The fog of depression can sometimes catch us unawares. We may be feeling like we’re moving through sludge and just going through the motions for weeks (or longer) before we are able to put a name to this perplexing state of mind.
Unfortunately, depression is all too common in perimenopause, affecting up to 38% of women at some point during this transition. Symptoms of depression can include depressed mood, feelings of worthlessness or guilt, fatigue, and reduced ability to concentrate or think. These symptoms can vary in intensity from mild to severe.
Our understanding of depression has changed over the past several decades. What was once thought to be an imbalance in brain chemistry is now widely being recognized as a result of inflammation and has strong ties to gut health.
When it comes to perimenopause and depression, the research is still in its infancy. Even as recent as 2005, researchers did not include depression as a symptom of perimenopause. Thankfully, newer research shows a clearlink between perimenopause and depression, though the exact whys for this link are still just theoretical.
It is reasonable to assume that the change in hormones during perimenopause is a large factor, but like depression in general, there can be more than one root cause. For example, we know that night sweats and insomnia are common in perimenopause. We also know that depression is ten times more likely to occur due to poor sleep. So, for some women, perhaps their depression in perimenopause is actually due to insomnia and that’s what should be treated.
While we don’t know the whys of depression in perimenopause, we do know that it can have a broad impact on day-to-day life. Since it can be hard to make changes when you’re depressed, here’s a few simple tips that can help move the needle.
Making extensive nutritional changes when you’re depressed can be challenging but I’ve found that nutrition can have a strong impact on mood so it is not an area to overlook.
If the thought of doing something like an elimination challenge is too much, start by bringing awareness to how much added sugar is in your diet. Sugar can give us a mood and energy boost immediately after consumption, but after a few hours, there can be a significant dip, especially if you have any underlying blood sugar issues.
Added sugars can hide in the most innocuous foods so reading ingredients is key. Keeping added sugar low is important for perimenopause in general so know that you’re helping more than just your mood.
A simple change that can be easier to implement when you’re depressed is the use of supplements. It is always important when incorporating any supplement or herb to check with your healthcare provider.
A common nutrient deficiency associated with depression is magnesium. Magnesium can generally be depleted from taking medications such as anti-depressants or birth control, which can exacerbate your symptoms. Magnesium is involved in over 300 chemical reactions in your body so suffice it to say, it does a lot! I’ve found magnesium glycinate to be the most well-tolerated form.
Another simple addition for depression is fish oil. The latest research suggests that depression is an inflammatory disease so what better way to combat inflammation (besides removing sugar) than giving your body more anti-inflammatory omega 3s.
The diet of the average American has a paltry amount of omega 3 fatty acids, putting us in a generally more inflamed state. The biggest mistake I find with patients taking omega 3s is not getting a supplement that shows the total EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), which are the active omega 3s, and should be at least 1,000mg.
For mood regulation, a similarly well-researched supplement is probiotics. The health of your gut has a strong impact on mental health and that theory continues to be solidified in research. What’s interesting is that our mental health can negatively impact our gut health and vice versa so it can become a vicious cycle.
One way to interrupt that cycle is through taking probiotics. Unfortunately, most over the counter probiotics are low in strength and therefore not effective. The minimum I would start someone on is 25 billion CFUs that have at least 5 different species.
While supplements can be important when dealing with depression, I love using stronger support like botanical medicine. There are several herbs that are great for depression but I will highlight just a few of my favorites.
If you can get past the taste, Rosemary (Rosmarinus officinalis) is a great herb for lifting your spirits. It is also good for memory. Rosemary is also a great digestive herb so it offers extra gut support. It is quite bitter so I don’t typically recommend using it as a solo tincture. And while it won’t be considered a therapeutic dose, adding the fresh herb to your cooking wouldn’t hurt and is infinitely more palatable.
Another herb I commonly use for depression is Rhodiola (Rhodiola rosea). Rhodiola works well for mild to moderate depression and helps with both short-term and long-term stress. It can help with fatigue and supports your endocrine system as a whole as well. While I use it a lot for those needing a thyroid boost, I find it to be a bit stimulating so I recommend taking it in the morning or early afternoon and have stopped using it with individuals that have any autoimmune conditions.
If you don’t have the budget or are unable to try supplements or herbs due to drug interactions, there are some simple lifestyle tips that can also help.
While it may seem counterintuitive, regular movement can help shift you out of the sludge. Start with something small like a 5 minute walk every day and gradually build up to longer and more intense activity. Research has shown that moderate intensity movement helps with depression.
It may be easy to overlook but your environment may be affecting your mood as well. Is your house cluttered with dishes everywhere, clothes overtaking things, and junk scattered about? It is hard to know whether the clutter is a symptom of depression or depression is worsened or caused by clutter. What we do know is that it’s important for your mental health to have a relaxing and inviting environment to spend your time.
Since cleaning up an entire house can be overwhelming, especially if you’re dealing with depression, start small. Focus on one room where you spend most of your time. Or some small area of that room. Or even one item in that room. If you want more guidance or support, a newer book that I highly recommend is called How To Keep House While Drowning by K.C. Davis. She offers a compassionate and bite-sized approach to what can feel like a daunting task.
Depression may also be a sign it’s time to do some reflecting. Are you feeling depressed over a specific situation and haven’t had time to grieve? Are you overwhelmed and need to work more on boundaries and self-care? Is it time to start (or restart) counseling? Or make a big life change like divorce or a new career? I strongly believe that symptoms are our bodies’ way of communicating to us so is there anything the depression is trying to tell you?
When it comes to depression, there is no one size fits all approach. The struggle can be different for different people. And while all of the tools discussed can be effective, they can take time to work.
Sometimes the hardest part is taking that first step towards getting help. For others, sometimes just acknowledging that you are in fact depressed is a struggle. Whatever the case, being more compassionate with yourself during this time is important.