Q&A – Diagnosing Menopausal Depression

I’m Dr. Jennifer Payne and I direct the Johns
Hopkins Women’s Mood Disorders Center which is located both at Johns Hopkins in Baltimore
and here at Howard County General. So, menopause is only one day in a woman’s
life. The time leading up to menopause is called
perimenopause and can actually last for years. But menopause is defined as not having ones
menstrual cycle for one year. And so menopause is actually one day and then
thereafter it’s called post menopause. So, in perimenopause, a women’s brain is
subjected to multiple hormonal fluctuations that really become somewhat random. During most of a woman’s reproductive life,
she has very regular hormonal fluctuations which result in a menstrual cycle. In perimenopause, they become more random
and that can affect a women’s mood and cognition as those hormonal fluctuations become random
and difficult to deal with. So, depression is twice as common in women
as compared to men during the reproductive years, so about 20 percent of all women will
have a depressive episode in their lifetime compared to about 10 percent of men. Depressive episodes are a little bit more
common at times of hormonal fluctuation, so postpartum depression is a very common time
for a depressive episode and women are a little bit more likely to have depression during
perimenopause. So depression is really defined by an inability
to function. So a woman’s mood will be low, but it will
be accompanied by a lot of other symptoms, so changes in energy, sleep, appetite, feeling
negative, certainly feeling suicidal is a sign of depression. But any psychiatric illness is defined by
having an inability to function in some area of your life. So when a woman is really suffering from a
major depressive episode, she’ll find it hard to work, or complete things at home, for example. Another common question I often get is “should
I get my hormones tested?” The answer is you can if you want, but they’re
not very helpful in terms of diagnosing depression or psychiatric illness. Most women who are experiencing a depressive
episode in the setting of hormonal fluctuations will have absolutely normal hormone concentration
levels compared to women who are not having depressive symptoms. So it’s not about the levels, per se, its
about a woman’s brain response to the hormonal fluctuations. So I don’t actually do hormonal testing, it’s
really about taking a clinical history and making a clinical diagnosis. If a woman is experiencing depression, she
should see her doctor. She could see her primary care doctor, her
Ob-Gyn, she can also go see a psychiatrist. There are a group of psychiatrists that specialize
in women’s mental health disorders, particularly during times of reproductive hormone fluctuation,
like perimenopause or for example during the postpartum time period. But really, she just needs to see a doctor
and get help.

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