Never Used Antidepressants Before, Still Can't Get Over It

[Sharonz]

I'll preface this by saying I think mental health is a legitimate part of one's total well-being. You can't holistically be healthy without treating and tending to all aspects of who we are.

That said, I am perimenopausal, early 40s, and have been taking low dose antidepressants to help with sleep for several months. I am on HRT, too. I started on the antidepressant a few weeks before I was able to get on HRT because my sleep issues were so desperate. For months before that, I resisted these types of meds because I do not have an official mental health diagnosis. But it turns out that the meds prescribed (Remeron/Mirtazapine) actually broke my cycle of insomnia.

I've been on HRT for about three months, and at times I have slept okay without the low dose antidepressant. But I find I need it about hald the time and have decided to just start using it consistently because I am tired of the merry-go-round.

A good thing is that the amount I need/use has been cut down by a lot. I'm using only a quarter of the original prescribed dose. But I still cannot get over having to take this medication. I never had sleep problems or anxiety, and now I see that so many women on HRT still continue to have sleep issues. I wonder, is this going to be a long-term medication for me?

Anyone else in this boat - on antidepressants now due to perimenopause (for sleep or anything else) and never needed them before? How did you overcome the stigma in your mind about using them?

Please don’t think about the stigma attached to any medication that supports with mental well-being. Times have changed so much, people are much more accepting and aware of mental health issues.
Also, who else really needs to know what meds you are prescribed? It’s really nobody else’s business.

With any medication like Mirtazipine, consistency is key, so you do need to take as prescribed, unless your GP prescribed it as a when required (PRN) medication?

How long have you been on the HRT for? And had the dose been reviewed as if your symptoms are settling then increasing again the dose may need adjusting.

Sorry should have added, I’ve taken anti depressants in the past, initially I didn’t like taking them but I know that I wouldn’t have gotten well again without them.

@Sharonz I'm trying to be kind here and this is no judgement about you.

NICE says very forcefully ( see Guidelines above) that GPs are not to prescribe ADs for peri menopause for any reason except if women have a formal diagnosis of depression that is not hormonally driven.

Your GP was wrong to offer you ADs. NICE says the first line of treatment is HRT.

There is masses on this in the website of Dr Louise Newson (meno GP) where women have been talking about being given ADs incorrectly.

There was a whole generation of women being given ADs by misguided GPs and meno specialists are trying all the time to get the message across to GPs.

I've used HRT for over 10 years (I see a consultant) and insomnia was one of major issues. I have tried to stop HRT and insomnia came back quickly. My consultant says lack of sleep can cause many other serious health issues, long term, so it's a good reason to use HRT.

Medical advice (and not your GPs) is that you should try increasing your HRT to get relief from the insomnia. You have only use it for a very short time so perhaps the type and dose needs some adjustment.

I'd also add that if you are only early 40s, you are classed as having an early menopause (depending if your periods have stopped or almost stopped) so you will need a larger dose of estrogen compared to older women.

The other option for young women is the CCP Qlaira. This contains the same type of natural estrogen as HRT and can be very helpful for younger women like you.

which hrt are you on now and the dose?

I'm in the US, but I am aware of the NICE guidelines. I'm on a .125 estradiol patch and 200mg progesterone, continuous. I am not menopausal, but perimenopausal. And, yes, early 40s. My current dose reflects the increase. I have heard of some women going as high as .150-.200 estradiol patches.

Why are so many women on HRT and antidepressants then? For sleep, mood, hot flashes, etc., particularly if HRT is supposed to fix it all?

I went on mirtazapine for insomnia (and related depression), albeit nothing to do with menopause. When I told my parents I was about to start taking them, they were sad and disappointed, as if I had let them down and it would have been better to suffer than take medication. They seemed to be more concerned about the medication than about how fucking awful I felt. I saw it as taking control of my situation and getting better, and their upsetting reaction spurred me on to feel actively proud of the choice I had made, and I told anyone who would listen that I was on antidepressants! Like you, I didn't need a large dose. I took them consistently and they massively improved my health. After 18 months, I had come off them and felt completely myself again. I don't know if my response helps with your question of how to handle the stigma, but this is my experience anyway.

