Clinical telemedicine care with Elektra’s board-certified providers is now available (and covered by select insurance)! Free intro call


Get smarter together



Women are at increased risk for depression during the menopause transition.

Stay updated

Subscribe to our weekly newsletter with cutting edge science, stories & recommendations for the 21st century woman.

    The science

    Mood swings and feelings of anxiety and sadness are common during both perimenopause and menopause.

    Like most other symptoms, they can be associated with fluctuating hormone levels, specifically estrogen, progesterone, and serotonin. However, like anxiety and mood changes, depression during this time of life can also occur for reasons other than menopause. Hormonally speaking, the following is happening:

    Estrogen & serotonin

    The production of estrogen is correlated with the action of serotonin, a neurotransmitter that acts as our “happy hormone” by reducing anxiety and fostering feelings of well-being. So as estrogen levels fluctuate during the menopausal transition, serotonin pathways can be disrupted, which can affect mood.

    Progesterone & GABA

    Progesterone is the “calming hormone” that may also influence Gamma-Aminobutyric acid, or GABA for short. GABA is a neurotransmitter that produces a calming effect when it binds to its receptors. Progesterone potentiates (increases) the effects of GABA, so lower progesterone levels during perimenopause and menopause may result in less GABA-like activity, which the increases the chances of mood swings, anxiety, and sleeplessness.

    Hormonal fluctuations can help explain why mood changes frequently pop up when we’re PMSing. After we ovulate but before we begin our period, we’re in what’s called the “luteal phase” where estrogen is high initially but then drops before your period starts (and remember, low estrogen can affect serotonin). This, along with progesterone fluctuations, can impact mood. Once we begin our period, estrogen levels rise, which causes our mood to stabilize.

    Women between the ages of 40 and 55 are more likely to report depressive symptoms than premenopausal or postmenopausal women, suggesting that the highest risk for new-onset depression is during the transition into menopause, not during postmenopause.

    “There’s a new appreciation of the perimenopause — defined as the early and late menopause transition stages as well as the early postmenopause — as a window of vulnerability for the development of both depressive symptoms and major depressive episodes.” — Journal of Women’s Health

    It’s important to note that there’s a difference between depressive symptoms and a depressive episode — symptoms may be sporadic and come and go over time, while episodes are when symptoms occur most of the day and nearly every day.

    In addition to classic depressive symptoms, menopause also presents physical symptoms such as hot flashes/night sweats and sleep disturbances which can overlap and complicate the presentation of depression, leading some researchers to believe that there is a correlation (not causation) between the two.

    Other menopausal symptoms often experienced simultaneously with depression include:

    • Brain fog & difficulty concentrating
    • Decreased energy
    • Increased appetite
    • Decreased libido (attributed to depression and/or vaginal dryness)
    • Urinary incontinence (The science behind this potential association isn’t 100% understood but may be due to decreased serotonin levels in the central nervous system, which is correlated with symptoms of depression as well as increased urinary frequency/bladder contractions. Of course, urinary incontinence can be linked to multiple factors, including its well-established link to declining estrogen levels and physical changes of menopause.)

    Mood swings and depression during this time can of course be independent of menopause (or compounded by it). In speaking with your provider about mood symptoms, s/he might ask a set of structured questions often used to screen for depression such as the PHQ9. These types of questionnaires can help identify depressive symptoms and, in turn, facilitate finding appropriate treatment.

    Keep in mind that there are so many factors at play here that are difficult to discern: socioeconomic considerations, psychological, social, health, etc. Plus, let’s not forget that we’re dealing with our fair share of life stressors during this transition. Maybe we’re caring for children or aging parents, navigating career shifts, or struggling with our changing bodies. All of the above can adversely impact mood and should NOT be discounted as “par for the course.”

    Severe symptoms like depression or anxiety that prevent you from functioning, disrupt relationships, and are associated with suicidal thoughts need medical attention and there is nothing shameful about it. In those situations, although we support integrative and holistic approaches, urgent medical care and even pharmacologic therapy may be appropriate first steps.

