Sunday, September 15, 2024

Misdiagnosis of Depression in Menopause: Yoga for Relief

Author
Ms. Krishnan N, a Zen entrepreneur in her 60s, founded Nava's Zen at 58. With 22 years as a lecturer, including 13 years in the Curtin University of Technology Perth, Australia Degree Twinning Program, she is now a certified yoga instructor, coach, and counselor. Her expertise enriches her current work.

Abstract
This article examines the misdiagnosis of depression during menopause and the potential benefits of yoga as a complementary treatment. It highlights the limitations of conventional approaches that often oversimplify menopausal symptoms by labeling them as depression. Through the author's personal experiences, it is demonstrated how yoga can offer significant relief and mental clarity beyond what is typically achieved with standard medical treatments. 

The discussion emphasizes the importance of integrating yoga into mental health care, not only as a supplementary remedy but as a vital tool for enhancing overall well-being. The findings suggest that a more nuanced understanding of menopause-related mental health issues and the inclusion of yoga in treatment plans can lead to improved outcomes and greater self-reliance.

Keywords
Menopause, Depression, Yoga, Mental Health, Misdiagnosis, Complementary Therapy, Self-Reliance, Holistic Health, Mental Clarity

Introduction
The mindset plays a crucial role in influencing overall well-being. What is fed to the mind - whether positive or negative - significantly impacts the breath, body, and soul. Yoga practice emphasizes nurturing a positive mindset, which, in turn, fosters well-being across these dimensions. Cultivating positivity is essential, as social and cultural factors also play a role in shaping one’s mindset. Human elements, integral to social and cultural dynamics, significantly affect mental conditions.

Exposure to negativity - whether intentional or unintentional, originating from oneself or from external sources such as medical expertise and social influences - can profoundly impact mental health. It is challenging to avoid the influence of others, as they are part of one’s environment. Persistent negativity in the mindset can lead to adverse mental states and potentially result in further negative elements. Yoga addresses this by promoting softness, calmness, and mindfulness, guiding the mind away from disruptive patterns and towards tranquillity.

In the 21st century, individuals encounter numerous influences that can undermine mental health. If these influences, combined with medical expertise, are not managed properly, they can lead to significant psychological distress. This distress often manifests as intense psychological pain, akin to a persistent, pricking sensation, which can escalate into deeper emotional and psychological issues, including depression.

For women undergoing significant life changes such as menopause, distinguishing between bodily changes and mental health challenges can be complex. Menopause, an unavoidable part of a woman's biological clock, affects not only the body but also has significant implications for mental health. Understanding menopause and differentiating it from depression or other mental health challenges requires careful consideration. 

While menopause can exacerbate mental health issues, depression is a serious condition that warrants appropriate attention and treatment. This article will integrate medical and scientific insights with the author’s personal experiences. As a qualified yoga instructor, counselor, and coach, the author adheres to ethical standards and personal values in addressing menopause, depression, and mental health concerns.

Methodology
This article is based on a single case study drawn from the author’s personal experiences with mindset confusion related to menopause. This includes health issues and, to some extent, the aftereffects of leaving behind a deeply passionate career. Personal life issues are mentioned but not explored in depth to maintain the privacy and confidentiality of those involved.

Data for this article were gathered through a video shared on TikTok and other social media platforms. TikTok comments provided substantial data on symptoms of menopause, with many women agreeing with the symptoms described and sharing their struggles in managing these symptoms. This feedback offered significant insights for this article.

In addition to the primary case study and social media data, insights were gathered through conversations with individuals who shared their experiences with prescribed medications for depression. These discussions revealed various effects of medications, including adverse reactions and the potential benefits of alternative therapies such as meditation. This additional perspective helps contextualize the challenges faced in managing mental health and supports the exploration of complementary treatments.

The methodology employs qualitative research approaches, particularly interpretative phenomenological analysis (Smith & Osborn, 2008), which supports the use of personal narratives and descriptive accounts to understand individual experiences. This approach allows for a deeper exploration of how individuals perceive and experience their conditions (Smith, Flowers, & Larkin, 2009). It is important to note that this article has not been peer-reviewed. It represents an unbiased personal perspective, supported by valid citations, and does not have any hidden agenda behind the content.

