Feeling Depressed? You’re Not Alone!

For many women, the perimenopausal/menopausal transition causes unpredictable hormonal fluctuations, which may lead to depressive symptoms. These hormonal changes combined with midlife stressors can make for a “perfect storm” if you will.  Perimenopausal depression involves many factors including, hormonal vulnerability, lifestyle factors, psychosocial resources, and stressful events. 

How many of you have experienced any of these midlife stressors?

  • Empty nest syndrome/undesired childlessness
  • Relationship difficulties with spouse/partner
  • Changes in self-esteem and/or body image
  • Divorce or widowhood
  • Struggles with teenage children, caring for young children or return home of grown children
  • Concerns and caring for aging parents or other family members
  • Career challenges/loss of work
  • Financial concerns/socioeconomic status

When evaluating these stressors, I believe that many of us have at least 1-2 of these, if not, more! Now add the Co-VID pandemic into the equation, and an increased number of women are suffering from symptoms of anxiety and depression.  

Let me share one of my recent patients to help illustrate this point.  Christy is a 52-year-old perimenopausal woman with three children.  When she came to my office, she complained of feeling tired, having low energy, and loss of interest in normal activities.  Previous activities like going out with friends, or walking on the beach, no longer brought her any sense of happiness.  Upon further questioning, she relayed that she was feeling more irritable and less able to focus.  With all of this, she also felt guilty about not being more joyful with her children and husband, only snapping at them at the smallest of things, which was especially disturbing to her because she hadn’t felt this way before.

After 10- 15 minutes, she broke down and started crying.  She exclaimed, “What is happening to me?  I feel so lost.”

While handing her the Kleenex box of tissue, I reassured her that she was not alone- many women especially with the CO-VID pandemic are feeling this way.  It’s as if this pandemic represents the last straw for many women, be they in the perimenopausal, menopausal, or beyond.

Initially, I needed to do an assessment of any previous mental health problems, like anxiety or depression, and Christy admitted to having post-partum depression with her third child.  She also stated that her sleep was more interrupted and she woke up 1-2 times/night with some nights not being able to fall back asleep.  

I also inquired about any family history of depression or other psychiatric disorders, substance abuse, psychiatric hospitalizations, suicidal thoughts, previous medications for depression, and present intake of alcohol or other stimulants, which might be used to “numb” herself from her depressive symptoms.

In addition, Christy noticed an increased appetite and she was making poor food choices, grabbing for the bag of potato chips rather than the fresh-cut veggies with hummus.

What should we do?

Well, after gathering a full medical history, I next perform a full physical examination and order labs.  This bloodwork will help to rule out any nutritional deficiencies and medical conditions that might be contributing to her depressive symptoms.  These include evaluating levels of Vitamin B, Vitamin D, thyroid levels, basic metabolic levels to look at liver and kidney function as well as complete blood count to rule out anemia.

I handed Christy her lab slip and gave her some lifestyle tips to help improve her mood until we met again in 7-10 days. 

Lifestyle Tips:

  1. Get regular exercise – 3-4 x/week with cardiovascular workouts.  Exercise naturally increases serotonin and endorphin levels in the body.
  2. Get adequate ZZZ’s- Sleep is crucial for mood stability and re-energizing the body.  Keep the bedroom cool, dark and devoid of electronics.  That means no TV, no computer, no i-pad or cell-phone.  One herbal remedy, valerian root, may help with night sweats and hot flashes, as well as lead to better sleep.
  3. Supplement with B-Vitamins - B-Vitamins are crucial for mood stability and emotional well-being.  In my office, I offer Vitamin B complex injections to help increase Vitamin B levels.  

My favorite B-complex supplement is made by Metagenics, called Glycogenics, which provides a full range of all of the B-vitamins. You can learn more about it here!

In next week’s blog, we’ll review Christy’s lab results and formulate a plan to help with her depressive and perimenopausal symptoms.  Stay tuned! 

In health and happiness, 

Dr. Diana

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