Depression

The NHS website describes depression as more than feeling unhappy or fed up for a few days. It is feeling persistently sad for weeks or months. The symptoms it lists range from lasting unhappiness and hopelessness to losing interest in things you used to enjoy and feeling very tearful, and many people have anxiety too. The body is part of it: constant tiredness, poor sleep, no appetite or sex drive, aches and pains.

NICE NG23 draws a line between depressive symptoms around the menopause, which do not meet the criteria for a diagnosis of depression, and depression itself. Low mood covers the first. This page covers the second. Neither page can tell you which you have; that takes a clinician who has listened to you.

Waking with dread before your feet touch the floor. Days that blur. Food that tastes of nothing. Prayers said on autopilot. People you love feeling far away, and no energy to reach them. A sense that this is just who you are now.

It does not always look like sadness. It can look like irritability, exhaustion or a body that hurts everywhere.

The NHS website says depression can follow a life-changing event such as a bereavement or losing a job, runs in some families, and can also arrive for no obvious reason.

Around the menopause, two sources add more. The British Menopause Society's sleep tool reports a two- to fourfold increase in depression during the menopause transition, and says women who sleep poorly are more likely to have it. The Pakistan Menopause Society says women who have had depression or anxiety before are at higher risk of it getting worse during the transition.

• The Pakistan Menopause Society asks doctors to use short, validated questionnaires to screen for depression and anxiety at menopause appointments (section 4.2.4.6). If nobody has asked you those questions, you can ask for them.
• The NHS website lists exercise, cutting down on alcohol, stopping smoking and eating healthily as changes many people with depression benefit from, along with self-help books and support groups.

The NHS website says treatment for depression can combine lifestyle changes, talking therapies and medicine, decided by how severe it is. For mild depression a doctor may suggest watching and waiting, exercise, guided self-help or a talking therapy such as CBT. For moderate to severe depression, talking therapy with antidepressants is often recommended, and severe depression may need a specialist mental health team.

For women going through the menopause, NICE NG23 tells doctors to follow its menopause recommendations alongside NICE's depression guideline, so the two are planned together. The PMS recommendations list CBT, stress management, support groups and education about the menopause, and list antidepressants for moderate to severe mood disorders after a specialist has assessed them (section 7.2).

One finding from Pakistan is worth carrying into the room. An audit of 250 women aged 45 to 55 diagnosed with depression at Benazir Bhutto Hospital in Rawalpindi, presented at a conference in 2024, found that 78% had significant perimenopausal symptoms that had at first been overlooked (Gul, 2024). Asking whether perimenopause has been considered gives your doctor the full picture.

The NHS website says to see a GP if you think you may be depressed, and not to wait: many people delay, and the sooner you are seen, the sooner recovery can start.

The Pakistan Menopause Society lists severe depression, suicidal thoughts and symptoms that stop you functioning among the red flags that need evaluation or referral (section 2.3).

The British Menopause Society notes that mental health is rarely talked about in South Asian communities, and the PMS says mental health problems in Pakistan are often missed because of stigma. That silence makes depression easy to dismiss, at home and in your own head.

Women ask whether depression is a test, or a sign their faith is lacking. Those are questions for a qualified scholar. They are not a reason to keep it from your doctor, and the NHS is clear that depression is an illness, not a weakness. If it helps, bring someone you trust to the appointment.