“I’m so excited – I’m in menopause!”… said no woman ever. Along with the infamous hot flashes and night sweats, menopause can mess with your emotions (through mood swings, anxiety, and/or depression), your sleep (insomnia), your sex drive, and more. (1)
A 2023 report by the Fawcett Society, based on survey data of over 4,000 menopausal and peri-menopausal women in the UK, revealed that 77% found at least one menopause symptom “very difficult” and 44% experienced three or more that qualified.
Menopause can be brutal
Women experience menopause differently, but for some, it can be debilitating. UK data confirmed this:
22% of disabled women – and 9% of non-disabled women – who were employed during menopause said they’d left a job due to their symptoms. (2).
In another UK survey, 75% of women reported problems with memory or concentration during menopause and 69% reported feeling anxious or depressed enough to reduce their concentration and confidence at work.
Kate Muir, author of Everything You Need to Know About Menopause (but Were Too Afraid to Ask), points out that the insomnia middle-aged women often experience may be a menopause symptom. This concerns her because lack of sleep is associated with both depression and future dementia.
In Johns Hopkins’s article Can Menopause Cause Depression? the author explains, “The time leading up to menopause (called perimenopause) is a physical and emotional roller coaster for some women. The so-called ‘change of life’ comes with a host of symptoms triggered by hormonal shifts — hot flashes, insomnia, mood fluctuations, and even depression.”
“When women go through sudden hormonal changes like those that come with perimenopause, puberty, postpartum, and even their monthly cycle, they’re at a higher risk for depression,” says Jennifer Payne, M.D., psychiatrist and director of the Women’s Mood Disorders Center at Johns Hopkins. In general, women are twice as likely as men to develop the condition.
The same hormones that control your menstrual cycle also influence serotonin, a brain chemical that promotes feelings of well-being and happiness. When hormone levels drop, serotonin levels also fall, which contributes to increased irritability, anxiety and sadness.
“Falling estrogen and progesterone levels can trigger mood swings that make you less able to cope with things you’d normally let roll off your back,” says Payne. “For some women, these hormonal dips can set off a depressive episode, especially for those who’ve gone through major depression in the past.”
Source: John Hopkins (3).
Psychedelics and menopause
Doctors often prescribe hormone and bio-identical hormone therapies, which are not without side effects. Not all women are suitable candidates, others don’t want to take these drugs, and not everyone who takes them gets the results they hoped for.
Enter psychedelics. Though there’s no reason to believe they can resolve the issues at the heart of the problem, their supervised medical use may bring relief from some of the more severe symptoms. That supervision is essential, as the quality of the compound must be ensured and patients must be screened and monitored for potential side effects.
Sleep
Although it’s too early to tell, ketamine may help with sleep issues. Its antidepressant effects (some of which work by affecting certain aspects of sleep), its interaction with the circadian system, and its positive neurocognitive effects all suggest that it could improve sleep. (4) While there’s no research to answer the question “Can ketamine help you sleep?”, it does look promising.
One of the current theories about psychedelics is that they work by improving neuroplasticity, the brain’s ability to make new connections between neurons. (5) Psychiatrists are using psychedelic-assisted therapy to help patients with a variety of mood issues, including depression and anxiety.
A study published in 2016 found that a single dose of psilocybin produced significant and lasting decreases in both depression and anxiety among patients faced with life-threatening cancer. Six months later, 80% of participants continued to show clinically significant decreases in mood issues and anxiety – and over 80% experienced an increase in well-being or life satisfaction, which they attributed to the psilocybin experience. (6)
Anxiety
In a 2021 research article, Whittaker et al. concluded that “acute ketamine may be broadly effective across treatment-resistant anxiety spectrum disorders” – in other words, it may succeed where current treatments fail. (7) They also stated that the effects could be maintained through maintenance therapy (which, unfortunately, raises the cost considerably).
