menopause and depression

[spaghetticarbonara]

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.

Every single time someone comes on here to post that they are peri and have depression, someone else (and I'm convinced it's the same person with different login names) will come on to preach about Louise Newsome and why we shouldn't have ADs. Perimenopause is a really complex condition and there isn't a one-size-fits-all solution.

I was put on HRT in March after showing several severe symptoms including very bad depression, and it did work to a certain extent. But, I had to come off it after developing hypertension. I slid back so badly that I very nearly lost my job because I could no longer do it, and they only reason I am still with the same organisation is because I requested a move to a different department. I was put on fluoxetine which gave me the confidence to ask for the move, and the confidence to know that I should be able to cope with the new role.

My GP (a perimenopausal woman) fully acknowledged that she didn't know enough about the menopause, and referred me to a specialist gynocologist at my local menopause clinic. We have got my blood pressure down to a manageable level, I am now back on HRT, and my specialist wants me to stay on the fluoxetine, which I am happy to do.

My specialist explained that there is absolutely no way to distinguish between "normal" depression and "premenopausal" depression, and the only way to sort it, is to treat both conditions. My specialist added that HRT on its own will not even begin to touch some depression and it would be irresponsible of any doctor to fob a patient in this state off with only HRT.

My specialist explained that there is absolutely no way to distinguish between "normal" depression and "premenopausal" depression, and the only way to sort it, is to treat both conditions

And that is a guaranteed way never to know which was the right treatment!

It's not a case of 'someone coming along' to quote Louise Newson (and why not anyway?? she's an expert) -- it's a case of reporting ALL medical advice.

ONE consultant's opinion unless they are one of the top menopause specialists in the UK, cannot be relied on to know more than the BMS and Nice. Surely?

The consensus statement from the British Menopause Society AND NICE does not agree with your dr.

thebms.org.uk/publications/consensus-statements/hormones-and-depression/

Hormones and depression
Summary
It has been known for more than a century that depression is more common in women that man. Suicide attempts and prescriptions for antidepressants are more common in women. The question is whether this is due to environmental, social or hormonal factors. An endocrine cause is suggested by the observation that this excess of depression occurs at times of hormonal change such as in the days before a period as premenstrual depression (PMS or PMDD) or in the weeks after pregnancy as postnatal depression (PND) and the years approaching the menopause as climacteric depression (CD). This latter problem is at its worst in the few years before the cessation of periods – the transition phase. This subgroup of depressive disorders is called Reproductive Depression (RD) and are important because the causation is endocrine rather than psychiatric and the most effective and logical treatment is by hormones rather than antidepressants.

chocaholic72 - I have no idea who the quoted person is and I’ve been off MN for a good while. As a GP I treat the person in front of me according to their preferences, history, contraindications etc, with regard to guidelines. Plus referral if it’s not straightforward.

And that is a guaranteed way never to know which was the right treatment!
Does it matter? Chocaholic seems to have found a combination of treatment that means she's found her life back. That's a great outcome. Why should she care whether its more thanks to the hrt or to the antidepressants. She feels in control and that's all that matter.

Patients are no guinea pigs to validate researchers hypothesis. Patients want to be well safely. When they are, they are treated correctly.

The NICE menopause guidelines were produced to help non-specialist drs as well as women be more informed and make the best choice for treatment. Like all Nice guidelines, they are published after extensive consultation with a range of specialists and researchers.

They key part of these, re. HRT or ADs, is that HRT is the first line of therapy when mood disorders coincide with peri or post menopause and there is no previous history of depression or extenuating life events at the same time.

This latter problem is at its worst in the few years before the cessation of periods – the transition phase. This subgroup of depressive disorders is called Reproductive Depression (RD) and are important because the causation is endocrine rather than psychiatric and the most effective and logical treatment is by hormones rather than antidepressants.

The NICE guidelines say this:
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)

They also suggest CBT and other talking therapies as a first-line treatment, with HRT.

ADs are suitable as a treatment for hot flushes for women who cannot use HRT due to previous or current disease, such as cancer.

Many GPs prescribe ADs because they are not confident about the right HRT to offer, or they have not kept up to date with the research on HRT which has replaced the discredited research, which exaggerated the risks.

It's never been proved that HRT causes high blood pressure. Women with high BP can use HRT as long as they are treated for high BP at the same time. Obviously high BP can occur during periods of stress which may be caused by mood swings due to hormonal changes.

There is plenty of evidence that HRT improves arterial health and subsequently heart health, by measurement of the carotid artery and lipds in women using HRT.

Chockaholic it is very common a lot of gyns have absolutely no idea about the whole meno issue and we have to get informed and find the suitable treatment for us!
That’s the main reason I use the forum.
When I diagnosed with early meno at 42 I was suicidal and I had no history of depression. Actually I can distinguish between clinical depression and hormonal.
With hrt I am back to my normal self! No signs of depression and no dark thoughts. It was impossible for me to continue my work and my life in general without hrt.

And I think that there is a way to distinguish between clinical depression and hormonal. If taking hormones we feel better that is a sign for me that we need estrogen and not antidepressants. I am not an expert, it is my personal view of course.

@chockaholic This thread and my posts are not about you. You are not the OP who asked the original question. Information linked to here is for any women reading this who need information. It is not my opinion. Your posts are your opinion and based on yourself and and the advice of one doctor (who doesn't seem that clued up to be honest. As Emerald has said, mental health drs can diagnose true depression.)

The NICE guidelines and the BMS advice are the advice of many years of research by many experts. They are not 'theories' or hypotheses, and women are not 'guinea pigs' as another poster said.

Being sarcastic and personal in posts is not terribly adult or helpful. If you want to take drugs that may not help you or indeed have side effects, that's your choice. But to get angry and personal just because another poster is linking to best medical practice, is rather odd to say the least. Makes it look as if you have another agenda.

And if you want to dismiss the advice a specialist GP like Dr Newson, get the spelling of her name right! I wonder how she would view your rant ????

It's great you are feeling better, but don't come along getting all angry at another poster who simply links to medical advice!

If taking hormones we feel better that is a sign for me that we need estrogen and not antidepressants.

If someone has side effect on HRT, most drs would offer another sort before stopping HRT. And of course it's hard to distinguish between high BP caused by other things such as anxiety, which may be hormonal- driven in itself.

High BP is very rare with HRT because the dose is tiny compared to the Pill. It's usually found with the horse urine Pre- type ( Premarin or Prempak) rather than body identical types, and transdermal patches or gel are far less likely to affect BP.

Just a quick note to remind you that antidepressants can make you feel worse for a couple of weeks before they kick in.

And you should ask for psychotherapy first and not antidepressants! They had a lot of side effects and they are not a medication forever. You can depend on them very easily if you use high doses.