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The Menopause Depression Trap

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If you’re a woman, there’s a 25% chance that you’ll experience depression some time in your life. One vulnerable time is adolescence. Another is menopause.

In fact, a clear risk is emerging. A particular combination of menopausal symptoms may increase your chances of falling into a depressed state, according to new research.

Most women sail through perimenopause and into postmenopause without a hint of depressive symptoms. But if you personally have any particular reason to be wary of depression—or even if you just want to be extra careful—you should know which menopausal symptoms put you at greatest risk.

Hint: It happens at night.

DEPRESSION RISK AND MENOPAUSE

What triggers a slide from menopausal moodiness to spirit-sapping depressive symptoms or depression—but only in some women? Certainly a history of depression increases your risk. But some women who’ve never been depressed experience it for the first time during perimenopause or in the first few postmenopausal years. Hormones are part of the story. It’s not just the sometimes wildly fluctuating hormones of early perimenopause that are the culprit. Depression often strikes toward the end of perimenopause and in the first years of postmenopause when estrogen levels are low but stable.

To tease out how hormones, symptoms and moods interact, researchers at Harvard Medical School actually studied 29 young, premenopausal women (average age 27). Why? That way, they could temporarily induce menopause and readily study the “before” and the “after” in the absence of other changes of “aging.” Each woman got a single dose of a medication that suppresses estrogen production for four weeks.

Beforehand, the women underwent sleep studies and psychiatric testing to make sure that none had sleep disturbances or depression. Each woman then kept a record of how many hot flashes she got during the day and how many at night (when they’re often called night sweats). After four weeks, the women repeated the psychiatric testing and sleep study—this time with a test that objectively gauged hot flashes by measuring skin temperature.

DEPRESSING DUO: NIGHT SWEATS AND DISTURBED SLEEP

Nearly 70% of the women experienced hot flashes—about the same percentage as with women who go through natural menopause. Some had most of their flashes during the day, others, at night. Mild depressive symptoms emerged for about 60% of the women, although only one showed signs of full-blown clinical depression.

Did daytime hot flashes give the women the blues? Not at all! While undoubtedly bothersome—especially if you’re 27!—daytime hot flashes had nothing to do with an increase in depressive symptoms for these women.

Nor did night sweats—unless they messed up sleep.

In women whose night sweats woke them up, depressive symptoms reliably went up. That was especially true for women who woke up and couldn’t get back to sleep for a while—in some cases, the women were unhappily awake for more than two hours a night. Not being able to fall into that deep, restorative phase of sleep called REM also upped the chance of feeling depressed.

GETTING THE SLEEP YOU NEED TO FEEL GOOD

Getting a good night’s sleep, undisturbed by night sweats, is very important if you want to safeguard your emotional health throughout the menopausal transition. JoAnn E. Manson, MD, DrPH, a professor of women’s health at Harvard Medical School in Boston and a member of the panel of experts for Bottom Line’s Menopause Center, has this advice…

• Don’t ignore bothersome hot flashes, especially if they happen at night and disturb your sleep.

• Don’t let your health-care provider ignore them, either. Bring them up so that, together, you can find ways to manage them that work for you.

• Avoid triggers. Although hot flashes seem to come out of nowhere, many women notice that they seem tied to a particular activity or situation. Common night sweat triggers include a warm room (see below), feeling stressed, eating spicy food and drinking alcohol. The best way to find your triggers? Keep a hot flash diary.

• Sleeping in a warm room or under blankets is a particular trigger for night sweats. Make your room cooler, and consider sleeping with a fan or, in the summer, with the air conditioner running. (The ideal sleeping temperature is between 60F and 67F, according to the National Sleep Foundation.)

• Get educated about your treatment options. Download the MenoPro app (available on both iTunes/IOS and Android/Google Play) created by The North American Menopause Society. It’s free and not supported by industry, so you won’t see any drug advertisements.

• Consider mind-body approaches. There is evidence from randomized controlled trials that both cognitive behavioral therapy and hypnosis help reduce hot flashes/night sweats.

• Consider medication options. Hormone therapy is effective in reducing hot flashes and night sweats, as are SSRIs and other antidepressants. Women in early menopause without elevated breast cancer or cardiovascular risk are usually good candidates for hormone therapy.

Bottom line: If night sweats are keeping you up at night, it’s a serious health threat. Get help. It’s an investment in your emotional well-being.

For more sleep tips, see Bottom Line’s “21 Ways to Get The Best Sleep Of Your Life.”

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Source: Study titled “Independent Contributions of Nocturnal Hot Flashes and Sleep Disturbance to Depression in Estrogen-Deprived Women,” by researchers at Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts, published in Journal of Clinical Endocrinology and Metabolism. JoAnn E. Manson, MD, MPH, DrPH, chief, division of preventive medicine, interim executive director, Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital and professor of medicine and Michael and Lee Bell Professor of Women’s Health, Harvard Medical School, Boston. She is the author of Hot Flashes, Hormones & Your Health. Date: August 11, 2017 Publication: Bottom Line Health
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