Mood Swings / Depression / Anxiety

Mood Swings

Nervousness, irritability or depression may result from a variety of things, such as fluctuating hormone levels, sleep deprivation due to hot flashes, or stress.

Women who seem especially vulnerable to mood disturbances at menopause include those who suffered from postpartum depression after giving birth, had bouts of depression at some point in their lives, or have a family history of depression. Also, according to a New England Research Institute study, women whose ovaries were surgically removed, were more likely to be depressed than those who underwent natural menopause. They were more negative about menopause in general and more likely to regret the loss of their periods. These women also reported more hot flashes and more sleep disturbances, probably because their estrogen supply was cut abruptly. This sudden deprivation of estrogen may also explain the decline in sexual interest and ability to climax reported by some women whose menopause resulted from surgery.

 Source: www.Healthpages.com

Depression

See your doctor, endocrinologist and/or gynecologist to measure your hormone levels. If you consider replacing the hormones, you will get help to your body by adding estrogen, progesterone and/ or testosterone. This will help with you feel more in control of your moods.

If you do pass on replacing the hormones but opt for antidepressant or anti-anxiety medication, be aware that the side effects of these drugs may cause low libido. Did you know that the side effect of an anti-anxiety drug could be depression? To medicate or not to medicate is between you and your doctor. And it’s great to have the help when you need it, but be aware of the side effects so that you can make a good decision for yourself.

Symptoms of Depression

In addition to having five or more of the symptoms above, in order to lead to the diagnosis of major depressive disorder (MDD), the symptoms must cause significant distress or impair the person's ability to function. This means the symptoms have a negative affect on how the person functions socially, at his or her job, or in some other aspect of their life.

Source: National Institute of Mental Health

Causes

1. Chemical Imbalance

There are many reasons or even a combination of reasons why a person might become depressed. These include traumatic life experiences such as the death of a loved one, certain diseases or medicines, substance abuse, hormonal changes, or a family history of depression. Sometimes the cause of depression is unknown. More often it is a combination of genetic, psychological, and environmental factors that bring on a depressive episode.

Whatever the circumstances, depression is caused by an imbalance of certain chemicals in the brain. Normally, these "chemical messengers" help nerve cells communicate with one another by sending and receiving messages. They may also influence a person's mood. In the case of depression, the available supply of the chemical messengers is low, so nerve cells can't communicate effectively. This often results in symptoms of depression.

TREATMENT OPTIONS:

Antidepressant Medications

Antidepressants are used most widely for serious depressions, but they can also be helpful for some milder depressions. Antidepressants, although they are not "uppers" or stimulants, take away or reduce the symptoms of depression and help the depressed person feel the way he did before he became depressed. 

Antidepressants are also used for disorders characterized principally by anxiety. They can block the symptoms of panic, including rapid heartbeat, terror, dizziness, chest pains, nausea, and breathing problems. They can also be used to treat some phobias.

Your physician will choose a particular antidepressant based on your symptoms. When you begin taking an antidepressant, improvement generally will not begin to show immediately. With most of these medications, it will take from 1 to 3 weeks before changes begin to occur. Some symptoms diminish early in treatment; others, later. For instance, energy level, or sleeping and eating patterns may improve before the depressed mood lifts. If there is little or no change in symptoms after 5 to 6 weeks, a different medication may be indicated, and you should discuss this with your physician. Some people respond better to one medication than to another. There is no certain way to determine which medication will be effective, so your doctor may have to prescribe first one, then another, until an effective one is found. Treatment with medication is continued for a minimum of several months and may last up to a year or more.

