Research presented at the North American Menopause Society’s annual meeting suggests the risk of a major depression doubles when women are going through menopause.

According to Reuters, the effects of reduced estrogen on the brain, coupled with the stress of hot flashes and other menopausal symptoms, can trigger depressive symptoms for middle-aged women.

A study at the University of Pittsburgh has found that menopausal women were more than twice as likely to have a major depressive episode, and almost four times as likely after menopause, compared to the period before its onset.

The study’s co-author, Dr. Karen Matthews, says doctors need to take symptoms of depression seriously. “When women come in and are thinking that they have some extra difficulties with life and feel down and blue…take it seriously. It is not just a passing thing,” she said.

Other believed to help treat the symptoms of menopause, including depression, are St. John’s wort, black cohosh, evening primrose oil and flaxseed.

Calcium, vitamin D, vitamin K and magnesium are also recommended to avoid bone loss during menopause.