As women unconsciously enter perimenopause the first signs may be related to their emotional and mental wellbeing, rather than physical symptoms. A 2015 Royal College of Obstetricians and Gynaecologists’ survey found that a whopping 45 per cent of ‘older women’ - their words, not ours - were concerned about depression. 
“Rainy Days and Mondays”, this Carpenters wistful song certainly sums up those ‘down days’.  

Women with a history of severe premenstrual syndrome, post-natal depression or previous episodes of clinical depression, may be predisposed to developing depression as their hormones surge and dip. While we’re all allowed to feel down occasionally, a low mood should improve after a few days. But depression is different. It’s a continuous feeling of extreme sadness and loss of interest and enjoyment in life lasting for more than two weeks. According to NHS Choices other indicators for depression include feelings of hopelessness, tiredness and lack of energy, changes in your sleeping and eating habits, and having thoughts about suicide or self-harm. If any of that sounds familiar, talk to your doctor. And the good news is…. If depression is caused by hormonal imbalance in perimenopause and menopause it should lift when your hormones begin to level out. 

The best ways to deal with menopause depression Depression caused by hormone fluctuations is a serious mental health condition, which should be treated by your doctor. But improving your diet, exercising, and being kind to yourself certainly won’t do any harm.

What to eat to help with depression 
There is no specific medically prescribed diet for depression. Symptoms of depression have been linked to poor eating habits and vitamin and mineral deficiencies. The Mayo Clinic in the USA noted the increased likelihood of depression being reported by people with a diet high in processed foods, sweet treats and junk food, versus those who ate a diet rich in fruits, vegetables and fish. 
Vitamin B: deficiency has been linked to depression. Eat more: sunflower seeds, pistachios, tuna, salmon, turkey and chicken, dried fruit, bananas and avocados. 
Vitamin D: deficiency has been linked to aches, pains and depression. Found in a limited number of foods (the body gets the bulk of vitamin D from the sun’s UVA rays). Eat more: eggs, oily fish, fortified cereals, margarine and spreads. 
Omega-3 fatty acids: may reduce depressive symptoms. Eat more: SMASH, (the acronym to remember which oily fish are good for us), salmon, mackerel, anchovies, sardines and herring. Also, walnuts, linseed and chia seeds. 
Minerals: calcium, magnesium, zinc, iron and selenium may all help to lessen the effects of depressive symptoms. Eat more: spinach, kale, broccoli, almonds, seafood and pumpkin seeds.

What to avoid to help with depression 

Cut out the caffeine Caffeine stimulates the central nervous system, and is thought to increase anxiety. As depression and anxiety often go together, cutting out caffeine may help. 
Alcohol and fizzy drinks sap your fizz. The risk of depression increases for menopausal women. Drinking alcohol when you’re feeling down or stressed temporarily calms the effects of stress hormones but also depresses the nervous system. See our vlog Get Sober with Club Soda on the effects of alcohol and menopause. 
Sweet fizzy drinks are a no-no too. High caffeine content can give you the jitters, intensifying other menopausal symptoms including; hot flushes and insomnia. It’s time to find a caffeine and alcohol-free drink! Try alcohol free ginger beer, Feel Good’s mocktails, Elderflower presse or bitters (they do contain a trace of alcohol), with tonic. Adult tastes without the alcohol. Seedlip have produced a couple of spicy, herbal alcohol-free spirits, which could be a tasty alternative when you feel like an end of day treat. 

Lifestyle & wellbeing tips to help with menopause depression 

Why tiptoeing through the tulips may help! Regular exercise releases feel-good endorphins and lowers levels of harmful chemicals linked to depression. Getting more active can be particularly useful for people with mild to moderate depression. The Catch 22 of depression is that even though you know it helps, you can’t summon up the energy to exercise. Start gently. Blow the cobwebs away by gardening, walking the dog or hiking with friends. Walking helps with breathing which can have a calming effect and make a very real difference on your ability to cope with the symptoms of depression. An ITN Tonight programme broadcast in February 2017 delving into the benefits of exercise, acknowledged that sticking with any form of exercise can be difficult but if we do something for 100 days, it becomes a natural part of our daily routine. You may have more success if you exercise as part of a group so people rely on you to turn up and will notice when you don’t! Play tennis, netball, aerobics or boot camp in the park. If you need more support about exercise talk to your GP. Lots of UK surgeries offer exercise on prescription for conditions like depression. 

Switch off and ask for help Mid-life can be chaotic: health issues, work problems, relationship breakdown, empty-nesting, caring for elderly parents or just realising that we’re ageing. Stress levels rise, which can worsen the symptoms of depression. 

So, what can we do? Go easy on ourselves, lower our expectations, look for support from others. Grab some rest, socialise, laugh, meditate, practice mindfulness or take up yoga. A 2017 study looking at the benefits of hatha yoga found that the positive impact of yoga builds up over time rather than being immediate. If you don't already do yoga, start! The more yoga you do, the more it may help with your depression. You don’t need to join a group. 
Not getting your z’s? As oestrogen levels fall, the quality and quantity of our precious, energy-renewing sleep may suffer. Incredibly, 40% to 60% of women going through menopause experience sleeping difficulties. No surprise then that a 2004 American study found that menopausal women suffering insomnia are more likely to report depression and other mood disorders. 