Transition Through Menopause
At 45, the author began experiencing menopause, encountering challenges such as sleep disturbances and hot and cold flashes. Despite consulting four doctors at a reputable clinic, the diagnosis remained unclear until the fourth doctor referred her to a gynecologist. This specialist provided a clear diagnosis, attributing the symptoms to menopause, discussed the potential side effects of hormone replacement therapy, and advised the author to continue with activities she enjoyed, such as gardening, blogging, and cooking. For six years, the author managed well, but a relapse occurred at 52.

Menopause Relapse and Associated Challenges
At 52, the author experienced a relapse of menopause, presenting severe headaches, body pain, and persistent palpitations with increased intensity. This relapse also triggered significant anxiety and panic attacks, particularly at night. The author returned to the medical center for a series of tests to uncover the underlying causes of these symptoms (Freeman, 2012; Maki & Murphy, 2022).

The author also faced career and personal challenges. After leaving her lecturing career at 50, she spent two years traveling, gardening, and enhancing her cooking skills. However, she later sought to return to her passion for lecturing. Despite numerous applications, she struggled to secure employment, finding herself overqualified for administrative roles, even after lowering her salary expectations (Maki & Murphy, 2022). Additionally, she was given the responsibility of caring for and financially supporting her unwell mother, a task not shared by her siblings. These factors contributed to notable physical and mental fatigue (Stefanick, 2019).

During this period, the author felt overwhelmed, leading to crying during a medical appointment. Despite thorough medical evaluations indicating no significant issues, the doctor prescribed Xanax (alprazolam) to manage anxiety and panic attacks, along with another medication for relaxation. These prescriptions are documented in the author’s medical records, which can be reviewed for further verification (Freeman, 2012).

Medication Reaction and Subsequent Management
After taking Xanax (alprazolam) and another medication, each at half a tablet, the author initially experienced a full night of sleep, from 10 PM to 11 AM the following morning. Upon waking, she reported to her husband that she had slept well. Following his suggestion, she took the remaining halves of the tablets after a meal. However, within an hour of going to bed, she experienced severe confusion, feeling as if her body, mind, and soul were in conflict, and was tempted to jump out of the window. Overwhelmed, she reached out to her husband, shouting that something was wrong. He quickly calmed her down, and she eventually found solace lying on his lap for half an hour, after which she settled (Baldwin et al., 2014).

Following this episode, both the author and her husband questioned whether the medications were the cause of her confusion. Discontinuing the medication, she sought further medical advice from a familiar doctor. Despite knowing that the author had been menopausal for seven years, this doctor recommended hormone tablets, suggesting they would regulate her hormones and provide relief. Trusting this advice, she began taking two types of hormone tablets, at a significant cost. However, these did not alleviate her persistent headaches or produce any noticeable improvement. After a week, she stopped the hormone tablets and sought another opinion.

A different doctor diagnosed her with severe migraines triggered by the menopause relapse and advised that hormone tablets would not be effective at this stage. Instead, the doctor recommended dietary changes, including avoiding coffee and maintaining a healthy diet, to manage her symptoms, and advised discontinuing migraine medication once feeling better (Maki & Murphy, 2022; Gompel, 2021).

Mental Health and Societal Perceptions
During this period, the author accepted invitations to blogging events as a way to avoid being confined at home and to socialize. Although she appeared different from her usual self, she mentioned feeling a bit down when asked about her well-being. This led some acquaintances and so-called friends to suggest she might be experiencing depression, a term frequently used by others in social situations. The persistent use of the term “depression” caused the author to question her own mental state.

Despite engaging in activities she enjoyed - such as traveling, gardening, cooking, and blogging - the term “depression” remained a source of ongoing concern. Her husband advised her to disregard these thoughts, but the word continued to linger.

Over the next three months, the author began experiencing insomnia, panic, and anxiety attacks, which seemed to occur primarily at night. The severity of these attacks escalated, leading to feelings of breathlessness and an inability to relax, even during the day. Concerned about her worsening symptoms, she returned to the medical center. The first female doctor suggested a brain scan and a consultation with a psychologist, suspecting the issue might be related to mental health, but the author declined these recommendations. Another doctor, recognizing the severity of her attacks, provided intravenous fluids and advised her to calm down, which offered temporary relief (Miller, 2020; Katon, 2021).