@Sharonz

I'm in the US, but I am aware of the NICE guidelines. I'm on a .125 estradiol patch and 200mg progesterone, continuous. I am not menopausal, but perimenopausal. And, yes, early 40s. My current dose reflects the increase. I have heard of some women going as high as .150-.200 estradiol patches.

Why are so many women on HRT and antidepressants then? For sleep, mood, hot flashes, etc., particularly if HRT is supposed to fix it all?

@Sharonz Based on what you have said, the type and dose doesn't sound right.

In the UK the highest dose of estrogen only patch is 100mcgs.

Also, the dose of 200mgs daily for Utrogestan is odd. In the UK the dose is 100mgs if used daily, or 200mgs x 12 days per month.

200mgs daily is a huge dose and may override the benefits of estrogen.

Women who are being given ADs should not be. It's as simple as that, unless they are diagnosed as clinically depressed.

Here, women are advised to use HRT for at least 3 months (the time you have been on it now) to see if they feel better. Ideally, you should not use ADs and get your dose of HRT correct. Has your dr explained why they have put you on 200mgs Utrogestan daily? That is likely to give you side effects.

Also in peri women do not use continuous combined hrt- they use it in a cycle. so that's progesterone for 12 days

Thanks, Jingling.

Actually continuous is fine in peri, 100mg continuous is only the minimum needed for endometrial protection. Higher doses help additionally with sleep, night sweats and anxiety. In fact, continuous doses as high as 300mg are not uncommon for those reasons.

I combine a .1 patch and a .025 patch, thus the .125mg overall. What you are referring to are common minimum dosages, and those minimums, I suspect, are why so many women end up in a polypharmacy state -- they are underdosed.

Thanks, PirateHugs.

What dose(s) of mirtazapine were you on? I was never diagnosed as being depressed, only the insomnia and, I guess, low-level anxiety, but the sleeplessness was the prevailing issue. I am sure the HRT is helping a lot, otherwise there is no way I would have been able to go down from 15mg at the start to 3.75mg now. I really don't have a sense of "shame" per se, because AD's are prescribed for all kinds of reasons - even pain management in the case of meds like Cymbalta or migraine headaches in the case of amitriptyline.

My inner struggle has been the association of me being on an antidepressant but without a diagnosis of depression, just perimenopausal-based insomnia. My hope is that I will be able to discontinue it entirely, as I am in general not a fan of being on any medications unnecessarily (I am the type of person who puts off taking meds for even a headache, in case it starts to go away on its own). Plus, I hope I can discontinue it without incident, without all the issues so many people talk about with ADs, though I am on such a low dose, it may not matter much.

@Sharonz quite a bit of the points you have made about dosage are not accepted in the UK , so it looks as if US drs work differently perhaps?

(The US approach to HRT has always been different as conjugated estrogens were used and still are whereas here they are avoided by most drs.)

Many women find 200mgs Utrogestan far too much and actually makes them hotter at night and have poor sleep. In the UK the amount of progesterone tends to be kept at the lowest amount for safety.

I doubt women in the UK are under dosed. The starting dose is usually 1mg daily, sometimes 2mgs and for very young women can be 3mgs (using gel.)

Hi!

Hoping someone will help me with their experience.
Sorry for my spelling, English is not my firt language.

So, I am 48 perimenopause: struggling 3 months with night hotflashes which keep me wide awake from 2 am till 6 am when I get up unable to function. Sleep deprivation caused my anxiety, now I am depressed.

Tried Hrt Lanzetto spray 2 pumps and Utrogestan for 12 days. After 1 month my anxiety was through the froof and depression was even worse.

Then I tried Trisequence pills and I was really really suicidal. Stopped after one week.

Now I cant get out of bed, I cant wash myself, cant eat, crying constsntly wishing to be dead.

I went to gp and was prescribed 15mg mirtazapine. I took it 2 years ago after having trouble sleeping because I was suffering from long covid and it helped. Problem was getting off that drug because of horrible withdrawl which lasted 9 months!

I am desperate what to do. I don t want Hrt!!!!
Anyone here with the same situaton? And only mirtazapine helped?

Would be happy and gratefull for any information. Thanks!

Emmi