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What is perimenopausal depression?

Perimenopause is the transition that females go through prior to menopause.

It causes abnormal menstrual periods, erratic fluctuations in hormone levels, and insomnia. For many people, it also causes unpleasant hot flashes.

Several studies have linked perimenopause to depression, as well as worsening of existing depressive symptoms.

In a pair of older studies from the early 2000s, published in the Archives of General Psychiatry, researchers found that perimenopausal women were twice as likely to be diagnosed with major depressive disorder (MDD) as those who hadn’t yet entered this hormonal transition.

The studies also found that perimenopausal women were four times as likely to develop depressive symptoms as women who hadn’t gone through perimenopause.

Women with the greatest frequency of hot flashes reported the most significant depressive symptoms. Other women at a higher risk for depression include those who:

More recent studies have also reinforced this connection between perimenopause and depression.

MDD is a serious condition that can be managed with treatment.

Whether experienced during perimenopause or at any other point in your life, the symptoms of the disorder may include:

Other symptoms related to perimenopausal depression may include:

Some studies show that fluctuating levels of the female hormone estradiol are one predictor of depression.

However, there are several other factors that may account for perimenopausal depression.

A 2010 review of studies found that perimenopausal women with no prior history of depression were two to four times more likely to develop depression than women in the premenopause stage.

Hot flashes and their impact on sleep patterns were also implicated in the review.

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

Several other factors have been linked to perimenopausal depression including:

Many women experience mood swings during the transition to menopause. These mood swings may be related to fluctuating hormone levels.

When estrogen levels fluctuate, the serotonin and norepinephrine levels in the brain are affected.

Serotonin, norepinephrine, and dopamine are chemicals that work in the brain and play a direct role in your mood. They can make you feel happy by reducing anxiety and improving sleep, among other things.

You experience a general state of calm and well-being when these mood power players are balanced.

Hormone imbalances — such as your estrogen rising while your progesterone is falling — can inhibit the ability of serotonin and norepinephrine to act as effective neurotransmitters.

The result is mood swings that could lead to depression.

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 studyfound 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 as to 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. These risks include:

Women using antidepressants were three times as likely to enter perimenopause early than those who weren’t, according to the study.

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

A 2011 study found that escitalopram (Lexapro) reduced the severity of hot flashes and also reduced their occurrence by half when compared to a placebo.

Escitalopram belongs to a group of drugs called selective serotonin reuptake inhibitors (SSRIs).

The study found Lexapro to be three times as effective at relieving depressive symptoms as hormone replacement therapy (HRT). Additionally, only 31 percent of the women who received HRT reported relief for their hot flashes compared with 56 percent of the women who took the antidepressant alone.

This is good news for anyone concerned about the 2004 Women’s Health Initiative study which found HRT raises the risk of heart attack and stroke.

It’s still unknown why escitalopram works. However, the findings reported no “serious adverse effects” on women participating in the study.

Nevertheless, antidepressants may have their own side effects, including:

A number of home remedies and lifestyle changes can help you deal with the symptoms of perimenopausal depression.

Regular exercise

Regular exercise can release serotonin and endorphins into the body.

An increase in these chemicals can help people who currently have depression as well as head off depression before it takes hold.

Proper sleep

Adopt good sleep habits, such as going to bed at the same time every night in a quiet, dark, cool room. Avoid using electronics in bed.

Mindful breathing

Mindful breathing can help reduce anxiety. A common technique involves paying attention to your body’s response to natural relaxation as you slowly breathe in — from the abdomen — and then exhale.

Doing this for 15 minutes a day will help bring down your stress levels.


The plant valerian has been shown to help with perimenopausal depression. Using valerian may reduce hot flashes and may lead to better sleep.

Shop for valerian capsules.

B vitamins

B vitamins can be important to the mental and emotional well-being of perimenopausal women.

Examples of B vitamins include:

Foods containing these B vitamins include dairy products, leafy green vegetables, and beans. B vitamins are also available in supplement form.

Shop for B vitamins.

The risk of depression during the time of transition toward menopause is higher than you might think.

It’s wise for anyone in perimenopause to keep an eye out for the symptoms of depression and know when to seek help.

If you’re experiencing mild, moderate, or clinical depression, make an appointment with your doctor to discuss your treatment options.