Perimenopause Anxiety and Depression: The Under-Explored Link

Years ago, in the 1970s, I spent time with an older woman who was beset by extreme anxiety and some depression. Longtime friends of hers told me that during her younger years she had been a cheerful, optimistic and socially active person. They noted that they thought she had changed around the time of her change of life (as they used to call it). They observed that what had been marginal traits of nervousness and perhaps a bit of excessive worry had, by the time she was in her early fifties, transformed into extreme symptoms of daily fearfulness and agoraphobia (fear of leaving home). What followed were visits to doctors, doses of valium, (the tranquilizer of the day) as well as some pre-prozac-era versions of anti-depressants.

Diagnosing what exactly had happened to my friend would, of course, be a complex and individual story, based on her family history, her life experience, her psychological history and her physical health. Nonetheless, her story is an all-too-familiar one! Literature and history are full of accounts of women who suffered from what used to be called nerves as well as nervous breakdowns; who often entered institutions, saw psychiatrists (in the 20th century), and generally lost it when they hit middle age. Feminists have written about this phenomena for years. I recall a book that was popular in the 1980s entitled Women Who Marry Houses : Panic and Protest in Agoraphobia, by Robert Seidenberg and the feminist writer, Karen DeCrow, New York : McGraw-Hill, c1983. In it DeCrow asks why so many women of her mother's generation developed agoraphobia (fear of going out into the world). Feminists saw these situations as having been engendered by the social and economic disempowerment of women. However, having hit middle-age myself, I now have a different opinion on the matter, described by a word that didn't exist when I encountered my friend and her experience: perimenopause.

I believe, as a result of my annecdotal interviewing of friends and acquaintances, that a growing number of baby-boomer era women, now arriving at their early stages of the "change of life" are reporting the same kinds of unaccountable emotional symptoms that their mothers, grandmothers and great grandmothers experienced. In the years (how many years seems to vary) just preceding the fluttering, waning and final disappearance of their menstrual periods, many woman are finding themselves beset by overwhelming emotional duress: previously unknown fears; unrelenting worry about health, loved ones, finances and survival; feelings of doom; panic attacks and mis-triggering of the fight-or flight response; emotional paralysis; fear of doing anything; feeling of guilt and incompetence.

Since women are all too familiar with the monthly effects of such fluctuations, there is obviously a hugely hormonal and thus brain-chemical component to these symptoms during perimenopause. It is well known that fluctuations in estrogen and progesterone can, though a series of effects, trigger changes in neurotransmitters in the brain.

Why don't we hear more about this in the media? When one looks up perimenopause and anxiety as keywords on Google, one finds many websites that are devoted to selling remedies to women. They discuss the issue with a sales biases and, just to be seen as objective, huge inclusion about the social and psychological issues that lend to anxiety: children leaving the nest; changes in health; experiencing the effects of aging, etc. While these are undoubtedly true to a degree, it seems that the constancy of the symptoms reported by women throughout the centuries would lend credence to the biochemical theory being predominant. the difficult is that because everyone's individual story and biology is different, anecdotal remarks lack credibility.

Though science has provided little study of this widespread source of distress for men, it has provided new generations of anti-anxiety and antidepressant drugs. These have, undoubtedly, been a source of relief for many. However, there are problems with the SSRI antidepressants for women in perimenopause: the most common side effects of these drugs: weight gain, raised cholesterol, raised blood pressure, loss of sexual desire, mimic the very physical hazards of perimenopause. Doctors will readily prescribe these drugs, but rarely discuss their side-effects, perhaps fearing that fearful and depressed patients will psychologically develop what ever side-effects are suggested.

Ironically, we in the 21st century, may feel that it is riskier and less than all right to reveal this level of emotional distress. After all, most women must work to support themselves and their families. The workplace is a world of unrelenting competition. Everyone, it seems, is expendable and replaceable these days. In addition, since insurance companies rule the day when it comes ot money for psychological counseling and psychotherapy, the chance to talk things through with a professional, as a way of getting through the biological shocks of peri-menopause is largely a thing of the past.

I do hope that as more baby boomer women experience the roller coaster ride of perimenopause, that they will begin to more fully describe their experience. It would be a blessing if the medical community, and then the media, would commit itself to gaining a firmer grasp on this issue.

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