One of the most difficult aspects of perimenopause for me has been the 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 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. 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 9am)

* Testosterone, free & total (ideally in the morning before 9am)

* Estradiol (ideally timed during your period or 1 week before your next period)

* Cortisol (ideally in the morning before 9am) 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.

Begin supplementation~

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

What are some alternative treatments for anxiety and depression?

Here are a few of my favs:

* Therapy, therapy, therapy! There are great studies showing that therapy can be as effective as antidepressant medications 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”, too, if you feel like your first visit or two was not the best fit. Know that it can take time to both find a therapist who fits and to build the bond of trust. I have a colleague who recommends each of her patients find a therapist, even when they’re feeling well. This is a wonderful idea, as we know life gets hard sometimes and often unexpectedly. Having someone on your team waiting for you can save a ton of time when you really need them the most. While you are 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 Light box: This is obviously not a supplement, but 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 have lots of options. You want a box that gives you 10,000lux of light and that you can see directly with your eyeballs. The box needs to be in your eyesight, in other words, not just lighting the room. It also needs to be within arms length. Most women do this in the morning before heading out for the day or first thing at work. Place the box on your dining table, couch arm, bathroom sink or work desk. Use it by 9am; later than that and your sleep can get disrupted. I do have some patients whose anxiety is worsened when they use these lights, so use caution if anxiety is more your jam.

* Fish oil: I have mentioned this in past posts, but the dose for depression/anxiety is much 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 feel this immediately and most that notice it after a month. There are DOZENS of options here as far as brand and type of oil. For this high dose, the liquid oil is the most cost effective, although it is an oil and kind of weird to take. They don’t taste like fish, which is awesome, but taking a spoonful of oil can be odd no matter what the taste is. You want to be careful with where the fish is sourced and how it is processed. My go-to brands 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. I think about this herb for women who are having mental health challenges and feeling less resilient to stress (again, all of us). 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 here.

* 5-HTP: This amino acid is one of the ingredients your body needs to make serotonin, the feel good brain hormone or neurotransmitter. 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. I read a study that showed taking 200-300mg per meal was effective, which tells me there is room to experiment with dosing and timing of those doses. 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 to minimize the side effects of doing so.

* 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.