Depression and Women

Advice and treatment for menopausal depression

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While everyone feels sad occasionally, a persistent low mood could indicate depression – a serious condition that affects women at double the rate it does men. Fortunately, most people recover well with appropriate treatment.

While everyone feels sad occasionally, a persistent low mood could indicate depression – a serious condition that affects women at double the rate it does men. Fortunately, most people recover well with appropriate treatment.

Overview

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We often say “I’m depressed” to mean we’re feeling temporarily dejected, but this is different to clinical depression: a serious medical condition characterised by a persistent low mood that impairs your ability to enjoy and manage daily life. This mood disorder typically involves a chemical imbalance in the brain, and can be experienced to varying degrees of intensity and duration, from a mild but long-lasting low mood, called persistent depressive disorder / dysthymia, to major depressive disorder / major depression which severely interferes with normal thinking and functioning.1

Causes and risk factors

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Depression is likely caused by a combination of factors: genetic, biological, psychological and social.2

There are certain risk factors that put you at a higher risk for developing depression, which include:1-4

  • Previous episodes of depression.
  • Family history of depression.
  • Stressful life events e.g. abuse or neglect in childhood, violence, death in the family, divorce, leaving home for the first time.
  • Poor social support.
  • Personality traits such as low self-esteem, or having a pessimistic outlook.
  • Women are more vulnerable to depression, with a rate about twice that of men – likely because of gender-specific biological and social factors.

Types of depression unique to women

The menstrual cycle, pregnancy, the period post-birth and menopause are all associated with significant physiological and hormonal shifts that may cause a chemical imbalance in the brain. In some women, these could contribute to the onset of depression.2

Premenstrual Dysphoric Disorder

Premenstrual syndrome (PMS) refers to the moodiness and irritability women experience a week or so before menstruation. A less common, more severe form of PMS is premenstrual dysphoric disorder, a mood disorder with depressive and other psychological symptoms, accompanied by physical symptoms such as bloating and joint or muscle pain.2

Perinatal Depression

Pregnant women often experience mood swings, along with stressful physical changes such as nausea and weight gain.

After giving birth, women may get the “baby blues” – mild low mood and fatigue. This usually resolves within a couple of weeks.5

Perinatal depression includes depression that begins during pregnancy (prenatal depression) and depression that begins post-childbirth (postpartum depression). Women with perinatal depression could experience depressive symptoms that make it hard to perform daily tasks, including caring for themselves and their baby.Factors that  raise the risk for perinatal depression include difficulty conceiving; multiple birth (e.g. twins, triplets); teen pregnancy;  pregnancy and birth complications.2

Perimenopausal Depression

Menopause, which marks the end of a woman’s reproductive years, usually begins between ages 45 and 55, and occurs one year after the last menstrual period. Perimenopause, the transition to menopause, typically begins in the 40s. (People may use the term “menopausal” broadly, referring to both perimenopause and menopause).2,6

The hormonal changes that accompany perimenopause can cause various symptoms such as hot flushes (hot flashes) and sleep disturbances; mood swings are also not uncommon. But an ongoing low mood that negatively impacts your life is not normal, and could be perimenopausal depression. While there is no evidence that this period directly causes depression, it does appear to raise risk: during the transition to and the years immediately after menopause.  In addition to hormonal changes, stress factors commonly seen in this stage of life, such as health concerns, caring for ageing parents and work pressure can further increase vulnerability to depression.2,6,7

Symptoms of depression

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Symptoms of depression may include:1,6

  • Depressed mood: persistent feeling of sadness, anxiety, hopelessness, helplessness, worthlessness or emptiness
  • Loss of interest or pleasure in activities you previously enjoyed
  • Excessive, inappropriate guilt or self-blame.
  • Impaired ability to think, concentrate, remember or make decisions
  • Poor self-care
  • Social withdrawal
  • Thoughts of death or suicide, or suicide attempts
  • Unintentional weight loss or gain, or changes in appetite
  • Sleep disturbance – sleeping too much or too little
  • Agitation (restlessness, trouble sitting still); or retardation (moving or talking more slowly)
  • Fatigue or loss of energy; struggling to perform daily tasks.
  • Aches or pains or digestive problems with no clear physical cause.

