Postmenopausal Depression Is Real — And More Common than You Think

A study conducted in Turkey in 2018 on 485 postmenopausal women found that nearly 40% of those women had symptoms of depression.

That number is staggeringly high, though not entirely unexpected, given the changes a woman’s body undergoes during her perimenopausal and menopausal years.

The study also found that risk factors for postmenopausal depressive symptoms included being single, drinking alcohol, needing medication for chronic conditions, and having many children, among others.

Postmenopausal depression is very real and very common. That speaks to an urgent need for effective treatments.

At the office of board-certified anesthesiologist Dr. Michael Kullman, he and his team treat all forms of depression, including major depressive disorder (MDD), postpartum depression, and postmenopausal depression.

If you’re postmenopausal and are dealing with a persistent low mood, here’s what you need to know about the options available to you that can give you relief.

What is the menopause and depression connection?

If you have depression when you’re postmenopausal, there’s a good chance you struggled with it during perimenopause, the years leading up to the end of your reproductive ability.

That’s because, during perimenopause and menopause, you can experience extreme fluctuations in your reproductive hormones, ultimately leading to levels much lower than those in your reproductive years.

What’s important is that the same hormones that control your menstrual cycle also influence serotonin and norepinephrine, neurotransmitters in the brain that help regulate your mood. When hormone levels drop, transmitter levels also drop, leading to increased irritability, anxiety, and feelings of sadness.

Falling estrogen and progesterone levels can also trigger mood swings that impair your ability to deal with things that wouldn’t have been a problem before. Especially for women who’ve been diagnosed with MDD in the past, this can lead to a persistent low mood, eventually turning into depression.

In addition, major life changes in general can trigger depressive episodes, and the symptoms your body goes through as you transition from fertility to menopause can themselves make you depressed.

You spend half the night battling hot flushes and night sweats, so you don’t get enough good-quality sleep; vaginal dryness and other structural changes may make sex uncomfortable, which can lead to friction with your partner; and you realize that even if you didn’t want children, now there’s no possibility if you change your mind.

Many women use hormone replacement therapy (HRT) to help manage their symptoms, as it restores premenopausal levels of both estrogen and progestin.

But not every woman is a good candidate for HRT. For these women, antidepressant medications, such as the selective serotonin reuptake inhibitors (SSRIs), are the first-line treatment for depression.

SSRIs can treat depression more easily when you pair them with cognitive behavioral therapy to address emotional issues and lifestyle adjustments like exercising and limiting alcohol.

What if SSRIs don’t help?

Not everyone responds well to SSRIs, leading to what’s called treatment-resistant depression (TRD).

Your doctor diagnoses you with TRD if you don't see any improvement in your symptoms after trying at least two different first-line antidepressants taken at an appropriate dosage and duration (at least six to eight weeks each).

TRD is more common than you may realize. Roughly 30% of people diagnosed with MDD and who have been prescribed antidepressants like the SSRIs end up with a diagnosis of treatment-resistant depression.

Fortunately, Dr. Kullman offers another treatment option that might serve you better.

What is ketamine and what benefits does it offer?

Ketamine is a dissociative anesthetic that’s been used in operating rooms for decades. It’s only recently that it’s found a new purpose in helping people with chronic pain and TRD.

Dr. Kullman uses ketamine infusion therapy to help people with TRD find relief from their symptoms. He administers a low dose through an IV into the arm, and it rapidly goes to work on the glutamate – not the serotonin – pathway in the brain. Glutamate is a neurotransmitter that also helps to regulate mood.

Patients can experience benefits in 24-48 hours, and the effects may last from days to weeks.

The FDA has also approved a ketamine-based nasal spray called Spravato®, which is also administered in the office under medical supervision. Both forms of ketamine are usually used together with an oral antidepressant to maximize effectiveness.

If you’re struggling through postmenopausal depression, know that you aren’t alone, and that Dr. Kullman can help. Book your consultation by calling our office at 914-465-2882 or visiting our website for more options.