For a natural process, menopause can be accompanied by a bunch of seemingly unnatural changes in biology, emotional wellbeing and physical appearance. Another unwelcome challenge for women during their transition out of childbearing years is depression.

Postpartum depression may get more play in the media, but menopausal depression is a common problem for aging women, according to Sheryl Green, Ph.D., a psychologist with the Women's Health Concerns Clinic in Hamilton, Ontario and assistant professor in the Department of Psychiatry and Behavioral Neurosciences at McMaster University. During the so-called "window of vulnerability" that occurs during menopause, women are four times more likely to develop depression, even if they have never experienced the condition before. For women who have previously grappled with depression, this risk is 13 times higher.

"The constant change and fluctuation of hormones (estrogen, progesterone) that occur during menopause is thought to increase one's vulnerability to mood disorders," says Green, mainly because the hormones that are changing are also the ones in charge of maintaining mood stability. Physical symptoms such as hot flashes and trouble sleeping can also play a role in elevating depression risk.

Antidepressants (SSRIs, SNRIs) and hormone therapy (low-dose estrogen) are two treatments that have proven effective in reducing menopausal depression, but such medications come with a few undesirable side effects and—in the case of hormone replacement—a potential increase in cancer and cardiovascular risk.

Drug-free depression treatments

After finding only a handful of scientific studies that investigated the effectiveness of non-pharmaceutical interventions for menopausal depression, Green set out to explore the potential of alternative treatments. "Additional non-pharmacological treatment approaches are certainly needed if a woman cannot or chooses not to take medications," she says.

Antidepressants are somewhat effective in easing depression symptoms about 50 percent time, according to Cheryl Myers, RN, an integrative health practitioner, author and expert on natural medicine, who was not involved in the study. But, she says, "These drugs carry a significant side effect profile that is not acceptable to many women."

For hot flashes and night sweats, Myers points to studies that have demonstrated the effectiveness of natural interventions like standardized hop cone extract, standardized black cohosh and pomegranate. For depression symptoms, she says St. John's wort may be as effective as antidepressants, for some people.

There are, however, some important factors to keep in mind when taking a more natural approach to menopausal depression treatment. Myers cautions against going it alone, and she suggests seeking the expertise of an integrative health professional before taking any new dietary supplements.

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With regards to psychological treatments for menopausal depression, after analyzing over 5,100 research studies on treatments for menopausal depression.

Drug-free ways to combat the condition:

Cognitive Behavioral Therapy (CBT): According to Green, CBT can be just as effective as medications for treating depression, and it's an approach that tends to be more easily tolerated by patients. CBT, which can be delivered one-on-one with a psychologist or in a group setting, is all about helping people cultivate healthier thinking patterns. As Myers points out, "Even though negative thinking may originally be triggered by hormonal changes, people can learn to work actively to reframe negative thoughts to create a more positive experience." CBT often involves an exercise called "Behavioral Activation." Depressed individuals tend to isolate themselves from other people, and avoid the activities that used to bring them joy. "This problematic behavior continues the depressive cycle, depriving one of the ‘good feeling' that has been associated with these activities in the past," says Green. Caregivers can be especially vulnerable to this behavior. They may contend that there is no time for them to do the things they want to do because they're too busy taking care of their loved one. Behavioral Activation is all about gradually starting to integrate enjoyable activities back into a depressed person's schedule, no excuses.

Mindfulness: While it's certainly a buzzword in the health and wellness community—credited for being able to combat a number of different mental and physical ills—mindfulness has been proven to have a positive effect on people with depression. In some menopausal women, mindfulness-based therapies may also alleviate hot flashes. For information on how to foster a more mindful approach to both life and caregiving, see How to Break Out of a Mental Rut.

Managing menopause's ups and downs

The menopause transition is taxing—physically, emotionally and spiritually. For women who are trying to meet the demands of caring for an elderly family member while undergoing these changes, their state of duress can be multiplied manifold.

Tips for coping with the change:

  • Know your enemy: The key to dealing with menopause, according to Green, is to learn everything you can about it. "I would also encourage her to talk to other women about their experiences going through menopause in order to help normalize and de-stigmatize the transition, as well as learn what type of treatments they have found helpful," she says.
  • Evaluate your options: Talk to your doctor about all available courses of treatment for menopause symptoms. "Because there are a number of effective options out there for treatment for both menopausal symptoms in general and depression more specifically, I would say it is helpful to evaluate all of them before making a decision," says Green.
  • Put yourself first: Because caregivers often adopt a "fix-it" mentality, they may begin to feel as though they have to do everything and be everything for their aging family member. But Myers says it's essential to put things in perspective and remember to take care of your needs as well. "It may be an overused axiom, but you cannot take care of others if you do not take care of yourself."
  • Avoid isolation: Steer clear of the desire to avoid social interactions with others. "Even if you're not in the best mood, or are tired, try to nudge yourself into a walk with friends or to lunch out with your favorite people," says Myers.