Up to 29% of menopausal women will experience depression during the menopausal change. The erratic hormone fluctuations during this transition can cause depressive symptoms (1;2;3). In the female brain estrogen is a neuromodulator, meaning it can change or disrupt the production of neurotransmitters, including those involving mood. In most women, until the onset of pre-menopause, the brain is able to deal with changes brought on by fluctuating hormones during the menstrual cycle. At the onset of pre-menopause some women (with a history of depression, premenstrual depression, or postpartum depression/baby blues, or those with a genetic vulnerability to depression) may be vulnerable to hormone related depression (1). The symptoms of which are: tiredness, sadness, irritability, disinterest in things, sleeping too much or too little, eating too much or too little, and even anger. These symptoms are due in part to wild shifts in sex hormones, which then effect neurotransmitter production (1;2;3).
For the 18% to 29% of women experienceing hormonally related menopausal depression (1), the “inability to rapidly establish a new baseline of neuronal function could lead to increased susceptibility to mood disorders and diminished brain-related functions” (1, p.5). In other words, their ability to think clearly may be altered and their mood may become depressed or erratic.
This phenomenon is rooted in part in the adrenal glands role in producing hormones, including sex hormones. In the female body the adrenals produce sex hormones (4), up to 50% after menopause, and stress related hormones, like cortisol and adrenaline. If the adrenals are producing stress hormones, they are less likely to be able to make sex hormones at the same time (5). Ironically, in this situation stress and depression act like a feedback loop, making it harder for women to regulate ovarian hormones, which can lead to early onset menopause (1). To make matters worse, if a woman’s body is under prolonged stress, her body will convert progesterone (a sex hormone) into cortisol (a stress hormone). Cortisol then disrupts the brains production of something called BDNF (Brain-derived neurotrophic factor). BDNF is associated with keeping the brain healthy (helping make new neurons and connections between existing neurons). Low levels of BDNF have been connected to depression (53). If a person’s brain stops making enough BDNF for a prolonged period of time, parts of the brain will start to atrophy or shrink (6).
How to deal with this problem:
Sleep hygiene is important. Having a routine helps maintain dopamine levels (56).
Manage stress, high stress levels are connected to low dopamine levels (56).
Exercise is important to psychological well-being as increases the production of neurotransmitters (Dopamine, Norepinephrine and Serotonin) that are necessary for healthy brain functioning and emotional well-being (32). It also increases blood circulation in the brain, which positively impacts hormones and increases dopamine levels (56). Exercise forces the brain to make BDNF (7). It is also linked to improved mood and feeling fewer physical symptoms of menopause (34;35). In fact, menopausal women who exercise have been shown to assess their symptoms as being less important and so cope better with them (36). Do yoga, it helps make the neurotransmitter GABA (gamma-aminobutric acid) which lessens anxiety and helps keep you calm. Yoga practice helps individuals learn to control negative emotions like anger, anxiety, and depression, (37). It may be better than cognitive behavioral therapy for stress management, anxiety, and depression (38). Exercise helps make the hormone DHEA (Dehydroepiandrosterone) (41), which helps depression (39) self esteem and low energy (40). DHEA can improve immune response (41) and memory (42). Exercise four times a week to improve GABA. Get enough sleep, as this helps balance hormones and neurotransmitters (52).
Dietarily:
To increase GABA eat the following foods high in glutamic acid: oats, whole wheat, whole grains, almonds or tree nuts, oranges and other citrus fruits, bananas, beef liver, halibut, lentils, broccoli, brown rice, rice bran, potato’s (52).
For BDNF production eat oily fish, blue berries, red grapes, and dark chocolate (12;13).
For DHEA eat good fats with plenty of omega 3 fatty acids. Eat pumpkin seeds, raw butter, ghee, and the following oils: flax, palm, olive and cod liver (43).
For serotonin eat the following foods: turmeric, dark chocolate, green tea, cold-water fatty fish, and fermented foods (yogurt, kefir, unpasteurized sauerkraut). The last helps balance gut bacteria as too much of a bacterium called lipopolysaccharides can lower serotonin levels (22;26;27). Also, eat Tryptophan (an amino acid) rich foods. Eat complex carbohydrates, these make more serotonin than protein based foods with Tryptophan. Protein has been found to block the production of serotonin so, eat sweet or starchy (ideally complex) carbohydrates without protein (22;23; 24). Eat low or fat free, and protein free, carbohydrates on an empty stomach (about three hours after a protein). The food source (like gram crackers, pretzels etc.,) should have at least 25 to 35 grams of carbohydrates and no more than 4 grams of protein. Try to eat less than three grams of fat per serving as this can increase your weight. If you want a quick boost to your mood try a simple carbohydrate, but keep in mind that this will raise your blood sugar levels. You should feel an effect 20 to 40 minutes after eating (25).