Most people experience some of these symptoms occasionally. However, if you’ve been experiencing the first and/or second symptom on this list, as well as other symptoms, most of the time, for two weeks or longer, you may have clinical depression and should consult a healthcare professional without delay.1

It is important to note that you don’t need to have major depression to benefit from treatment. If any of these symptoms are negatively impacting your life more than occasionally, seek help.1

Diagnosis

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Your doctor will do an evaluation to determine if you are merely feeling stressed or blue, or if you could be clinically depressed. This will include taking a medical and family history, identifying depression symptoms, and understanding contributing social and environmental factors. You may also need a physical examination and possibly a blood test to rule out other medical causes (e.g. thyroid disorders, vitamin deficiencies) that can have similar symptoms to those of depression.3

If your depressive symptoms are severe, or you have a history of depression, you will likely be referred to a psychiatrist or psychologist.3

Treatment

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Depression is among the treatable mental disorders: 80-90% of patients respond well to treatment.3

Antidepressant medication used in combination with psychotherapy (“talk therapy”, especially cognitive behavioural therapy, which focuses on changing negative thoughts and behaviours) is the gold standard for treating depression, which could bring about an improvement in your symptoms within a few weeks.  Some antidepressants may not be suitable for you, or may have negative side-effects such as dizziness, agitation or lowered sex drive. Your doctor will work with you to find one that is a good match.3,7.8

Hormone replacement therapy, which can help reduce menopausal symptoms such as hot flashes, may help with mild to moderate symptoms related to mood. However, it is not considered a form of treatment for perimenopausal depression.6

Please consult with your physician, to know more about your treatment options.

Prevention and lifestyle changes

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Successfully managing depression, and helping prevent episodes, ideally employs a holistic approach that includes medical treatment plus healthy lifestyle changes, such as:3,6,7,9-11

  • Getting regular exercise. In addition to numerous other health benefits, exercise helps relieve depression by supporting nerve cell growth and connections in the brain, while releasing mood-boosting chemicals called endorphins.
  • Following a nutritious diet rich in fruits, vegetables, lean proteins, complex carbohydrates and good fats, as well as maintaining a healthy weight. Being obese in particular has been linked with depressive symptoms.
  • Making and maintaining social connections. Spend time with and get support from friends and family, and consider joining a depression support group. The South African Depression and Anxiety Group (SADAG) sadag.org can connect you with support groups and other valuable resources.
  • Taking part in activities you enjoyed before the depressive episode.
  • Reducing alcohol consumption; quitting smoking. Alcohol affects brain chemistry and worsens depressive symptoms; smokers are more likely than non-smokers to develop depression over time.
  • Self-care and stress management. Mindfulness meditation – mental training where you focus on being in the moment and calming your mind – can be helpful.




  1. National Institute of Mental Health. Depression. Reviewed September 2022. Available from: https://www.nimh.nih.gov/health/topics/depression
  2. National Institutes of Health. Depression in women. Revised 2020. Available from: https://www.nimh.nih.gov/health/publications/depression-in-women
  3. American Psychiatry Association. What is depression? Reviewed October 2020. Available from: https://www.psychiatry.org/patients-families/depression/what-is-depression
  4. Anxiety and Depression Association of America. Available from: Women and Depression. https://adaa.org/find-help-for/women/depression
  5. Centers for Disease Control. Depression Among Women. Available from: https://www.cdc.gov/reproductivehealth/depression/index.htm
  6. Lindberg, S. An overview of menopause and depression. Very Well Mind. February 2022. Available from: https://www.verywellmind.com/the-connection-between-menopause-and-depression-4767577
  7. The North American Menopause Society. Depression and Menopause. Available from: https://www.menopause.org/for-women/menopauseflashes/mental-health-at-menopause/depression-menopause
  8. National Health Services. Antidepressants overview. Reviewed November 2021. Available from: https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/overview/
  9. Harvard Health publishing. Exercise is an all-natural treatment to fight depression. February 2021. Available from: https://www.health.harvard.edu/mind-and-mood/exercise-is-an-all-natural-treatment-to-fight-depression
  10. Medical News Today. The link between depression and weight changes and how to manage. October 2022. Available from: https://www.medicalnewstoday.com/articles/depression-weight-gain#summary
  11. National Health Services. Stopping smoking for your mental health. March 2021. Available from: https://www.nhs.uk/live-well/quit-smoking/stopping-smoking-mental-health-benefits/

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