    What you can do

    We’re all about equipping you with the know-how to understand your symptoms, and we especially emphasize the specific, tangible ways to manage them. Our goal is to empower YOU to take charge of your menopause journey, starting today.

    A quick note about product recommendations…Elektra Health is not paid to feature any products. We just like them and think you might too, though we can’t guarantee any results.

    Many lifestyle interventions have been studied to assess their effect on mood disorders such as depression. Some — such as meditation, exercise, and improved sleep — present conclusive, positive results while others — such as diet — are more difficult to discern. Elektra’s founding physician, Dr. Anna Barbieri, MD recommends the following lifestyle interventions for mood improvement regardless of whether you’re also pursuing pharmacologic therapy.


    Nutrition & Diet

    There is a strong positive correlation between a plant-based Mediterranean diet and a lower risk of anxiety and depression. The diet is low in saturated fats and animal proteins, rich in antioxidants and fiber, and loaded with B vitamins (which have been clinically proven to impact depressive symptoms, anxiety, and stress). It’s anti-inflammatory, veg-heavy, low-carb, low-sugar, and high in brain-healthy fats. And because it kicks most refined and concentrated sugars to the curb and focuses instead on non-starchy veggies, beans, fruits, and whole grains, it’s considered a “low-glycemic index” diet — meaning it won’t dramatically spike our blood sugar. This is what we want to see (and eat)!

    The Mediterranean diet is often grouped together with the traditional Japanese diet, which has the added bonus of fermented foods that act as natural probiotics. Both are excellent alternatives to a typical “Western” diet. In fact, studies have found that the risk of depression is 25-35% lower among those who follow Mediterranean and Japanese-style diets.

    For more information, refer to our full guide to nutrition during menopause.

    Holistic Practices

    Get out in nature

    Routine, frequent exposure to the great outdoors has been shown to reduce anxiety and depression while improving an overall sense of well-being. Don’t underestimate Mother Nature!

    Reduce stress

    This is so, SO important — although easier said than done when everything and everyone seems to be competing for our attention. Here are a couple of our top techniques:

    Cultivate a meditation practice

    Over time, you’ll condition yourself to be more present while letting thoughts come and go. We recommend guided meditations on apps such as Headspace, Insight Timer, and Calm. Meditation not your thing? Try Heathmath, a form of biofeedback that focuses on breathing and heart rate, two powerful physiologic functions that you can activate to manage anxious feelings in real time.

    Cultivate a gratitude and/or journaling practice

    Studies have linked both practices to improved mood, and they can also help improve general feelings of well-being and facilitate mindfulness. Here are some great tips on how to start a gratitude practice.

    Optimize high-quality sleep

    Sleep disruptions affect neurotransmitter and stress hormone levels which, in turn, impair thinking and emotional regulation. That’s why it’s so important to prioritize those Zzzzsss. Here’s a handy guide with behavioral, nutritional, and supplemental solutions.


    There are two types of psychotherapy recommended for menopause-related depression: interpersonal therapy and cognitive behavioral therapy (CBT) — both of which are often used in conjunction with medication. If you are interested in seeing a therapist, be sure to ask about their particular approach and practice.

    Cognitive Behavioral Therapy (CBT)

    CBT involves working with a coach or therapist to recognize and change beliefs — including negative thoughts and worries. That’s the “cognitive” part. And then there’s the “behavioral” part, which helps you develop better habits and mindset.

    Interpersonal therapy

    Interpersonal therapy focuses on understanding how human relationships may contribute to or relieve symptoms of depression.

    A note about therapy: Societal stigma around mental health issues is strong, and many people are ashamed to see a therapist for help with depression (or anything). Elektra Health believes in smashing *all* the taboos around our health — emotional and mental health included — and we wholeheartedly embrace the evidence-based science behind therapy and counseling.

    If you’re experiencing depression, anxiety, or other mood changes that interfere with your life, we encourage you to talk to a mental health professional.


    Scientists have found that regular movement decreases overall levels of tension, elevates and stabilizes your mood, improves sleep, and boosts self-esteem. The effect of exercise specifically on depression has also been studied, with results proving that it can be used as a form of protection from the development of depression in adults, as well as a tool to acutely manage and treat symptoms.