During this challenging time, an acquaintance recommended yoga as a potential remedy to help calm her mind. This suggestion marked the beginning of the author’s journey into yoga. She began practicing regularly, joined yoga groups, and gradually found it beneficial. Over the course of three years, she developed a passion for yoga and decided to pursue it professionally. Today, she is the founder of Nava’s Zen, where she conducts yoga sessions (Smith & Yeo, 2022; Larkey et al., 2023).

Societal Perceptions and Personal Challenges
While participating in various yoga groups, the author encountered differing approaches to managing her migraine symptoms. An older male yoga instructor suggested a remedy involving pouring and squeezing lime into the eyes and over the body, claiming it to be an effective cure for migraines. Despite his persistent attempts to convince her, the author chose to discontinue yoga with this instructor due to her reservations about his unorthodox methods, and she subsequently joined a different yoga group (Furlan et al., 2015).

Throughout the three years of pursuing her interests - gardening, cooking, and blogging - the author stopped attending blogging events. She found it increasingly challenging to fit in with those who flaunted their popularity and event attendance, and experienced feelings of jealousy and envy from fellow bloggers who questioned her presence at events. This led her to withdraw from such events, recognizing that they no longer contributed to her happiness and had become burdensome (Noble & McGrath, 2022).

Additionally, the author's status as a non-working individual led to negative judgments and assumptions from others. People often labeled her as a "housewife" and questioned how she occupied her time. One individual, a so-called corporate star, derogatorily referred to her as a "confused housewife" and "bloody housewife" during a conversation. The broader social commentary she faced suggested that women who do not work are less accomplished and lead uninteresting lives (Williams & Crittenden, 2019).

The harshest criticism came from those closest to her. Family members criticized her solo travels, with some making disparaging remarks about her perceived dependence on her husband’s finances. They accused her of using her husband’s money for personal gain and even implied that she was a threat to their relationships. This judgmental behavior, including gossip and overt hostility, reflected a broader societal discomfort with her choices and independence (Krishnan, 2024)).

The Evolution and Meaning of Depression
By 2014, the term "depression" had become a globally trending topic, frequently used across various contexts. From professionals to laypeople, the term was applied liberally, often without a deep understanding of its implications. As a counselor with years of experience and a yoga instructor for five years, the author has encountered diverse social and cultural dynamics that shape perceptions of depression.

In a simplified view, depression can be described as inner unhappiness and confusion affecting the breath, body, mind, and soul. It stems from an inability or unwillingness to express oneself, societal pressure to maintain a façade, and a general uncertainty about one’s feelings. Depression may develop suddenly, akin to rising floodwaters, or gradually over time due to suppressed emotions and unaddressed stress. The true meaning of depression is complex and subjective, with various individuals defining it differently, sometimes leading to over-exaggeration or misunderstanding of its true nature (American Psychiatric Association, 2013; Kessler et al., 2003).

Evaluating Doctor Diagnoses and Treatment for Depression
Determining whether all medical professionals are qualified to diagnose and certify someone as depressed is crucial. Despite medical education including psychology, it remains questionable whether a general practitioner alone can provide an accurate diagnosis. The author’s experience during a menopause relapse highlights this issue, raising concerns about whether a single consultation is sufficient or if a series of evaluations is necessary to confirm depression (Katon, 2021). Symptoms such as crying or feeling down are often interpreted as signs of depression, but these indicators may not always be conclusive (Miller, 2020).

Additionally, conversations with two individuals provided insights into prescribed medications for depression. One reported adverse effects, including lethargy and a lack of motivation, which led to discontinuation of the medication and a search for solace in religion. The other emphasized the importance of meditation for his spouse's mental health, suggesting it as a lifelong support since, without medication, the spouse struggles to remain calm. This raises critical questions about the efficacy of meditation for depression and whether doctors should exercise greater caution in prescribing treatments (Smith & Yeo, 2022; Larkey et al., 2023).

Qualifications and Claims in Mental Health
It is crucial to scrutinize whether counselors, coaches, or mental health responders are genuinely qualified to diagnose depression based on their credentials. Today, qualifications can be easily obtained online or through institutions that may not have rigorous accreditation, raising concerns about their validity (Smith & Yeo, 2022). The implications of diagnosing depression are profound, and qualifications should reflect comprehensive training and adherence to stringent standards.