There are a number of different types of antidepressant medications available. They differ in their side effects and, to some extent, in their level of effectiveness. Tricyclic antidepressants (named for their chemical structure) used to be the most commonly used medications for treatment of major depressions. Monoamine oxidase inhibitors (MAOIs) were often used for "atypical" depressions in which there are symptoms like oversleeping, anxiety, panic attacks, and phobias. More recently, newer antidepressants have been developed. Several of them are called "selective serotonin reuptake inhibitors" (SSRIs). Some examples of SSRIs are fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). (Luvox has been approved for obsessive-compulsive disorder , and Paxil has been approved for panic disorder.) Though structurally different from each other, all the SSRI antidepressant effects are due to their action on one specific neurotransmitter, serotonin. Two other antidepressants that affect two neurotransmitters serotonin and norepinephrine have also been approved by the FDA. They are venlafaxine (Effexor) and nefazodone (Serzone). All of these newer antidepressants seem to have less bothersome side effects than the older tricyclic antidepressants.

The tricyclic antidepressant clomipramine (Anafranil) affects serotonin but is not as selective as the SSRIs. It was the first medication specifically approved for use in the treatment of obsessive- compulsive disorder (OCD). Prozac and Luvox have now been approved for use with OCD.

Another of the newer antidepressants, bupropion (Wellbutrin), is chemically unrelated to the other antidepressants. It has more effect on norepinephrine and dopamine than on serotonin. Wellbutrin has not been associated with weight gain or sexual dysfunction. It is contraindicated for individuals with, or at risk for, a seizure disorder or who have been diagnosed with bulimia or anorexia nervosa.

Antidepressant Medications

Trade Name Generic Name Adapin doxepin Anafranil**  clomipramine Asendin amoxapine Aventyl    nortriptyline Desyrel  trazodone Effexor venlafaxine Elavil amitriptyline Ludiomil maprotiline Luvox (SSRI)   fluvoxamine Marplan (MAOI) isocarboxazid Nardil (MAOI) phenelzine Norpramin desipramine Pamelor nortriptyline Parnate (MAOI) tranylcypromine Paxil (SSRI) paroxetine Pertofrane desipramine Prozac (SSRI) fluoxetine Remeron mirtazapine Serzone nefazodone Sinequan doxepin Surmontin trimipramine Tofranil** imipramine Vivactil protriptyline Wellbutrin bupropion Zoloft (SSRI) sertraline

Source: National Institute of Mental Health

Side Effects of Medication for Depression

Tricyclics have been used as antidepressants for a long time now. They include these brand names: Tofranil, Elavil, Aventyl, Norpramin and Pramelot. They take 4 to 6 weeks to work and have these side effects.

Side Effects

Tricyclics have side effects that include dry mouth, constipation, blurred vision, difficulty in urinating, drowsiness, or trouble sleeping, weight gain, and lack of libido. Can be fatal when overdosed.

SSRI Selective Serotonin Reuptake Inhibitors have fewer side effects and are not fatal when overdosed. (an obvious benefit for depressive patients)
These include: Prozac, Zoloft, and Paxil They take on average, four to six weeks to work. Bear in mind that the same drug, even in the same category will not work for everyone nr will it produce the same side effect. This means that you should be aware of how you are feeling and communicate this to your doctor. Keep a daily diary to track your emotional flow..

Excerpt from Annne Sheffied, How You can Survive When They’re Depressed, Three Rivers Press, 1998.

Hormone Therapy for Menopause

 Estrogen Therapy: Estrogen therapy is a relatively new therapy for depression in menopausal women. It operates on the theory that decreased levels of estrogen affect the mood negatively. Estrogen supplements can help to revive your mood dramatically. In a study reported in the American Journal of Obstetrics and Gynecology, 80% of menopausal women reported a positive change in their mood as a result of oral doses of estrogen. This therapy may work best when combined with an antidepressant

Progesterone: Progesterone offers hormonal balance with estrogen therapy. It inhibits the harmful side effects of estrogen. Estrogen excess can cause bloating, and high blood pressure. More seriously, estrogen unopposed by progesterone can lead to uterine cancer and breast cancer.

Testosterone: Testosterone, the main male sex hormone, taken with estrogen is an option for relief of some symptoms of menopause. Taking testosterone may help increase sex drive, increase bone density, improve mood, and increase energy. Synthetic testosterone is available as a tablet (combined with estrogen). Natural testosterone is available as an injection or a cream. Side effects include decreasing the HDL (the good) cholesterol level. When taken in usual doses, testosterone may have some masculinizing effects.