    Exercise can play an important role in physical AND mental health.

    According to the World Health Organization, 150 minutes per week of moderate-intensity movement (a brisk walk counts!) is enough to do the trick and reduce the risk of developing symptoms of anxiety and depression. 150 minutes = about 22 minutes per day — for most of us, that’s very doable!

    Keep things interesting with a mix of different workouts, including strength training, cardio, and yoga. And if possible, bring it outdoors since research indicates that there may be added benefits when physical activity is done in nature.

    Supplements & Over-the-Counter Solutions

    Supplements and over-the-counter solutions may be effective in addressing some emotional symptoms associated with menopause, including anxiety and other mood changes, but if you are experiencing feelings of depression, it’s important that you see a provider for an evaluation.

    We frequently get asked about St. John’s Wort, a supplement commonly used for depression. If you are considering this, Elektra strongly recommends that you discuss it with your provider to ensure you’re not risking negative interactions with other supplements or medications.



    Hormone therapy is a viable treatment option for women with elevated depressive symptoms who have been screened for common risk factors. Oral contraceptive pills are typically prescribed for early-late perimenopause, while hormone replacement therapy (HRT) is prescribed for late perimenopause-menopause.

    Estrogen therapy alone is not approved to treat perimenopausal depression; however, there is evidence that it has antidepressant effects, particularly for those suffering from vasomotor symptoms (e.g., hot flashes & night sweats).

    To learn more, refer to our full guide to HRT.


    SSRIs and SNRIs remain the first line of pharmacologic defense for anxiety and depression in peri- and menopausal women. SSRIs are selective serotonin reuptake inhibitors and SNRIs are serotonin and norepinephrine reuptake inhibitors — total tongue-twisters! These neurotransmitters are antidepressants that work by regulating serotonin (the “happy hormone” that controls mood) and norepinephrine (plays a key role in the body’s “fight-or-flight” response to stress). It should be noted that common side effects include weight gain and low libido.

    Like therapy, there is still a stigma around taking these medications but for many of us who experience symptoms, they can be incredibly effective and helpful, and we have decades of research to back this up.

    There are many SSRIs on the market, like sertraline/Zoloft and fluoxetine/Prozac. Other examples of SSRIs include:

    • Escitalopram/Lexapro: associated with less weight gain and sexual side effects (i.e. low libido) than others
    • Venlafaxine/Effexor: associated with higher risk of withdrawal symptoms, like agitation, headache, and flu-like symptoms, so proper weaning is important and should be done under the guidance of your provider

    Future Treatments for Depression

    Over the past several years, there has been more and more research looking at the use of psychedelics, like psilocybin (“magic mushrooms”) and MDMA (better known as molly, or ecstasy), for the treatment of depression. Several clinical trials are ongoing, including this one, and results are starting to suggest some positive benefits. This is an exciting area of research that Elektra will be keeping an eye on!

    If you’re experiencing an emergency and need immediate help, call 911 or go to the nearest emergency room.

    Suicide Prevention Lifeline
    + 1-800-273-8255

    Crisis Text Line
    Text HOME to 741741

    We’re always keeping an eye out on emerging research and the latest clinical studies. Subscribe to our weekly Elektra Digest for the latest, science-based info direct to your inbox. Something work well for you that’s not listed here? We want to hear it! Shoot us a note at [email protected]. (We’re human, promise.)

    Disclaimer: This information is for general educational purposes, and should not be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem.

    As with anything you put into your body, taking dietary supplements can also involve health risks. You should consult a medical professional before taking supplements and inform your doctor about any supplements, as well as any medications you already take, since there may be interactions.


    Expand to see more

    Learn more

    Anxiety SYMPTOM
    Mood changes SYMPTOM
    Mood changes
    Sleep problems SYMPTOM
    Sleep problems

    Get the menopause care you deserve

    Understand and manage your symptoms with expert care, online education, and a supportive community. No pseudoscience allowed.

    Get started For organizations