New Options for Treating Postmenopausal Depression

Menopause is a time of tremendous change in a woman’s life — the time at which she’s no longer able to bear children. The period leading up to menopause is known as perimenopause, and it’s the time when all the dreaded symptoms like hot flashes and mood swings show up.

Even though menopause may be inevitable, having to deal with symptoms isn’t, and treatment is geared toward reducing the number and severity of the symptoms you experience, including depression.

At the office of board-certified anesthesiologist Dr. Michael Kullman, he and his team treat all manner of depression, including major depressive disorder (MDD), postpartum depression, and postmenopausal depression. Although treatments such as antidepressants can help, some patients are treatment-resistant, making new options a keen target for research.

What is postmenopausal depression?

If you’re depressed when you become postmenopausal, there’s a good chance that you experienced mood swings and depression going through perimenopause and menopause itself.

The same hormones controlling your menstrual cycle also influence serotonin, a neurotransmitter in the brain that promotes feelings of well-being and happiness. When hormone levels drop, serotonin levels also drop, contributing to increased irritability, anxiety, and sadness.

Falling estrogen and progesterone levels can also trigger mood swings that make you less able to deal with things that normally wouldn’t be a problem. For some women, these hormonal dips can set off a depressive episode, especially for those who’ve had MDD in the past.

Major life changes can bring on depression, as well, and the symptoms themselves can make you depressed. You end up spending half the night battling hot flushes and night sweats; vaginal dryness may make sex uncomfortable, which can lead to friction with your partner; and you realize that even if you didn’t want children, now you have no choice.

Hormone replacement therapy is one way to help manage symptoms, as it restores your premenopausal levels of estrogen and progestin. For those who aren’t good candidates, antidepressant medications, such as the selective serotonin reuptake inhibitors (SSRIs), are the first-line treatment for depression.

Coupled with cognitive behavioral therapy and lifestyle adjustments like exercising and limiting alcohol, the SSRIs are the most effective approach to managing depression.

New options for treating postmenopausal depression

However, not everyone fares well with SSRIs.

Treatment-resistant depression (TRD) occurs when you don't see any improvement of your depressive symptoms after trying at least two different first-line antidepressants. The two medications must be taken at an appropriate dosage and duration (at least six to eight weeks) prior to your doctor diagnosing you with TRD.

TRD is more common than you may think. Roughly 30% of people diagnosed with MDD and have been prescribed antidepressants have treatment-resistant depression.

Fortunately, Dr. Kullman offers other treatment options that might serve you better.

Ketamine infusion

Ketamine, a dissociative anesthetic, can be delivered through an IV in low doses to rapidly treat people with TRD, and its effects may last from days to weeks. Doctors usually administer it in decreasing frequencies over several weeks.

The FDA has also approved an intranasal form called esketamine, which you take in a physician's office or clinic under the supervision of your doctor, who monitors you for possible serious side effects and because of the potential for abuse and misuse of the drug.

Ketamine and esketamine work in the brain in a different way than the SSRIs. They target the transmitter glutamate (also involved in mood) instead of serotonin. They also work to build new neural pathways to aid in cell signaling and mood regulation. The drugs are typically used in tandem with an oral antidepressant.

Repetitive transcranial magnetic stimulation (rTMS)

A newer treatment for postmenopausal depression,  rTMS uses magnetic fields to stimulate the nerve cells in your brain and relieve your depression symptoms. The doctor places an electromagnetic coil against your scalp near your forehead, which creates electric currents that target the nerve cells in the area of your brain involved in mood control and depression.

This treatment is usually delivered in rapid bursts during a 30-minute session, though intermittent theta burst stimulation can be performed in less time. You may need a number of sessions to see a positive result.

If you’re struggling with postmenopausal — or any other type — of depression, there’s hope. Even if you have TRD, new treatment options can fill in the gaps and alleviate your symptoms. Learn more and book your consultation with Dr. Kullman by calling our office at 914-465-2882 or visiting our website for more options.