Why water works! Dehydration may be linked to depression. Brain tissue is 85% water. Energy generation in the brain decreases and slows down when you are dehydrated. And if you’re having hot flushes and/or night sweats you need to drink plenty of water to replace lost fluids anyway. 

Supplements worth trying for depression 
The Royal College of Obstetricians and Gynaecologists (RCOG) feel that there’s insufficient research to say that supplements work. Depression is a very serious issue and all treatments must be discussed with your doctor. The products below are marketed as being appropriate for mild to moderate depression that may be associated with menopause: 
St John’s Wort ‘appears to be effective in treating depression during the menopause but it can interfere with other medication so it is important to speak with your doctor before taking’ says the latest RCOG guidance. 
St John’s Wort Complex combines St John’s Wort with hops and lemon balm, both relaxants (both by A.Vogel) or Viridian Saffron Extract taken as a tincture or a capsule 
Black Cohosh may increase your natural oestrogen levels, possibly dealing with the underlying cause of menopause depression. Talk to your doctor as there are concerns about the long-term safety of black cohosh. 
Omega-3 fish oil supplements could help with depressive symptoms. Try Bare Biology Lion Heart Omega 3 Fish Oil Maxi Capsules. We’ve no link, we just like this UK based, female developed omega-3 brand. Your doctor will be able to advise you about how appropriate they are for you.

Alternative help for depression 

Aromatherapy Good quality essential oils can make a natural contribution to managing the symptoms, but not the cause, of depression. 
Lavender oil is known for a sedating effect. Add 5 drops to bath water. Burn in a diffuser to help you sleep, or sprinkle a couple of drops on your pillow. 
Clary Sage a calming oil that can be added to the bath or burnt in a diffuser before bed 
Ylang Ylang has mild sedative qualities which may lower stress responses. Rub 3 drops on your palms, inhale for a positive effect on your mood. 
Bergamot a citrus oil may boost your mood by improving blood circulation. 
Acupuncture and Chinese Herbal Medicine In September 2015 Psychology Today said that whilst acupuncture is not a stand-alone treatment for depression, there's evidence that used alongside medication, it has a place in treating depression. Find a practitioner through The British Acupuncture Council website. 
Homeopathy According to the British Homeopathic association, homeopathy ‘may have a part to play as an additional or complementary treatment but NOT as a stand alone therapy’ in more serious cases of depression. NHS Choices caution ‘some homeopathic remedies may contain substances that are not safe, or that interfere with the action of other medicines’. 
Women taking medication for depression should speak to their doctor about whether homeopathy is appropriate for them. 
And why not treat yourself occasionally? We like Aveda’s Stress Fix Body Lotion*. Good for a gentle pick you up. This is what Aveda say: ‘Hydrating body lotion with aroma proven to relieve feelings of stress. Aroma includes essences of lavender, lavandin and clary sage from organic farms and is formulated using the science of aromaology and the power of pure essential oils.’ A little goes a long way so you could indulge and give yourself a treat. Massage carried out by a skilled practitioner can boost your mood in the short term whether it is Swedish, acupressure, Ayurveda or aromatherapy, *We have no commercial arrangement with Aveda we just like this product. 
CBT to help you frame your thoughts Talking therapy may be helpful for tackling depression in menopause, encouraging you to reframe negative thoughts and change behaviours. CBT is not an instant fix but you could see results in a short period. The National Centre for Health and Care Excellence (NICE) recommend a course of between 16-24 hours. 

When to see your doctor about depression 

Depression is a serious mental health condition. It’s essential that you consult your doctor to help you deal with it, whatever the cause. However, it can sometimes be hard to articulate how you’re feeling when sitting in front of a doctor. Before an appointment think about your own history including your periods, any post-natal issues or any depressive episodes. 
Keeping a diary of moods and periods before an appointment may help. A period tracker will help you monitor your moods. 
Severe cases of hormonal depression may be premenstrual dysphoric disorder (PMDD) this is a very severe form of premenstrual syndrome (PMS), which can cause many emotional and physical symptoms every month during the week or two before you start your period. It is sometimes referred to as 'severe PMS'. PMDD symptoms are much worse than PMS and could have a serious impact on your life. Experiencing PMDD can make it difficult to work, socialise and have healthy relationships. In some cases, it may also lead to suicidal thoughts. If you are suffering severe symptoms you should seeks help and support. 
There are PMDD Facebook pages you can join to find additional help. In an emergency call the Samaritans for free on 116 123, or go to A&E. 
Hormonal depression can go unrecognised. Many women don’t realise they are perimenopausal, so don’t make the hormone connection. Women struggling with low moods, tiredness and focus, may therefore be prescribed anti-depressants by their doctor when the possibility of perimenopause is not discussed. However, guidelines on menopause from The National Institute for Health and Care Excellence (NICE) say, ‘It has not been shown that antidepressant drugs called SSRIs and SNRIs can help with low mood during menopause if you haven't been diagnosed with depression.’ 

And then there’s always HRT…. 
Where depression is caused by hormone fluctuation and you are able to take HRT, transdermal oestrogen, is an option. Results of a research published in January 2018, in the American JAMA Psychiatry journal, found fewer women given HRT went on to develop symptoms of depression than those who were given a placebo. NICE guidelines recommend the use of HRT for symptoms of low mood. GPs will look at your unique risk factors to see whether or not HRT is appropriate for you. The usual caveat here, that there are pros and cons to taking HRT. 

And we can help 
Your Fbl Team x