Supplementing testosterone can be a substantial help in restoring a woman to her familiar level of energy, libido and sense of well being.

According to Dr. Waxenberg of New York’s Sloan Kettering Institute published in 1959 source: The Hormone of Desire by Susan Rako, MD  page 25

 Menopause and Thyroid Function

The thyroid gland is vital to both sexes – a little gland in our necks that controls the rate of function of every cell and gland in the body, including growth, repair and metabolism. Women have a greater tendency than men to suffer thyroid problems, especially hypothyroidism, which is low thyroid function. No one clearly knows why. It probably has to do with the relationship between our reproductive hormones – i.e. estrogen and progesterone -- and thyroid hormones. Many women experience under-active or hypo-thyroid during perimenopause, just as some do during adolescence and pregnancy. Since these are times of hormonal change, it makes sense that an imbalance in female hormones affects thyroid function.

http://www.womentowomen.com/hypothyroidism/index.asp

The symptoms for low thyroid include mood swings and depression. Have your blood work checked by your doctor. There are both pharmaceutical and bioidentical hormones available for you. If you have been on pharmaceutical hormones for low thyroid, have a conversation with your doctor and your compounding pharmacist. It may be best to stay on your already prescribed course .

Excerpt from Marcel Pick, MD ob/gyn

  Psychotherapy

Two types of psychotherapy are highly recommended for depression related to menopause. Interpersonal therapy focuses on understanding how changing human relationships may contribute to, or relieve, depression. Cognitive-behavioral therapy focuses on identifying and changing the pessimistic thoughts and beliefs that accompany depression. When used alone, psychotherapy usually works more gradually than medication, taking 2 months or more to show its full effects. However, the benefits may be long-lasting. Psychotherapy is usually combined with medication in major depression. It is unlikely to help severe depression if used by itself.

What if the first treatment isn’t helping?

It is important to give each treatment strategy enough time to work before considering another. If hormones are tried first, a response should be seen within 2-4 weeks. If the response is not satisfactory, the experts strongly suggest adding an antidepressant. If an antidepressant is used first, it must be adjusted to a high enough dose, and then given for at least 1–2 months to tell if it will help. If an SSRI antidepressant does not work in this time frame or produces intolerable side effects and has to be stopped sooner, the experts strongly recommend switching to a second SSRI. The doctor may also suggest combining the SSRI with a second medication, which could be either another kind of antidepressant, or hormone replacement therapy if not already in use.

Excerpted from, Depression during the Transition to Menopause: A Guide for Patients and Families American Menopause Foundation, Inc

Create a Positve Self Image

Find an exercise that you can do religiously. Enjoy it and try doing it two or three times a week. The endorphin rush keeps the color in your cheeks and keeps your metabolism moving. Like the woman you see in the mirror. Coco Channel said, at 50 you get the face you deserve. Dress for your body, respect your age but don’t succumb to it. Create a mental picture in your mind of what you like best about yourself and play to that image. Look into your closet. Is everything a variation of black or beige? Color really enhances the tones of your skin. If you are overweight, relax with it. Don’t over compensate by trying to hide with black tones.

Anxiety

Anxiety is as common as an alarm clock. But if your anxiety is out of proportion to reality and combines with depression, it’s serious. The anxiety associated with depression may provoke feelings of paralyzing dread and foreboding. Discuss with your doctor what alternatives are available to you. There are medications that reduce the anxiety and allow you to function daily.

If there is something going on in your life that needs to be addressed, you may need help adjusting back to the person you were before your hormone depletion. At this point in time, you may need to reinvent yourself or at the very least assess your life as you now see it. You may want to build up your arsenal of emotional strength back to what you remember before your hormone depletion.

All of your sex hormones: estrogen, progesterone and testosterone, can positively affect your mood. Have your doctor test for these levels and work out a solution that fits your body’s needs.

