are not addictive and do not change your personality. Below is a list of some commonly prescribed antidepressants and the symptoms that they may be used for.

SSRIs

There are many types of antidepressants, including the SSRI Prozac (fluoxetine) and Zoloft (sertraline), both of which are available in generic formulations.

• Sarafem (fluoxetine): The first SSRI to be FDA-approved to treat severe PMS.
• Lexapro (escitalopram): The active ingredient of a previously popular antidepressant, Celexa (citalopram), Lexapro does not interfere with hormone levels or many other medications metabolized in the liver. It comes in a liquid formulation whose dose can be gradually adjusted in sensitive patients and is helpful with panic disorder.
• Paxil (paroxetine): I don’t tend to prescribe Paxil as it is associated with constipation and weight gain, and it can reduce levels of Tamoxifen (a drug used to treat as well as prevent breast cancer) in some patients.
• Prozac (fluoxetine): This commonly used antidepressant has a long half-life. The generic can be used either daily or once weekly and was the first SSRI approved to treat severe PMS/PMDD with the brand name Sarafem.
• Zoloft (sertraline): This is a commonly used antidepressant with a short half-life. The generic can be used in women with anxiety, depression, or PMDD (premenstrual dysphoric disorder, which is severe PMS).

SNRIs
The SNRIs (serotonin-norepinephrine reuptake inhibitors), like the SSRI, do not change your personality and affect the norepinephrine neurotransmitter system as well as the serotonin.

• Cymbalta (duloxetine): This drug may help reduce stress and incontinence, but it’s important to monitor liver function while taking it. It is also FDA-approved to treat fibromyalgia.
• Effexor XR (venlafaxine): I frequently prescribe this drug for women with hot flashes. It is available in generic form. Low doses help hot flashes while higher doses help depression and anxiety but not hot flashes!
• Pristiq (desvenlafaxine): I also may prescribe this drug for women with hot flashes, as it is the active ingredient of Effexor XR (venlafaxine) and is currently FDA-approved to treat depression—so if a woman has both depression and hot flashes, I find it to be an effective agent.
• Wellbutrin XL (bupropion): I prescribe Wellbutrin XL for women who do not have anxiety, seizure disorder, or eating disorder and who suffer from depression and/or fatigue and low motivation. Wellbutrin XL is also good for women currently taking SSRIs who are suffering from sexual side effects (such as a delayed ability to climax), which some SSRIs—especially at higher doses—are known to produce. Wellbutrin XL is known for its lack of associated weight gain and sexual side effects.

Will antidepressants affect my libido?

Researchers are constantly testing new and improved antidepressants that do not negatively impact sexual function. Currently, studies are being conducted on a 5-HT1A agonist called Flibanserin, which seems to be a fast-acting antidepressant that actually stimulates sex drive. It wasn’t found to help major depression but did boost sex drive. However, despite promising studies, the FDA recently nixed approval of this drug to treat low sex drive. (This is just like the male-only FDA panel that in 2004 nixed the testosterone patch to boost libido in women despite good research data showing improvement in female sexual function. I think this is overt sexism. Our European women friends have access to the testosterone patch, while America women have to resort to the use of compounded products that are not commercially available or regulated if they need testosterone hormonal therapy.)

What if I am “anti” antidepressants?

Some women don’t want to take antidepressant medication. They don’t want to deal with another pill, or they’re uncomfortable with the idea that they need antidepressants, reacting to a cultural stigma against mental illness that is only slowly disappearing.

Often, women grin and bear it, brushing off serious mood disorders because they see a diagnosis as a sign of weakness. Forget that! You must take care of yourself. Quite simply, you deserve it. And if taking care of others is part of your mid-life situation, you know that you must care for yourself before you can help others.
Depression is just as much a medical problem as diabetes or migraines. There’s no reason to feel embarrassed or ashamed or to feel as if you should be able to conquer the condition on your own. After all, would you expect willpower alone to cure strep throat?
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Dr. Holly Thacker is a menopause health specialist and the author of the Vibrant Nation Health Guide, Recognizing and Treating Menopause Symptoms: A 50+ woman’s guide to managing hot flashes, weight gain, mood swings, depression, vaginal dryness, night sweats and other menopause symptoms.