Furthermore, the term "depression" is increasingly used across various sectors, including supplement sellers and yoga practitioners, often for marketing purposes. Some of these individuals are supported by dubious endorsements and promote their products or services (Krishnan, 2024) under the pretense of mental well-being without adequately addressing the potential impacts on mental health (Larkey et al., 2023).

As advanced degrees like PhDs become more prevalent, it is worth questioning whether such qualifications are adequate for diagnosing depression or if more specialized expertise is needed. Similarly, the use of yoga for mental health by individuals without proper counseling qualifications raises concerns about the effectiveness and appropriateness of their interventions.

Societal Misuse of "Depression"
In the 21st century, while society has made significant strides in raising awareness about depression, this awareness is often undermined by the casual and sometimes harmful use of terms such as "mad" or "mental" to describe individuals struggling with mental health issues. When people exhibit symptoms of depression, they are frequently labeled without a comprehensive understanding of their condition (Smith & Yeo, 2022).

This hasty judgment is exacerbated by a misplaced sense of authority, where individuals lacking proper qualifications or knowledge assume the role of amateur diagnosticians. The casual use of the term "depression" by those seeking attention or social media influence further complicates the issue, diluting the term's significance and potentially exacerbating self-diagnosis and misconceptions about mental health (Larkey et al., 2023). There is an urgent need for more nuanced and informed discussions about depression, as well as greater sensitivity to the impact of language on those experiencing mental health challenges.

Understanding Depression Across Different Life Stages
Depression is often perceived as a uniform condition, applicable universally regardless of race, religion, ethnicity, gender, or socio-cultural differences. However, this view oversimplifies the complexity of depression, as its manifestations and treatments can vary significantly between different age groups and life stages. For instance, research indicates that depression in younger adults can present differently compared to older adults, with variations in symptomatology and treatment responses (Smith & Yeo, 2022).

The impact of menopause on mental health adds another layer of complexity. Menopausal depression may not only involve typical depressive symptoms but also include unique challenges such as hormonal fluctuations and their effects on mood (Larkey et al., 2023). This suggests that while depression shares common elements, the approach to treatment must be adjusted to account for these specific factors.

When addressing depression or mental health issues arising from menopause, standard treatments might not always be suitable. For example, medications like Xanax, prescribed for panic and anxiety attacks, may not be effective or appropriate for managing menopausal symptoms. Clinical guidelines recommend a more nuanced approach, including hormone therapy and lifestyle modifications tailored to menopausal women’s needs (Freeman, 2012; Maki & Murphy, 2022).

It is crucial to recognize that while depression shares common elements across various contexts, the approach to treatment must consider individual circumstances and life stages to ensure effective and appropriate care. Tailoring treatments to the specific needs of menopausal women can lead to better outcomes and more effective management of mental health issues.

Yoga's Neglect in Modern Health Care
Despite advancements in knowledge and education in the 21st century, yoga remains an underutilized remedy for mental well-being, including as a relief for women undergoing menopause. Yoga can be a natural therapy to manage menopausal symptoms, especially for those who might be hesitant to start or are seeking alternatives to hormone replacement therapy. Yoga offers a way to understand and alleviate menopausal symptoms, and can be beneficial either as a complementary approach alongside hormone therapy or as a primary method for managing symptoms.

Unfortunately, this ancient practice, known for promoting inner peace and relaxation, is often overlooked by modern society and the medical community. Despite its proven benefits for mental health, many doctors either do not recommend or are unaware of yoga’s potential advantages (Gothe et al., 2013; Cramer et al., 2013). Instead, there is a prevailing trend toward prescribing modern medications or endorsing supplements, often driven by commercial interests rather than a holistic view of health (Smith et al., 2021).

This neglect extends beyond Western practices; even within the Indian medical community, yoga is frequently overshadowed by alternative therapies like Ayurveda. Medical professionals, irrespective of their background, often prioritize promoting commercial products or treatments over incorporating yoga into their practice (Saxena, 2015).

Furthermore, efforts to promote yoga within medical settings, such as employee wellness programs, often face indifference. This reflects a broader societal preference for quick fixes and commercially driven solutions, rather than embracing the more sustainable benefits of yoga (Gothe et al., 2013; Cramer et al., 2013).

