Mental Health: Is It Depression, Anxiety, or Menopause?

Q: Mental Health: Is It Depression, Anxiety, or Menopause?

Hello： Stress often leads to emotional burdens, and after a period of adjustment, it is possible to overcome or adapt to it. <br>However, if stressful events occur in quick succession, there may not be enough time to cope or adapt, leading to feelings of anxiety or depression. <b

Could you please clarify whether this is classified as depression, bipolar disorder, anxiety disorder, or simply menopause?

Hello, doctor.
I apologize for the lengthy description.
My mother is 52 years old and runs a store at home, but the revenue fluctuates significantly between the summer and winter seasons.
She has been worried about this issue for many years, and due to some family problems and living with her in-laws, the pressure has been quite high.
Starting this autumn, possibly due to my older sister's relationship issues combined with her existing worries, along with the poor business in winter, my mother's mental state has really deteriorated.

My mother has a history of colon cancer and has had her uterus completely removed.
About two months ago, she started experiencing insomnia, became fatigued, and rarely smiled.
She then began to feel extremely anxious over small matters, to the point of being overwhelmed.
Recently, I have been talking with her, and she expressed that she feels "very tired, constantly worried about unfinished tasks, her mental state is unstable, she hardly smiles, and she is anxious about not being able to do anything, her memory has worsened, her attention span is poor, her appetite has decreased, she has insomnia, and she feels very guilty," among other things.

Three weeks ago, my father took her to see an internist, who indicated that her blood test results suggested she is in menopause and prescribed medication for her.
However, so far, the only improvement has been slight improvement in her sleep; other symptoms have not shown significant improvement.
I researched menopause and found that it mentions some of the symptoms she is experiencing, but I believe it shouldn't be this severe.
Given her age and the fact that she has had her uterus removed, I would like to ask the doctor if her symptoms during menopause could be more severe, or if these issues are no longer just menopausal symptoms but rather signs of depression or bipolar disorder.

My father and I have been in close contact with her, and both of us are feeling quite exhausted.
We really hope to see my mother return to her former self, but we cannot express this to her.
Doctor, could you please help us understand what might be happening with my mother?

Gao San Sheng, 10~19 year old female. Ask Date: 2017/01/22

Dr. Liang Sunyuan reply Psychiatry

Hello: Stress often leads to emotional burdens, and after a period of adjustment, it is possible to overcome or adapt to it.
However, if stressful events occur in quick succession, there may not be enough time to cope or adapt, leading to feelings of anxiety or depression.
Business pressures, family interactions, cancer, surgery, and changes during menopause can accumulate and potentially result in depressive symptoms.
There are several sources of stress, but addressing or alleviating one or two of these stressors may provide some relief.
Support, acceptance, and understanding from family, as well as engaging in relaxing activities together, can often help with depression.
If there is no improvement over time, it is advisable to seek medical assistance.

Reply Date: 2017/01/22

More Info

Your mother's situation is indeed concerning and reflects a complex interplay of factors that could be contributing to her mental health challenges. Given her history of colon cancer and the surgical removal of her uterus, it is essential to consider both the physiological and psychological aspects of her current condition.

Firstly, menopause can significantly impact a woman's mental health. The hormonal changes that occur during this transition can lead to symptoms such as mood swings, anxiety, depression, and sleep disturbances. Since your mother has undergone a hysterectomy, she may experience a more abrupt onset of menopausal symptoms, which can exacerbate feelings of anxiety and depression. The absence of estrogen can lead to increased vulnerability to mood disorders, and this is particularly relevant given her age and the timing of her symptoms.

Your mother’s symptoms—insomnia, fatigue, lack of joy, anxiety, memory issues, decreased appetite, and feelings of guilt—are concerning and may indicate more than just typical menopausal symptoms. While hormonal changes can contribute to these feelings, they can also overlap with clinical depression or anxiety disorders. The fact that her symptoms have intensified in response to stressors, such as family issues and business pressures, suggests that she may be experiencing an adjustment disorder or a more severe depressive episode.

It is also important to consider the psychological impact of her previous health challenges. The stress of dealing with cancer and the subsequent surgery can have long-lasting effects on mental health. The fear of recurrence, changes in body image, and the emotional toll of such experiences can contribute to feelings of helplessness and anxiety.

Given the complexity of her situation, it is crucial to approach this with a multifaceted treatment plan. Here are some recommendations:
1. Professional Evaluation: It is essential for your mother to see a mental health professional, such as a psychiatrist or psychologist, who can conduct a thorough evaluation. They can differentiate between menopausal symptoms, depression, and anxiety disorders and provide an accurate diagnosis.

2. Medication Management: If her symptoms are severe, medication may be necessary. Antidepressants or anxiolytics can help alleviate her symptoms, but this should be managed by a healthcare provider who can monitor her response to treatment.

3. Therapy: Cognitive-behavioral therapy (CBT) or other forms of psychotherapy can be beneficial. Therapy can provide her with coping strategies to manage stress and anxiety, as well as address any underlying issues related to her past health experiences.

4. Lifestyle Modifications: Encourage your mother to engage in regular physical activity, which can improve mood and reduce anxiety. Additionally, a balanced diet and adequate hydration are essential for overall health. Mindfulness practices, such as yoga or meditation, can also help reduce stress.

5. Support System: As her family, it is vital to create a supportive environment. Encourage open communication about her feelings and experiences. Sometimes, just knowing that she has a support system can alleviate feelings of isolation.

6. Follow-Up: Regular follow-up with her healthcare provider is crucial to monitor her progress and make any necessary adjustments to her treatment plan.

In conclusion, your mother's symptoms warrant a comprehensive evaluation to determine the best course of action. While menopause may play a role, the severity and nature of her symptoms suggest that she may be experiencing a significant mental health issue that requires professional intervention. It is commendable that you are seeking help for her, and with the right support and treatment, there is hope for her recovery and return to her previous self.

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