Perimenopause, the transition women go through prior to menopause, causes abnormal periods, erratic fluctuations in hormone levels, insomnia and, for many women, unpleasant hot flashes. It has also been linked to depression according to several studies.

In a pair of studies published in the Archives of General Psychiatry, researchers found that women in perimenopause are twice as likely to be diagnosed with major depressive disorder (MDD) and four times as likely to develop depressive symptoms than those who haven't yet entered this hormonal transition. The studies found that women with the greatest frequency of hot flashes reported the most significant depressive symptoms.

Women who haven't given birth and those who have taken antidepressant medications are at a higher risk for depression as well.

Risk Factors for Perimenopausal Depression

Although some studies show that fluctuating levels of the female hormone estradiol are one predictor of depression, there are several other factors that may account for perimenopausal depression.

One interesting finding from a Seattle-based study in 2008 published in the journal Menopause found that women with no prior history of depression were four times as likely to develop depression as a result of perimenopause than previously-depressed women. Hot flashes and their impact on sleep patterns were also implicated in the study.

In contrast to prior studies, new research shows that changing levels of the female hormone estrogen have little impact on perimenopausal depression. This may explain why hormone replacement therapies have little impact on overall depression (although it provides some relief for more severe depression, perhaps because it helps with hot flashes). 

Stressful life events such as divorce, job loss, or the death of a parent are common occurrences for women in this stage of life and may also trigger depression.

Several other factors have been linked to perimenopausal depression including:

  • a family history of depression
  • a prior history of sexual abuse
  • negative feelings about aging and menopause
  • severe menopausal symptoms
  • a sedentary lifestyle
  • smoking
  • social isolation
  • low self-esteem
  • disappointment in not being able to have any more children (or any children)

Symptoms of Perimenopausal Depression

Major depressive disorder is a serious condition that requires treatment.

Symptoms of the disorder may include fatigue and lack of energy, slowed cognitive function, inattentiveness, a lack of interest in once-enjoyable activities, and feelings of worthlessness, hopelessness or helplessness.

Other symptoms related to perimenopausal depression may include:

  • mood swings
  • irritability
  • crying for no reason or tearfulness
  • heightened anxiety
  • profound despair
  • sleep problems related to hot flashes or night sweats

Depression and Its Effect on Perimenopause

Perimenopause and depression have a complex relationship.

Not only can the effects of perimenopause cause depression, a 2003 study found that depression itself may lead to early-onset perimenopause. The study, published in the Archives of General Psychiatry found that women with "significant symptoms of depression in their late 30s and early 40s" were more likely to enter perimenopause before their 45th birthday than women who hadn't experienced depressive symptoms.

Research was inconclusive whether early perimenopause led to early menopause or if it simply resulted in an extended period of perimenopause.

Lower estrogen levels during both phases are associated with other health risks including impaired cognitive functioning, heart attack, and stroke. Women using antidepressants were three times as likely to enter perimenopause early than those who weren't according to the study.

The Other Side of Antidepressants and Perimenopause

Although antidepressants are linked to an earlier onset of perimenopausal depression, they also help relieve one of its most uncomfortable symptoms.

A 2011 study published in the Journal of the American Medical Association found that the selective serotonin re-uptake inhibitor (SSRI) escitalopram (Lexapro) reduced both the severity of hot flashes and also released their occurrence by half when compared to a placebo. The study found Lexapro to be three times as effective at relieving depressive symptoms than hormone replacement therapy.

Additionally, only 31 percent of the women who received hormone replacement therapy reported relief for their hot flashes compared with 56 percent of the women who took the antidepressant alone. This is good news for women concerned about the 2004 Women's Health Initiative study which found hormone replacement therapy raises the risk of heart attack and stroke.

It is still unknown why escitalopram works, but the findings reported no "serious adverse effects" on women participating in the study. However, antidepressants may have their own side effects including dizziness, insomnia, fatigue, and stomach problems.