Need mental health advice, don't know what's going on with me

[Overated]

I have needed anti-depressants for most of my life, having suffered numerous bouts in the past, paired with extreme anxiety. I have also had problems with PMT exacerbating my mood issues. I have had plenty of counselling/therapy and CBT over the years, which have helped to varying degrees, but certainly never 'solved' the depression.

The last couple of years I have had serious mood problems again despite being on ADs already; tried switching to a heavier duty AD which seemed to help for a while. I am also menopausal so quite possibly that isn't helping.

Today I have felt so low and horrible that I was close to begging for an emergency appointment with my GP. Yesterday however I felt ok. Day before that I felt awful and was ready to catch a train somewhere (anywhere) and never come back. And so on. My moods are swinging ridiculously. I have also made some stupid decisions lately that at the time I thought were fantastic ideas, but actually I have majorly fucked up. I feel like I can't trust my judgement at the mo. I have done a no show with my current counsellor because I just feel embarrassed, one week I tell him things are going well and I feel I'm making progress, the next I'm in the depths of gloom again. The groundhog day nature of it is getting to me. If nothing else though I have realised that my mood swings are not recent, this has been going on for a while, and it's not being controlled by my medication. What should I do? I feel so worn down by it.

Get yourself to the GP (one who's helped you in the past). Write down what you've told us so you don't forget to mention it. You may feel Ok in the morning but it will come back if you don't act.

Is it possible you have suffered from severe pms/pmdd which is better treated with hormone approaches than ADs. I say this as someone who spent years on psych meds before realising my problem. Many women don't realise their depeession or bipolar or whatever is actually pmdd because they dont know that mood symptoms can kick in from ovulation so be there two weeks a month and very up and down. I would advise charting your cycle and moods on something like monthly cycles app or period tracker lite which have mood trackers as well. If you do have/have had pmdd and are in menopause/perimenopause it often gets worse. The main docs working in this area for pmdd and menopause related mood disturbance are nick panay (gynae, nhs and private), michael craig (psych, nhs and private)and john studd (gynae, private) and all have more info on their websites or ask to join the pmdd severe pms uk FB support group as there are lots of women at different stages with good advice to offer. I was at the max dose of my AD and despairing when I worked this out, now in hormone treatment and no psych meds. On the plus side if it is pmdd and you're in menopause it will get better when menopause ends.

BTW many gps, even good well intentioned ones, are oblivious to this condition but it is recognised by the nhs and listed in the DSM (US medical bible of psych disorders)

Comma I have often thought that a lot of my issues are hormonal, but this has always been dismissed by counsellors/doctors. My GP is lovely but I suspect she will just want to increase my ADs. I can't afford private healthcare so I'm feeling pretty glum about what to do next. The stupid thing is, my latest crisis coincides with a change in my HRT from one kind to another...I was stable for a quite a while on the first one I was put on, but it was discontinued so I had to change, and it's all gone horribly wrong since. Doesn't this just confirm that I have hormonal problems?? It cant be coincidental!

Obviously online diagnosis can go wrong but if it's coinciding with a change in your hrt it sounds like it very well might be hormonal. To give you a bit of background to severe pms/pmdd as I understand it, it's not anything to do with a hormone imbalance - i.e. when tested your hormones will be at the same level as any other woman's of your age/stage - but it's to do with an extreme reaction or response in the brain chemistry to normal hormonal surges so in a woman before menopause that's a reaction to the normal surges of the menstrual cycle and most women with pmdd will experience pretty severe mood swings from ovulation onwards so for the last two weeks of their cycle. Obviously if you have this and are then in menopause or perimenopause you are just as susceptible to mood problems brought on by your brain chemistry's reaction to the hormone surges and drops of menopause. If this rings a bell then you need to try and get some specialist care because most gps know sweet FA about this. Here's a link to description of pmdd as used in the DSM which is the authoritative manual of psychiatric disorders emedicine.medscape.com/article/293257-clinical
There is lots of excellent and very credible research out there so maybe bring along some info to your gp. The doctor I see works within the NHS (although I'm Irish so I see him privately) and here's the website which includes a simple link for your gp to refer you www.national.slam.nhs.uk/services/adult-services/femalehormoneclinic/ You will see, on this website, that it specifically mentions menopause as a time of vulnerability for women with pmdd. Dr Craig works out of the the Maudsley which is the largest psychiatric teaching hospital in the UK (I say this because it may add credibility from your gp's point of view). Sorry if I'm a bit evangelical about this - I've spent most of my adult life on ADs and mood stabilisers and I've been on so many and they sometimes improved things a bit for a bit but never really worked longterm and then I finally worked out that the problem was my responses to hormones and it's been a bit of an hallejuiah moment.