What to Eat

Over the course of the normal aging process, everyone develops what is called insulin resistance. It is normal for a ninety year old person to be insulin resistant. However, because of accelerated metabolic aging, people are developing insulin resistance at much younger ages, fort, thirty, and even twenty five. When unhealthy eating and lifestyle habits interfere with hormone production, the metabolic system breaks down faster than normal. This premature breakdown is accelerated metabolic aging.

For Depression and Mood Swings

This is a list of brain food. Eat these: If you are depressed, have mood swings and need to change how you’re feeling quickly:

You need zinc, B vitamins, selenium, and antioxidants such as E and C

For vitamin B
Brown rice, chicken, corn, eggs, green leafy vegetables, legumes, meat, nuts, peas, poultry salmon, shrimp soy bens, spinach, sunflower seeds, tuna

Cyanocobalamin (B12)
Found in liver, meat, saltwater fish, oysters, eggs, and milk. B12 is essential to the normal function of all body cells and the growth of red blood cells. Need energy? Try B12

Niacin (B3)
Meat, fish, poultry, liver, eggs, legumes, mushrooms and whole grains

Pyridoxine (B6)
Found in legumes, seeds, whole grains, corn, potatoes, green leafy vegetables, green beans
It helps with sugar and protein metabolism as well as the production of serotonin.
Pyridoxine deficiency can be the cause of anemia, fatigue, PMS and a low serotonin state.

Thiamine (B1)
Chicken, liver, fish, pork, beef, nuts, lentils, whole grains, and potatoes. I t helps with stored sugar utilization and is important in the metabolism and the maintenance of the brain. Irritable and tired? Eat B1

Riboflavin(B2)
Found in meat, fish, eggs, liver, milk, and green leafy vegetables. This vitamin is involved in protein metabolism and eye function. Feeling sensitivity to light? Eat B2

Vitamin E
Found in egg yolk, green leafy vegetables, vegetable oil, whole grains and legumes. Vitamin E is an important antioxidant. Vitamin E also helps stabilize all cell membranes and is important in red blood cell formation.

Vitamin C
Found in cabbage, kale, parsley, turnip greens, broccoli, tomatoes, citrus fruits, strawberries, and cantaloupe. Vitamin C helps heal wounds and broken bones, promotes toot and bone growth, protects against heart disease increases iron absorption and helps with collagen formation.

Minerals

For Calcium:
Almonds, asparagus, broccoli, cabbage, dairy foods, kale, kelp, oats, parsley, salmon sardines, seafood, tofu, sesame seeds turnip greens
Important for bones and teeth, blood clotting, muscle locomotion, transmission of nerve impulses, activation of enzymes, and hormone secretion.

Carnitine:
Found in liver, lamb, and beef. This lipoprotein is essential to the transport of long chain fatty acids and the transport of vitamin E and C. A lack of carnitine in the diet leads to low HDL levels, high serum cholesterol and triglyceride levels, and an overall difficulty in losing body fat.

For Magnesium:
Almonds, apples, avocados, beans, broccoli, brewer’s yeast, brown rice, cod, figs, flounder, green leafy vegetables, halibut, salmon, sesame, seeds, shrimp
Magnesium helps with muscle relation and energy release and is a catalyst for important metabolic reactions. Magnesium is a coenzyme to help your body build proteins and produce serotonin. Magnesium prevents constipation. A deficiency leads to muscle spasms, nervousness, irritability and tremors.

Tryptophan:
Almonds, cottage cheese, peanut butter, peanuts, shellfish, soy foods, (tofu) tuna, turkey
Tryptophan affects the seritonin level which in turn affects mood, behavior and sleep patterns.

Chromium
Found in meats, cheese, eggs and whole grains. Chromium is important in sugar metabolism.

The Menopausal Food Plan:
Excerpted from Dr. Diane Schwarzbein, The Scwarzbein Principle, Health Communications Inc.1999.