Perimenopause, anxiety, depression, ADHD, I’m lost and need signposting

[SleekWhisky]

I’ve been here before, so I feel like I should know what to do and yet I’m stuck again and looking for help, or at least clearer signposts to the right kind of help.

I’ve been on HRT for four years, and over the past few months my anxiety and depression have escalated badly. Sleep has completely fallen apart, I’ve only had about four decent nights in the last three months. When I do sleep, I feel noticeably better the next day, but the cycle quickly returns and I slide backwards again. The constant worrying about not sleeping has become relentless.

Because of this, my ability to focus, think clearly, and communicate has declined significantly, and it’s affecting my work, my relationships, and my confidence as a partner, parent, and friend. Mental health issues run deep in my family, and I strongly suspect undiagnosed ADHD may be part of the picture. I’ve also started questioning whether there’s something more going on, as I’ve never had a full psychiatric assessment. Could it be BPD, NPD or bipolar. I don’t strictly want a label but I know I’m not OK.

I’ve tried group talking therapy several times and individual CBT and seeing three therapists over the past 8 years, but it hasn’t worked for me, I struggle to translate it into practical help. I do have a supportive GP and access to private care, including a gynaecologist, so HRT may need reviewing.

What I’m really asking is this: if you’ve been in a similar place, what actually helped?
Was it a full psychiatric assessment if there is such a thing, medication change, a hormone adjustment, a specific type of therapy, or something else entirely?

I’m trying to work out the best next steps and use the support I’m lucky to have wisely. Any help signing posting me would really help and I cannot go on with these hourly suicidal ideations

Get help from somewhere, anywhere. Do not sit and wait for the the right thing, person, whatever just get in touch with some kind of health professional. Suicidal ideation is not a good place to be.
You said you have a supportive GP: start there, but make a start. Be honest with them and state directly that you have suicidal thought and want/need help.

Best wishes and hope you find the help you need.

I feel for you. I’ve just been through peri during which I was also diagnosed with ADHD (which was completely unexpected) and have struggled with my mental health on and off for years. I have spent most of my life wondering what the hell is wrong with me?! A doctor years ago asked me if I was bipolar. Turns out it was ADHD.

Maybe it isn’t ADHD for you, maybe it isn’t anything, but with a supportive GP and access to private heath care, you have nothing to lose by getting some help to try to find out. A diagnosis doesn’t define you but it may help you understand yourself better (and stop blaming yourself) and even if you don’t get a diagnosis, you will be sign-posted to finding coping mechanisms that may help you.

Hormonal changes (peri) make ADHD symptoms so much harder impossible to manage so it’s no coincidence that so many middle aged women get late diagnoses as their symptoms start to overpower a lifetime of masking. And of course many women are misdiagnosed with depression and/or anxiety throughout their lives when it is actually ADHD or other forms of neuro-diversity.

@SleekWhisky I can recommend Dr Alex Langford at Cognacity. He’s been amazing with me. He does face-to-face sessions in Oxford and Harley St but also over Zoom. See if your insurance will cover him.

https://www.cognacity.co.uk

Did HRT initally help? If yes then your dose probably needs to be increased.

Are you taking a high dose vitamin D tablet?

Have you had your thyroid checked. I have untreated ADHD, on HRT, have had a few depressive episodes and burn outs in the past. Not on ADs currently but thyroid was knackered - symptoms depression, lack of motivation and memory issues - I seriously was on the edge and also had a dementia test. Levothyroxine has really lifted me out of that physical state. All the symptoms of menopause, ADHD, hypo thyroid all overlap - as do BPD, Bipolar and complex PTSD -

This is all so very helpful, thank you so much to all of you who have taken the time to reply.
I’ll be very open with the GP tomorrow and write it all down so that she can take it all in without all the emotion and confusion getting in the way.

i’ll follow up on the personal recommendation and get thyroid checks done too.
Thank you for handholding.

Just wanted to say - sounds like you may have clocked this - but if you are feeling low or tending to, being tired will make it a million times worse. It can be the difference between just feeling down or feeling like there is no point in living.

It's a thought to try to hang on to if you are feeling it particular day - that tomorrow is likely to be better and you are feeling so bad today because you are extra tired.

One of the problems with this is that whether you sleep can be hugely dependent on your energy expenditure during the day which if you are feeling low to start with is hard to max out. No one can make themselves go for a long walk or go to the gym when they feel very down. If you find you are staying in bed longer in the morning, on one day engineer a reason to get up early - a meeting, appointment or a friend calling to at least try to get in a full day of energy expenditure.