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About Depression

Everyone feels sad, worthless and/or disinterested in normal activities at some stage throughout their life. However, one in five of us will experience these emotions intensely, for a prolonged period of time and often for no identifiable reason.

This is a condition known as clinical depression and is a serious illness with brain chemical and circuitry changes.

To find out what projects are currently being conducted in depression, please click here 

 

Note, depression occurring around the menopausal transition, known as Perimenopausal Depression, has a different clinical presentation compared with other types of depression. Anger, irritability, poor concentration, memory difficulties, poor self-esteem, poor sleep and weight gain can lead to depression.

Additional Resources

Australian Treatment Guide for consumers and carers

Beyond Blue Depression fact sheet

Black Dog Institute Depression fact sheets

Well ways: Understanding depression

Sad on Couch

Menopausal Depression

Depression in women in their mid-40’s to early 50’s is a significant problem. For women, middle age is the age with a very high risk of both first time depression as well as depression recurrence. Related to this is the tragic statistic that women aged 45-49, have a high completed suicide rate. The impact of menopause is a critical factor in the development of depression in this group, be it for the first time, or a recurrence of previous depression.

While many women do not experience significant mental ill health during the transition to menopause, an estimated 40% of perimenopausal women present to their primary healthcare physicians with depressive symptoms. Importantly, depressive symptoms experienced in the menopause transition are different and often worse in severity compared to depression in younger and older women.

MENO-D Rating Scale for Menopausal Depression

The menopause transition can bring a multitude of changes, including shifts in mood that are often overlooked. The Meno-D Rating Scale, devised by Professor Jayashri Kulkarni AM, is a valuable tool designed to help you detect and understand these mood shifts. Whether you choose to complete it as a self-report, with the assistance of a clinician, or as a healthcare professional alongside your patient, this resource is a tangible step towards recognising and addressing menopausal depression.

Download the Meno-D Scale to increase awareness and find support that resonates with your unique journey through menopause.

The gap in the Understanding and Treatment of Menopausal Depression

The cause of depression is no doubt multi-factorial and in middle aged women, the stresses of work, relationships, parenting and caring for elderly parents – all play a role. However , the number of new cases of depression, the different symptoms and the increased severity – all point to a biological ‘tipping factor’. The changes in the hormones that drive menopause are this biological tipping factor. A lack of understanding about the major role that gonadal hormones play in the brain has led to a significant gap in the the appropriate treatment of menopausal depression, with tragic results for many middle aged women and their families.

Broad brush, population wide, studies involving menopausal women, do not provide useful information on the role of reproductive hormone shifts and depression. Such studies focus on work stress, relationships, body image, ageing beliefs and other issues that are part of menopausal depression, but that can be measured in wide surveys. However, there is a growing body of laboratory animal studies that shed light on brain biology in menopause, which provides evidence for the role of hormones in causing depression and in treating it. Such animal work is not widely known and so the cause of menopausal depression, is most commonly ascribed to social stresses. The hormone shifts that underpin menopausal depression, at the very least as the ‘tipping factor’ remains intuitively obvious to women but unsupported by healthcare workers and population researchers.

Estrogen in the Brain

The reproductive hormone,estrogen,is a potent brain hormone that controls many neurochemicals including serotonin, dopamine and the GABA systems. Fluctuations and reductions in estrogen levels during menopause, particularly during the early stages (perimenopause), play a significant role in the development of depression and anxiety symptoms. Estrogen supplementation is neuroprotective by ameliorating the menopausal fluctuations and has a number of beneficial brain effects, such as regulating cell survival and enhancing neuronal antioxidants, thereby protecting against neurodegenerative diseases. Progesterone also has significant brain impact and the animal literature reveals the positive anti-anxiety effects that progesterone treatment provides.

Current Treatment of Peri-menopausal Depression

Current guidelines still recommend traditional antidepressants (SSRI’s particularly) plus psychological therapy and lifestyle changes as the management of depression during menopause. These guidelines do not include hormone treatment options for
menopausal depression citng a lack of formal clinical trial evidence. We currently are in a “Catch 22” situation – where the lack of clinical trials leads to less recognition of hormone shifts as the key drivers of this depression – which in turn leads to even less support for clinical trials of hormone therapy and so on!

However, many women with perimenopausal depression do not respond to standard antidepressants, or have an initial positive response that wains after a short period of time. Antidepressants also induce a range of potential unwanted side effects such as serotonin syndrome (a serious medical condition caused by an excess of serotonin in the body), weight gain, agitation, nausea, diarrhoea, anorexia, excessive sweating, decreased libido or anorgasmia, headache, insomnia, and akathisia (restlessness). Psychological and lifestyle interventions are important but do not address the underlying biological nature of perimenopausal depression.

 

Current Treatment of Peri-menopausal Depression

There is evidence for successful hormone treatment of menopausal depression in clinical practice. Many GPs, gynaecologists and other doctors describe successful outcomes for women with menopausal depression, when their other menopause symptoms are treated with hormones. Small scale clinical trials of estrogen treatment for menopausal depression have shown
positive results. No current guideline for depression treatment, even if it is clearly due to the menopausal transition, recommends hormone therapy. As a result, clinicians do not prescribe hormone therapy for menopausal depression citing a lack of clinical trial evidence.

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