Of course, the most immediately dangerous symptom on the list is suicidal thoughts. Ketamine has shown some promise here. In a study of 156 suicidal patients at seven French teaching hospitals, participants received two 40-minute infusions of ketamine, or a saline placebo, 24 hours apart, in addition to their other treatments. (8)
Ketamine use
In the ketamine group, 63% of participants reached full remission of suicidal ideas after three days, compared to only 32% of the placebo group – and the remission rate was still high after six weeks. While other disorders affected the results, the researchers still concluded that “ketamine is rapid, safe in the short term, and has persistent benefits for acute care in suicidal patients.” The researchers felt that ketamine’s “analgesic effect on mental pain” might be the reason for the effects.
It’s important to note that suicidal thoughts are not the same as suicide attempts. There was no significant difference in attempts between the groups. Ketamine on its own is not enough!
According to a 2019 article in the Indian Journal of Psychiatry, ketamine provided a significant improvement in depression, anxiety, and severity of illness just over six weeks after the last ketamine dose. The most impressive aspect of that improvement was its speed; the authors reported significant improvement at the first hour of the first dose for both depression and anxiety (though not for illness severity). (9)
But what about women?
Unfortunately, the subjects of the study were all male. This is a recurring problem with medical research, and it’s especially relevant here. In a recent article published in Frontiers in Psychiatry, the authors point out that depression rates for women aged 14-25 are nearly double those of men the same age. However, these differences decrease over time, evening out by late adulthood.
The article explores various models of depression, but the authors express its limits clearly:
“For the above hypotheses of ketamine’s antidepressant effects, most of the data has been derived from studies on males. As one might expect, there is a growing body of evidence which suggests that these theories do not hold the same for females.” (10)
They go on to say that evidence that is specific to females only demonstrates that well-researched theories do not generalize across sexes.
On the other hand, a Canadian study suggests that ketamine may be effective for both premenopausal and postmenopausal women (though no mention was made of those experiencing it at the time of the study). Those with TRD (treatment-resistant depression) reported significant symptom relief with repeated doses of ketamine. The authors described their findings as “preliminary suggestive evidence”. It’s a start. (11)
Hope for the Future
Though psychedelics are still illegal in most countries, some health authorities do recognize their potential. There is also growing research into their therapeutic use for a range of health issues, but not nearly enough to conclude in the area of menopausal symptoms and solutions.
References
(1) https://my.clevelandclinic.org/health/diseases/21841-menopause
(2) https://www.fawcettsociety.org.uk/news/landmark-study-menopausal-women-let-down-by-employers-and-healthcare-providers
(3) https://www.hopkinsmedicine.org/health/wellness-and-prevention/can-menopause-cause-depression
(4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8712478/Song B, Zhu JC. Mechanisms of the Rapid Effects of Ketamine on Depression and Sleep Disturbances: A Narrative Review. Front Pharmacol. 2021 Dec 14;12:782457. doi: 10.3389/fphar.2021.782457. PMID: 34970147; PMCID: PMC8712478.
(5) https://www.nih.gov/news-events/nih-research-matters/how-psychedelic-drugs-may-help-depression
(6) https://pubmed.ncbi.nlm.nih.gov/27909165/Griffiths RR, Johnson MW, Carducci MA, Umbricht A, Richards WA, Richards BD, Cosimano MP, Klinedinst MA. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016 Dec;30(12):1181-1197. doi: 10.1177/0269881116675513. PMID: 27909165; PMCID: PMC5367557.
(7) https://journals.sagepub.com/doi/full/10.1177/20451253211056743
(8) https://pubmed.ncbi.nlm.nih.gov/35110300/Abbar M, Demattei C, El-Hage W, Llorca PM, Samalin L, Demaricourt P, Gaillard R, Courtet P, Vaiva G, Gorwood P, Fabbro P, Jollant F. Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial. BMJ. 2022 Feb 2;376:e067194. doi: 10.1136/bmj-2021-067194. PMID: 35110300; PMCID: PMC8808464.
(9) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767816/Mandal S, Sinha VK, Goyal N. Efficacy of ketamine therapy in the treatment of depression. Indian J Psychiatry. 2019 Sep-Oct;61(5):480-485. doi: 10.4103/psychiatry.IndianJPsychiatry_484_18. PMID: 31579184; PMCID: PMC6767816.
(10) https://www.frontiersin.org/articles/10.3389/fpsyt.2021.797577/full
(11) https://www.sciencedirect.com/science/article/abs/pii/S0022395620309134
