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Menopause

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Original poster

menopause and depression

37 replies

spaghetticarbonara · 16/12/2018 13:34

Trying to get my ducks in a row before seeing the GP tomorrow.

The one thing that's certain is that I'm depressed. I am finding life like wading through treacle, and I can't stop crying. I am struggling considerably and very "down".

Two health issues are clouding the matter. Two years I had a hysterectomy but retained my ovaries. As I am obviously no longer having periods I have no idea whether I'm heading into the menopause or not (I'm 46 and a bit). If it's likely that the depression is as a result of menopause, HRT might be the answer.

However, I'm also on 125 mcg daily of thryoxine for an underactive thyroid. One of the symptoms associated with an underactive thyroid is depression too.

I just want to feel better.

OP posts:
LadyWithLapdog · 16/12/2018 13:42

I’d check thyroid levels first to see if you’re on the correct dose of thyroxine. Then address menopause and depression. You could start with an antidepressant first but if that doesn’t suit then over to HRT. Peri menopause can last several years, there must be something suitable for you.

Original poster
spaghetticarbonara · 16/12/2018 13:45

Last time I had my thyroid levels test they were "normal" but agree that another test would be sensible. Will discuss with gp - if I can get an appointment

OP posts:
LadyWithLapdog · 16/12/2018 14:07

If the result is relatively recent and you’ve been on a stable dose for quite a while then I’d get on to antidepressants/HRT, unless there’s other reasons for the depression, eg are you exhausted rather than depressed, is it anaemia etc? Good luck tomorrow.

JinglingHellsbells · 16/12/2018 14:22

They say that ovaries usually fail within 2 years of a hysterectomy so it's likely you are post meno now. HRT is the recommended treatment for hormone-related depression ( NICE guidelines.)

LittleCandle · 16/12/2018 14:26

Your thyroid tests can be normal and that means nothing. Mine are always 'normal', but I have constant symptoms. Please ask for a print out of your thyroid results and check them at Thyroid UK, who will give you good advice. hope you get things sorted out, OP.

Original poster
spaghetticarbonara · 16/12/2018 15:52

Will ask for printout of numbers as to be quite honest I have no idea what they are.

Feeling a little more positive this afternoon. Getting out into the fresh air really helps.

OP posts:
LadyWithLapdog · 18/12/2018 00:20

DId you manage to get an appointment? I hope it went well.

Original poster
spaghetticarbonara · 18/12/2018 07:22

I did, thanks for coming back and asking. I cried before I even sat down - poor GP. She was lovely though, has referred me to the local counselling service and prescribed fluoxetine. that's the bit I'm struggling with - I know it's silly but I don;t think of myself as someone who needs anti depressants. Taken the first one this morning though.

OP posts:
Emerald13 · 18/12/2018 08:11

If depression is due to hormonal imbalance, hrt is highly recommended.
I was almost suicidal a year ago because of my early meno. Things are better now after a year on hrt. For hrt makes a big difference in the way I feel.

JinglingHellsbells · 18/12/2018 08:13

ADs are not the right route for depression caused by menopause/ hormones. GPs have been advised by NICE 3 years ago to stop doing this. This video might help you see why.The likelihood is you do NOT need ADs, you need estrogen. I'd see another GP or at least go back and discuss. www.menopausedoctor.co.uk/menopause/anti-depressants-and-the-menopause

NICE

1.4.7 Ensure that menopausal women and healthcare professionals involved in their care understand that there is no clear evidence for SSRIs or SNRIs to ease low mood in menopausal women who have not been diagnosed with depression (see the NICE guideline on depression in adults).

Original poster
spaghetticarbonara · 18/12/2018 08:30

Gp doesn't think it is menopause related as i'm not having any other menopause symptoms like hot flushes.

OP posts:
JinglingHellsbells · 18/12/2018 08:43

You had a hysterectomy. Ovaries usually fail within 2 years of this. You don't have to have hot flushes or other symptoms. If you ave never had depression in your life, it seems too much of a coincidence that it starts after surgery. Your GP should follow the guidelines. That's why they were published.

LadyWithLapdog · 18/12/2018 20:09

JinglingHellsbells is quite right. The GP though doesn’t have to follow the guidelines as long as she’s given them consideration and something else is a better option or chosen with the patient etc.

JinglingHellsbells · 19/12/2018 07:57

Menopause symptoms can include physical symptoms like flushes and sweats, and / or psychological symptoms like low mood and anxiety. There is no requirement to have vasomotor symptoms to be prescribed HRT if a woman has - for the first time- psychological symptoms. Not all women have low mood during menopause, just as not all women have flushes or sweats. Sometimes there is a time lapse between the two with one coming first and the other months or years later.

The guidance from NICE was three years in preparation, involving a large team of specialists across the UK.

