About one in five women ages 40 to 59 and nearly one in four women ages 60 and over used antidepressants in the last 30 days during 2015 to 2018, according to the latest data from the National Center for Health Statistics. Among women ages 18 to 39, the figure was about one in 10. Among men, 8.4% of those ages 40 to 59 and 12.8% of those 60 and older used antidepressants in the last 30 days, according to the NCHS data.
The figures are drawing increasing attention from scientists and doctors. Many are alarmed at how high depression rates were among midlife women even before the pandemic, now that the past two years have exacerbated mental-health issues for many Americans. And some doctors are also concerned that antidepressants are being overprescribed for menopausal symptoms.
In general, women have higher rates of depression than men throughout much of their lives according to scientific research. In midlife, the risk is greatest during the years leading up to menopause and right after it. The dramatic fluctuations in hormones that cause the most-commonly known symptoms of hot flashes and night sweats can wreak havoc on mood, too.
“Estrogen and progesterone are fluctuating a great deal,” says Lucy Hutner, a reproductive psychiatrist in New York City. “Those shifts can be hard for our brain to take.”
Scientists are working to understand just how hormones may drive depression, but receptors for estrogen and progesterone are found throughout the brain including in regions involving movement, cognition and mood regulation, says Hadine Joffe, a professor of psychiatry at Brigham and Women’s Hospital and Harvard Medical School in Boston.
New treatments for depression in midlife women may be on the horizon. Scientists at the National Institute of Mental Health, for example, are studying a medication that acts on an estrogen receptor in the brain. The hope is that, unlike typical antidepressants, it will directly target depression symptoms related to estrogen withdrawal but without the side effects of traditional hormone therapy commonly used for menopausal symptoms, notes Peter Schmidt, chief of the Behavioral Endocrinology branch in NIMH’s Intramural Research program.
Studies have found that women’s risk of having an episode of major depression is two to four times higher around menopause than at other times during their lives; it is even greater for women who have a had a previous episode of depression. Menopause is defined to have occurred one year after a woman’s last menstrual period. The median age of menopause in the U.S. is 51.
Doctors also note that midlife is often a time of marked stress for women—and stress can increase the risk of depression. Many women are juggling careers, raising children and caring for elderly parents. “You have a lot on your shoulders, and there’s not a lot of room for taking time for yourself,” says Dr. Hutner. Women also may be more likely to seek care for a mental-health problem than men, which may lead to higher rates of diagnosis and treatment.
Valerie DeMartin, 59 years old, says she fell into a depression in 2020. She was dealing with sleep problems, the stress of the pandemic and a move with two teenagers from the family’s longtime home in California to Texas. An avid exerciser, she says she was also feeling sad to see her body changing in ways she felt she couldn’t control.
“I went through a life-altering move, my kids were angry with me, dealing with middle age and Covid and my body changing,” says Ms. DeMartin, who works in home remodeling in Frisco, Texas.
Ms. DeMartin says she didn’t seek therapy or take antidepressant medication. She says she has coped by reaching out to friends and staying busy with work. She’s also planning to try hormone-replacement therapy. “Hopefully I’ll have a little more energy and sleep better,” she says.
Researchers at NIMH who have been following 90 women since 1988 have found that the incidence of women’s midlife depression is concentrated in the two years before and after the last menstrual period, says Dr. Schmidt. The quality of women’s midlife depression is distinct, too, Dr. Schmidt says, in that it often involves intense anxiety, irritability and sleep problems along with the more typical sadness and loss of pleasure in once-enjoyed activities.
Doctors speculate that antidepressant use among middle-aged women is being driven in part by the reluctance of women—and many of their physicians—in recent decades to use hormone-replacement therapy for menopausal symptoms. In 2002, a large study, the Women’s Health Initiative, was stopped after women taking hormone therapy had an increased risk of breast cancer, heart attacks and strokes. Later analyses found that the risks were largely concentrated among women who were older when they started hormone therapy. For women in their 50s, hormone therapy actually reduced the risk of heart disease and death from any cause.
Hormone therapy, either estrogen alone or combined with a progestogen, is the most effective treatment for hot flashes and night sweats, according to the North American Menopause Society and the American College of Obstetricians and Gynecologists. Some research has found that it can also improve mood.
Still, many women and doctors are looking for alternatives. “People are so deathly afraid of prescribing hormones,” says Stephanie Faubion, medical director of the North American Menopause Society and the director of Mayo Clinic Women’s Health. “A lot of women, unfortunately, who are going to their doctors because of hot flashes and night sweats are getting slapped on antidepressants.”
Research has shown that some antidepressants can ease hot flashes and night sweats. But Dr. Faubion says they are much less effective than hormones. The even higher rates of antidepressant use among women 60 and over may partly result from women being put on them when they’re younger, during this earlier period of mental-health vulnerability, and then being left on them by default, says Dr. Hutner.
This story has been published from a wire agency feed without modifications to the text
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