For dopamine eat bananas, (the riper the better), almonds, apples, watermelons, cherries, yogurt, beans, eggs, and meats (56).
Drink green and black tea to increase BDNF (12;13).
Do not eat sugar, processed foods or high fructose corn syrup, as these disrupt BDNF production (10) and dopamine production (56).
For BDNF take these supplements: zinc, magnesium (14), and curcumin supplements, or cook with the spice turmeric (11;51) or curcumin (8). Some antidepressants do work to increase BDNF production (9).
For dopamine address any magnesium deficiencies (56). Symptoms include cravings for salt and carbohydrates, having high blood pressure, being constipated, muscle spasms or pain, head ache, feeling tired, mood swings (anxiety or irritability) and other signs of depression, and experiencing heart palpitations or a rapid heartbeat (56).
For dopamine take vitamins C and E (56).
Take vitamin B6 to increase GABA (52).
Regarding DHEA, in Canada it is only available as a prescription (44). Conversely, DHEA is available for sale as a supplement in the US (45).
Reduce or eliminate caffeine as it may desensitize brain cells to serotonin (46) and dopamine levels decrease after drinking coffee (56), and avoid artificial sweeteners (aspartame) as it inhibits the uptake and conversion of tryptophan (22; 47).
For depression in general adding vitamins (B6, B9 and B12), and supplements (SAM-e, that is S-adenosylmethionine) to your diet can help (28; 29). Magnesium has been found to substantially help with treatment resistant depression (82) as have vitamin D and amino acids, especially tryptophan (30).
Take the amino acids tyrosine and L-phenylalanine or phenylalanine (which the body makes into tyrosine) to make dopamine.
Chlorella, a green alga, has been shown in clinical trials to reduce the symptoms of depression and anxiety (31). Kava extract has been effective for some people as an alternative to pharmaceuticals (4).
The following have also been shown to improve mood in depressed individuals: music therapy, and relaxation training (33).
To increase both serotonin and BDNF eat probiotics and prebiotics. Eating probiotics (bacterial culture found in fermented foods like yogurt, kimchi, pickles and sauerkraut) or taking supplements and prebiotics help relieve depression, anxiety and thought related problems (54). Eat lactobacillus rhamnosus (55) Lactobacillus casei Lactobacillus helveticus and Bifidobacterium longum (54). Serotonin and BDNF production is also improved by eating prebiotics (starches that nurture good bacteria) like squash, onions, sweet potatoes and asparagus can also help increase BDNF (14;15) and serotonin.
Treatment for depression: Peri-menopausal depression and premenstrual symptoms also respond to hormone replacement therapy (HT/HRT) (1). And, many women opt for estrogen replacement therapy (ERT) (16; 17), which has been shown to increase a sense of well-being (18). For some postmenopausal women, HRT combined with a type of anti-depressant/anti-anxiety drug called selective serotonin reuptake inhibitors (SSRIs) may work better than SSRIs alone (1). Others may opt for natural remedies and biodentical hormone therapy.
In some studies light therapy (especially blue light) has recently been proven more effective than anti-depressants in treating depression (19) and combining light therapy with antidepressants was even more effective. Blue light exposure helps anxiety as well. It increases production of serotonin and may strengthen and stimulate the areas of the brain responsible for processing emotion and language. This in effect enables better handling of stressful situations and greater mood regulation (20). Ideally you would get enough light naturally, by walking outside in sunlight for 15 minutes a day. Alternatively, you can buy an inexpensive light box at most retailers, or online, or try installing full-spectrum high-quality (fluorescent) lightbulbs in your home and place of work. Keep in mind that blue light can harm your eyes, so don’t look directly at it. Also, avoid blue light at night as it may affect the ability to go to sleep (including TV and tablet screens). If you purchase a blue light box place it on a high enough surface to allow the light to hit the lower part of the eye, as this is where blue spectrum light naturally is absorbed (21). Red/infrared light also increases serotonin, dopamine, and BDNF.
Other pre-and perimenopause related medical problems that cause depressive symptoms and anxiety are thyroid problems (48), deficiencies in B vitamins (especially B 6 and 12 [49]) and iron (anemia) due to excessive bleeding (50).
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39 Wolkowitz, O.M., Reus, V.I., Roberts, E., Manfredi, F., Chan, T., Raum, W.J., Ormistron, S., Johnson, R., Canick, J., Brizendine, L., & Weingartner, H. x
Owen M. Wolkowitz
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Affiliations
- Department of Psychiatry, University of California, San Francisco, USA
- Center for Neurobiology and Psychiatry, University of California, San Francisco, USA
Correspondence
- Address reprint requests to Owen M. Wolkowitz, M.D., Department of Psychiatry, University of California, San Francisco, School of Medicine, 401 Parnassus Avenue, Box F-0984, San Francisco, CA 94143-0984.
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