One of their chief concerns has been the over-prescribing of ADs during menopause rather than HRT.
This is the same type of concern that is currently being voiced over the over-prescribing of antibiotics.

ADs can have side effects, many of which are not pleasant. They also tend to be the incorrect treatment if there has been no clinical diagnosis of depression or anxiety.

This is why the guidelines state- categorically- that they ought not to be prescribed during menopause for women who have had no history of depression or no life -changing events (at the time) that could exacerbate low mood. The wording of NICE is very clear "ADs...have no place in the treatment...." This is the result of years of research and consultation by menopause experts who wrote the guidance.

GPs tend to have no menopause training, or the bare minimum which can amount to no more than a short online training session. They are doing their best for women, but there is a lot of concern about under prescribing of HRT when it would be appropriate to offer it and over prescribing of alternatives like ADs. The BMS is running training courses across the UK on this for GPs and specialist nurses, but it's not mandatory of course.

LadyWithLapdog · 20/12/2018 23:25

Erm, yes, it’s still guidance and clinical judgement required. That’s why they sign the prescriptions and you can’t just buy them following an algorithm.

JinglingHellsbells · 21/12/2018 07:48

Hmmm! Interestingly, there has been a lot of evidence reported recently that AI & algorithms are producing far more accurate diagnoses than GPs. The UK has one of the lowest correct diagnoses of cancer for example by GPs compared to other countries, and there are many other examples where algorithms are more accurate. The Nice guidelines are very straightforward in their advice of depression starting at the time of ovarian failure, and there are additional research papers published after the Nice guidelines, confirming that guidance.

LadyWithLapdog · 21/12/2018 20:56

You’re repeating yourself about a point I agreed with early on (18/12/18 at 20:09). Still no reference for your assertion about algorithms being better than GPs.

LadyWithLapdog · 21/12/2018 22:50

Oh come on. You cannot expect GPs to have X-ray vision. Of course they can’t bloody detect cancer cells. Night night.

swingofthings · 22/12/2018 06:30

Your GP should follow the guidelines
The guidelines as you've pointed them makes it clear that as a whole, most women don't benefit from antidepressant WHEN they are menopausal. However it's hasn't been confirmed that OP is.

Non hormonal depression doesn't stop falling upon women the minute they get menopausal. Some menopausal women will also suffer from depression as younger women do totally unrelated to the menopausal, in which case, ssri might indeed be the right treatment from them.

The key is to identify first the trigger for depression. A few of my friends have become depressed in their late 40s/early 50s and have responded well to ssri.

JinglingHellsbells · 22/12/2018 07:49

@LadyWithLapdog
Have you even opened the links?

You asked for evidence of algorithms showing they could diagnose better than a GP. That's what I've linked for you. They are not all about cancer. And GPs don't need X ray vision to spot cancer signs and refer patients for tests. You can't be keeping up with the news if you have missed all of this- it's been in the media for weeks.

One link is specifically to do with mental health!

I guess you are a GP as you are so defensive.

LadyWithLapdog · 22/12/2018 13:41

I opened the links, which is why you’re being silly. It’s not comparing like with like. A GP trying to work out risk factors from a patient’s jumbled history in less than 10 minutes vs computers scanning for cancerous cells. Yet it’s not the algorithm you’re going to sue but the GP. Bizarre, isn’t it.

LadyWithLapdog · 22/12/2018 13:45

I’m not defensive, I just think whipping people up about what GPs should or shouldn’t do is a bit irresponsible. You weren’t in the consultation and the OP has no obligation to give us her entire medical history so we can judge from the sidelines. When it’s your name and your signature to that prescription it’s a different matter.

Anyhow I think this discussion has run its course and maybe you can take it in a separate thread now.

JinglingHellsbells · 22/12/2018 15:01

I'm afraid I think you are over reacting and taking the thread into a different topic. However, if you insist on coming back each time, then it's only fair to point out the other side.This forum is littered with women who have been given either incorrect treatment for menopause or no treatment for menopause by GPs. (That's why they come here to ask Qs)

Of course neither you nor I were in the consultation. But based on what the OP posted it would appear that the offer of ADs is questionable, at least. It's only right to draw attention to the campaign- and it IS that- by consultants to stop GPs offering ADs when they are incorrect treatment. If you care to read the media reports on this - eg Allison Pearson in the Telegraph, Carol Vorderman, Kirsty Wark - and a whole lot more high profile women, their own experiences show the same thing. I'll leave this now and if you want to carry on the debate, do so, with evidence perhaps to support your view?

LadyWithLapdog · 22/12/2018 15:20

What view would that be? The one from four days ago where I agreed with you? FFS. Still, it’s only guidelines and neither you nor I were in the consultation. Neither you nor I have to take the responsibility of having signed for a prescription. You just don’t know.