“This Is Driving Women To Suicide”
It was the darkest time in Maryke Vaartjes’ life. “I felt like I was hanging, white-knuckled, over an abyss. There was an almost tangible feeling of blackness oozing out of my body; I felt that I was spreading blackness wherever I went,” the Melbourne nurse says.
“I had nightmares every night – not about zombies trying to kill me, but about going to my dance class, which I had always loved, and everyone standing there and looking at me and saying, ‘What are you doing here? You’re not welcome.’”
Maryke was not suffering from an ordinary depression. “I’d never been depressed before and at the time I thought it was linked to some life issues, including a relationship breakup and some medical issues,” Maryke says. “It wasn’t until a few years later, when I developed other menopausal symptoms and took part in a medical study, that it became clear that this depression was linked to the perimenopause.”
Never heard of perimenopausal depression? You’re not alone. “There hasn’t been a lot of discussion about this, even in the medical community, but the neuroscience is clear,” says Jayashri Kulkarni, professor of psychiatry at Monash University and head of the Monash Alfred Psychiatry Research Centre. “Because of the changing levels of circulating hormones – both in the pituitary gland and in the higher brain centres that control the pituitary and the ovaries – the period of perimenopause and menopause, which can last up to 10 years, is a time for heightened levels of depression and anxiety.”
The intensity of symptoms varies from woman to woman but the impacts can be severe. “They can destroy your quality of life,” she says. “Women lose their jobs or have relationships break down. This is even driving women to suicide. In both the US and Australia, middle aged-women have the second highest rate of completed suicide, after elderly men.”
Part of the problem, Professor Kulkarni continues, is that many women don’t get the help that they need. Too many doctors write off the symptoms as a reaction to other life changes, such as children leaving home or dealing with ageing parents. “The idea that a woman who has always been able to cope with her life – relationships, work, parenting – that she is suddenly unable to cope, is ridiculous,” she says.
Further complicating the situation is that peri and menopausal depressions can present differently to traditional depression. “Everyone can pick what a typical depression looks like and it’s easy to feel compassion for that,” Professor Kulkarni says. “However, when it manifests as irritability and hostility, it’s a lot harder to feel sorry for the person. It is easy to write her off as a grumpy old bag, and that reaction can actually feed the depression. I get women saying to me, ‘I’ve become a terrible person, I hate me. I never used to be like this.’”
“It is easy to write her off as a grumpy old bag, and that reaction can actually feed the depression. I get women saying to me, ‘I’ve become a terrible person, I hate me. I never used to be like this.’”
Fortunately, researchers around the world are increasing their understanding of the how mid-life hormonal changes affect the brain. “There are many biological systems involved. One that is currently getting a lot of research is the GABA-A system. GABA is the major inhibitory neurotransmitter, so it has a calming effect,” explains Lauren M. Osborne, associate professor of psychiatry and behavioral sciences at America’s Johns Hopkins University. “We need much more research into these biological pathways.”
The fluctuating hormonal levels associated with menopause mean that symptoms can appear and disappear, making diagnosis more difficult. “You may be experiencing a terrible cognitive fog – not being able to keep track of your to-do list or forgetting how to do a task you’ve done 1000 times. Then you get a sudden spurt of oestrogen, which has a protective effect on mental health, and you suddenly feel better,” Professor Kulkarni explains.
Even if a doctor accurately diagnoses depression, traditional treatments such as SSRIs [selective serotonin reuptake inhibitors] may not be the answer. “A small number of women may respond well to SSRIs but generally, we need to treat the problem at the source,” Professor Kulkarni says. “That means restoring the balance in different ways, from lifestyle changes to hormonal supplements.”
Maryke Vaartjes, who at her lowest was actively planning her own death – “I was going put fresh sheets on the bed, have a shower, put some nice comfy PJs on, take the pills and never wake up” – was one of the lucky ones. Her sister and her friend “marched me to a GP”, who prescribed anti-depressants that helped lift her mood. It was only a few years later, when she was dealing with a range of menopausal symptoms including a more general malaise, that her problem was identified as a hormonal issue.
“At that stage, I was feeling NQR – not quite right,” she explains. “I was lacking motivation and was fatigued a lot of the time. It wasn’t until I began a course of hormones that I began to feel good again. I realised how much I had been putting up with until then. As women, we put up with so much, and we really shouldn’t have to.”
Professor Kulkarni says that until women start discussing their own experiences, hormonal depression will remain an underreported problem. “The older generation had a ‘Shh, don’t talk about it’ attitude – women were just expected to get through it,” she says. “We really need to start having these conversations.”
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Words_ Ute Junker
Photo_ Alexander Krivitskiy/UnSplash