One of the most difficult aspects of this stage of life has been perimenopause’s effect on my mood. I am comforted knowing that many women struggle along with me. I talk to women every day who are having a harder time during this transition period. Hormones play such a big role in stabilizing our mental health and our hormones are wonky (a medical term) right now! Add to that the increasing demands of children, partners, aging parents and career that frequently occur around this same time and it’s no wonder that antidepressant medications are one of the most commonly prescribed drugs for women in this age group. I do not have any beef against antidepressants, and we’ll discuss that in more detail in a future post, but today we are going to review some natural ways to elevate and/or stabilize your mood through perimenopause.

Start with the basics~

First, though, go back through the previous posts about PMS and sleep and the foundations of health. The lifestyle factors I’ve already gone through and the few supplements mentioned in these posts are KEY in keeping our brains happy.

• Can a brain be happy when it is sleep-deprived? No.
• Can a brain be happy if it is not getting good blood flow and oxygen from exercise? No.
• Can a brain be happy if it is surrounded by negative, toxic people or a toxic environment? No.
• Can a brain be happy when it’s intoxicated? Maybe initially & briefly, after the first glass, but ultimately all of the research says No.
• Can a brain be happy if it is fed crap food and processed chemicals? You guessed it, Nope.

We all know these things. So what do we do next?

When you are struggling with depression or anxiety, though, it is extremely difficult to make the lifestyle and diet changes you know will help you. I know I just recommended reading those past blog posts to learn what foundational things you should be doing, but I often tell patients who are moderately or severely depressed to forget about their lifestyle and diet choices for the moment while we work on finding the treatment (sometimes an antidepressant, FYI!) that will bring back their motivation to make these changes.

Evaluate with labs~

It’s helpful to have some basic and sometimes more extensive lab work done to rule out potential underlying causes of anxiety and depression. Here’s what to ask for:

• CBC
• Iron and ferritin
•  Vitamin B12 and/or MMA
• Vitamin D (25-OH)
• TSH, Free T4, Free T3, Reverse T3, TPO antibody
• DHEA-sulfate (ideally in the morning before 9 am)
• Testosterone, free & total (ideally in the morning before 9 am)
• Estradiol (ideally timed during your period or 1 week before your next period)
• Cortisol (ideally in the morning before 9 am) OR 4-point salivary cortisol test (a better test)
• MTHFR gene mutation
• COMT gene mutation

With these labs, you can catch anemia, vitamin deficiencies, genetic predispositions, hypo or hyperthyroidism, and other hormonal changes that can cause or exacerbate anxiety and depression. Your specific treatment will vary depending on what lab results look like.

Let’s say you did these labs and all were normal (that happens a lot!).

What are some alternative treatments for anxiety and depression?

* Therapy, therapy, therapy! There are great studies showing therapy can be as effective as antidepressant medication for mild to moderate depression. This is huge! I have many patients who do not want to be on medication, so starting here is key. Don’t be afraid to “shop around” for the best fit. It can take time to find a therapist and to build trust.  While you’re working on finding your person, talk to your Naturopath about other strategies (perhaps based on your lab results), or start with the following recommendations.

* Happy light or Lightbox: The research on these is very clear. 15-45 minutes of use of a light box each morning decreases depression. This is especially important for patients living in northern climates because our sun exposure is so low. You want a box that gives you 10,000 lux of light. The box needs to be in your eyesight, in other words, not just lighting the room. It also needs to be within arm’s length. Most do this in the morning before heading out for the day or first thing at work. Use it by 9 am, any later can disrupt your sleep. Some patient’s anxiety is worsened when they use these lights, so use caution if you are prone to anxiety.

Sometimes supplements can help!

Fish oil: I’ve mentioned this in the past, but the dose for depression/anxiety is higher than for general health. You want to take 6000-9000mg of EPA + DHA daily for at least 3 months before you decide if it’s helpful. I have patients that improve immediately and most notice after a month. There are DOZENS of options for brand and oil type. For this high dose, liquid oil is the most cost-effective, although an oil  can be off-putting to take. Be careful with where the fish is sourced and how it is processed. My go-to’s are Pharmax, Douglas Labs, Nordic Naturals, and Carlson’s.

Saffron: Studies have shown that taking 30mg of saffron extract or 100mg of saffron herb daily for 6-12 weeks improves symptoms of major depression. This herb is very well tolerated but should be used with caution in folks who are also on blood pressure medications or barbiturates.

Rhodiola: A few studies have shown that this herb in doses of around 340mg daily (up to twice per day) decreases anxiety, depression, and symptoms of “stress”. I LOVE this herb. I think we should all be on it. It’s one of our most effective adrenal adaptogens, which is to say it normalizes your response to stress via the hormone cortisol. This herb is great for women with mental health challenges and feeling less resilient to stress. This herb has the potential to interact with many medications by slowing down how your body processes or detoxes the medication, so take care and ask your Naturopathic physician for support.

5-HTP: This amino acid is one of the ingredients your body needs to make serotonin, the feel-good brain hormone. The studies on this are positive but the dose is variable, ranging from 150mg to 900mg. I recommend taking this at bedtime and starting with a dose between 100-200mg. If you are already on antidepressant medication, you MUST work with your medical provider if you want to use 5-HTP with it. You risk having too much serotonin in the body, a situation called serotonin syndrome. That said, I’ve used these in combo for many women and often do so when trying to wean women off of antidepressant meds and minimize the side effects.

And just a reminder~

* Therapy, therapy, therapy! It’s so good, I’ll say it again. Reach out to your provider if you need help finding a therapist.

The goal in this life is to be your best self.

I’m hopeful these ideas can help. If not, please reach out so we can talk about other options available to you.