Depression, Panic Disorder Can Take Root During Menopause

Hot flashes. Brain fog.  Emotional ups and downs.  Some people treat the very real and challenging symptoms of menopause as if they’re the punch line of a bad joke. However, if you’re going through this stage of life, the process can be anything but funny. Along with the very uncomfortable physical symptoms that often occur, you may experience new or worsening symptoms of a mental health condition.

Hormones and Mental Health

The transition into menopause is called perimenopause. During this time, estrogen levels drop while other hormones, like follicle-stimulating hormone (FSH) and luteinizing hormone (LH), increase.  These hormonal fluctuations cause a variety of physical symptoms including menstrual irregularities, decreased fertility and insomnia. They often also cause temporary mood swings in many women.  For some, however, they can play a significant role in mental health problems as well.


Feeling “blue” can be part of the mood swings associated with menopause.  In some women, however, the transition may be associated with clinical depression, which is persistent depression that affects the quality of life.  An episode of depression can occur during or after any significant life change, including menopause. You may be at higher risk for depression during menopause if you:

  • Have a history of depression
  • Have negative feelings about menopause or life after menopause
  • Feel severe disappointment or sadness because you’re no longer able to have children
  • Don’t have (or feel you don’t have) adequate social support
  • Have severe menopausal symptoms that make you physically uncomfortable

Women who had no history of clinical depression before menopause were twice as likely to have depression symptoms once their bodies began to change, according to Harvard researchers [1]. In another study, women reported that most symptoms of depression occurred after they had started the menopausal transition [2]. Depression during perimenopause and menopause is treated the same way as depression that occurs at other times of life. Therapy is an important part of treatment for this mental health condition. You and your therapist will examine why you may have negative thoughts or emotions as well as find healthy ways to cope with them. Lifestyle changes may help too. In one study of low-activity, middle-aged women, researchers found that adding regular exercise boosted their mental health during menopause [3]. Since depression has biological roots, your mental health professional may also prescribe an antidepressant. These prescription medications, like selective serotonin reuptake inhibitors (SSRIs), allow the brain to absorb more of the neurotransmitters, or brain chemicals, needed to maintain a more positive mood. They’re often prescribed to work in combination with therapy and lifestyle changes.

Attention Deficit Hyperactivity Disorder (ADHD)

The decline in estrogen, which is often quite dramatic during perimenopause, can make ADHD symptoms worse in some women. The estrogen drop affects neurotransmitters, or brain chemicals, like dopamine, which contribute to the symptoms of the disorder. In addition to an increase in symptoms, women with ADHD may find that medications they had been taking successfully for the disorder are no longer as effective. If you live with ADHD and are transitioning to menopause, talk with your primary care physician or psychiatrist; he or she may need to adjust your medication.


While little research has been done to pinpoint a connection between menopause and anxiety, some health experts and women who’ve gone through menopause suggest the transition can trigger or aggravate anxiety symptoms. Panic disorder is a type of anxiety disorder that may also be affected by menopause. Studies suggest that panic disorder may develop, or its symptoms can worsen (if already present), with menopause [4]. In one study of women aged 50-79 years old, panic attacks were most common in women who were transitioning to menopause [5].

Bipolar disorder

Perimenopause may cause an increase in the number of depression episodes in women with bipolar disorder, according to a Stanford study. Participants reported more frequent episodes of depression during menopause then during their reproductive years. However, the research did not find any links between menopause and manic episodes [6].

Sleep Problems

Sleep problems are common in women transitioning to menopause, with about 75%-85% of women experiencing them [7]. While it’s not always clear whether insomnia contributes to mental health conditions, like depression, or if mental health conditions cause insomnia, it is clear that the two are linked. If you’re experiencing sleep problems, talk with your primary care physician; he or she will help you find strategies for getting the rest your physical and emotional well-being need.

4 Tips for Improved Mental Health

  1. Talk to someone about your symptoms. Reach out to a mental health professional if you’re having mental health symptoms you believe may be related to menopause. If you’re not sure who to talk to, speak with your gynecologist. He or she may be able to provide some insight and direct you to the resources you need.
  2. Make positive lifestyle changes. Incorporating simple changes, such as adding daily exercise or finding a relaxing hobby, can have a surprisingly positive impact on mental health. When possible, cut out activities that drain you or trigger anxiety.
  3. Find a way to relieve stress. Menopause itself can cause stress, but it also occurs during a time in life when other big changes are happening, whether it’s a child leaving home or the death of an elderly parent. Pressure and strain play a big role in your emotional well-being, so identify practical ways to keep stress under control. For instance, regular yoga practice lowers stress levels while increasing physical fitness. Expressing yourself through creativity can alleviate stress as well. Consider journaling your emotions or channeling them into an activity like art or music.
  4. Address relationship issues. During perimenopause and menopause, it’s common for a relationship with a significant other to become strained. A low sex drive might affect physical intimacy with a spouse, or the absence of children in the house may put a laser-focus back on unaddressed problems with your partner.  The related stress can increase the risk for depression. Consider addressing and resolving these issues with the help of family counseling or couples therapy.

Menopause is one of the most significant changes a woman will go through in her lifetime. If you’re experiencing new or worsening mental health symptoms, consult a mental health professional for an evaluation.  He or she will be able to help you develop a plan for reclaiming your emotional well-being.

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