Overcoming Societal Resistance to Yoga
Promoting yoga in the 21st century faces significant challenges. A prevalent reluctance to embrace yoga, often rooted in skepticism or unfamiliarity, hinders its acceptance as a remedy for mental health issues. Many people view yoga primarily as a physical exercise focused on strength and flexibility, overlooking its profound benefits for mental well-being. When discussions arise, the emphasis is often on yoga poses and types, rather than its potential for enhancing mental health. This misunderstanding leads to yoga being conflated with general exercise activities, such as badminton or walking, which are seen as sufficient for physical benefits but fail to address yoga’s unique mental health advantages.

This resistance extends to addressing menopause as well. Despite the potential benefits of yoga for managing menopausal symptoms, there is a notable lack of acceptance among some women. Conversations with women about incorporating yoga into their menopause management have often been met with skepticism. Additionally, comments on social media videos promoting yoga have revealed that many women are hesitant to consider yoga as a relief option, instead focusing on their experiences with menopausal symptoms.

Despite growing evidence of yoga's efficacy in improving mental clarity and emotional stability (Krishnan, 2024), societal inertia often favors conventional treatments and medications over exploring yoga as a viable alternative. This gap in understanding highlights the need for enhanced education and greater integration of yoga into mental health care practices (Sahasi et al., 2021; Goyal et al., 2014).

Finding Relief and Solace in Yoga
During a challenging period of menopausal relapse, when medical professionals were quick to label her condition as depression, the author found solace in yoga. Yoga emerged as a vital alternative to reliance on modern medicine and societal judgments, offering a refuge that went beyond conventional treatments. Her experience highlights the significance of self-reliance and the potential drawbacks of relying solely on standard medical diagnoses (Gothe et al., 2013).

Through dedicated yoga practice, the author experienced a gradual and profound transformation. While immediate results were not evident, yoga provided both physical benefits and a deeper sense of mental clarity and calm. This stands in contrast to contemporary society’s preference for quick fixes and external validation over internal peace (Cramer et al., 2013). Despite occasional setbacks, such as palpitations from stress or fatigue, yoga has been instrumental in helping her regain control and maintain resilience.

Leading yoga sessions has reinforced her belief in the practice’s benefits, complementing her personal practice. The integration of breathwork, mindfulness, and meditation has been invaluable for her overall well-being, serving as a constant reminder to cultivate positivity and resilience despite societal pressures and judgments.

Conclusion
In exploring the misdiagnosis of depression during menopause and the role of yoga as a complementary treatment, this article underscores the complexity of mental health issues and the need for a nuanced approach. The widespread tendency to label menopausal symptoms as depression can overlook the unique aspects of this life stage, leading to potentially misguided treatments. Yoga, often underestimated in modern healthcare, emerges as a valuable alternative for addressing both physical and emotional challenges.

The author's personal journey illustrates how yoga can offer profound benefits beyond conventional therapies, providing solace and relief during difficult times. Despite societal preferences for quick fixes and pharmaceutical solutions, integrating yoga into mental health care can foster greater self-reliance and long-term well-being. Embracing this ancient practice, alongside or even in place of more conventional treatments, may lead to a more holistic and effective approach to managing menopause-related mental health issues.

Ultimately, acknowledging the limitations of standard diagnoses and exploring diverse treatment options, such as yoga, can help tailor care to individual needs and promote a more balanced approach to mental health.

Conclusion
The integration of yoga into contemporary mental health care presents a complex yet crucial opportunity for advancing holistic well-being. Despite its ancient roots and substantial evidence supporting its benefits, yoga often remains underutilized in modern health care settings, overshadowed by conventional treatments and a general lack of understanding regarding its mental health benefits. This reluctance to adopt yoga as a therapeutic practice is exacerbated by societal misconceptions that reduce yoga to mere physical exercise rather than recognizing its profound impact on mental clarity and emotional stability.

The author's personal journey through menopause highlights the significant role that yoga can play in managing mental health crises, revealing its potential as a valuable complement to, or even alternative for, conventional treatments. As society increasingly prioritizes quick fixes and commercialized health solutions, it is imperative to foster a more nuanced understanding of yoga's contributions to mental well-being. This involves addressing the gaps in knowledge among medical professionals and the public, promoting education about yoga's benefits, and integrating it more effectively into mental health care practices.

Ultimately, embracing yoga as a legitimate and accessible option for mental health support could offer a more balanced approach to addressing the complexities of mental health, emphasizing the importance of holistic practices in achieving overall well-being.

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