Antidepressants

[vivainsomnia]

They have very bad press here. Many complaints about how GPs just prescribe them as soon as menopausal symptoms are mentioned instead of discussing HRT.

I was lucky, my experience was the opposite. GP suggested HRT before I had even considered that my symptoms were due to the menopause. It took a year or so for symptoms to get worse to decide to go on it. As recommended, I stuck it out for 3 months + and it was a disaster all around and just felt worse.

This led to trying 3 more HRT regimes, the last one under the care of the local hospital gynae consultant. Still no benefit and only feeling worse. I even try a drug normally given to people suffering from ADHD but can help with the menopause. It only made me feel awful with the side effects, no benefits at all.

Finally, 5 years later, living like a zombie through the chronic insomnia, I relented and decided to try an antidepressant. Didn't believe in it all, I just took it to tick it off the list and justify that nothing helped at all.

Except that it did. It took 2 months and I did struggle the 1st 6 weeks, but almost 4 months on and I'm a different person. I am finally sleeping again. Not sleeping but enjoying sleeping. Going to bed knowing I won't be awake at night, waking up in the morning feeling all comfy and getting up without feeling dizzy and sick.

I wish I'd had a crap GP, one who'd put me on antidepressants from the start. It would have saved me 5 years of hell.

HRT works well for a majority of ladies who need medical help. If it doesn't though, don't dismiss antidepressants. Somehow they might work for you. Through it all, I felt utterly exhausted and frustrated but never depressed so didn't think it could help me. It certainly did. I'm so relieved to be starting to be me again.

The only problem is that ADs do not offer bone or heart protection, or relieve aching joints and many more symptoms.
They also can have many side effects, compared to HRT.

It's not 'bad press' but actually guidance from NICE that says ADs are not to be used.

Obviously no one here knows you, or what HRT you tried, but there are very much more than 4 types. There are 4 types of progestin alone, without factoring in the different types of estrogen doses.

Anyway it's good you are on something that works, but no way should the clock be turned back with GPs offering to give women ADs as a first step for menopause.

I don't understand why you didn't try anti depressants alongside HRT?

What was the ADHD drug?

Another thumbs up here for antidepressants for menopause. Have tried hrt but seem to be intolerant for progesterone, so what to do? Have terrible vaginal dryness and fatigue which antidepressants don't address.

I take both ADs and HRT. Both have significant benefits for me.

The only problem is that ADs do not offer bone or heart protection, or relieve aching joints and many more symptoms
To be honest, I'm much less concerns about that than I was of the outcome poor sleep was having on my health.

As it is I exercise a lot, running, cycling, and at least 10k walk a day. Can't do better to protect against bone loss and heart disease.

no one here knows you, or what HRT you tried, but there are very much more than 4 types
When the private gynae (hospital gynae with 30 years experience) told me that she didn't know how to help anymore after all I tried, she admitted that hrt just didn't suit everyone and she suggested I tried antidepressants.

Anyway it's good you are on something that works, but no way should the clock be turned back with GPs offering to give women ADs as a first step for menopause
I never said that. The point of my post is that antidepressants shouldn't be dismissed, especially for women who have not get on with hrt. I met quite a few who didn't and felt that was the end of the road for them like I did and didn't believe antidepressants could help.

Just to add that I think the main benefit has been in terms of physical anxiety. I used to feel constantly flooded with adrenaline.

HRT made me feel much more anxious rather than less. Why, I don't know but it had the opposite effect on me.

I had tried propranolol but that left me feeling horribly dizzy and lightheaded, probably because my resting heart rate is very low already.

The other drug I tried was clonidine. I didn't do well on this at all, but it seems to work for some.

That's great that antidepressants have helped you. I started sleeping much better almost as soon as I started taking them years ago.

It's interesting what you say about being flooded with adrenaline during menopause. I started HRT just before Christmas for exactly this reason. I knew that it was a physiological thing as the only time I've experienced the same type of insomnia was when I was doing lots of long distance running training for a marathon and the adrenaline kept me awake.

HRT hadn't completely solved my poor sleeping, but I don't have the experience of 'getting more and more wired and awake' from the moment I go to bed which I was getting, so I'll take that as a win for now.

As it is I exercise a lot, running, cycling, and at least 10k walk a day.Can't do better to protect against bone loss and heart disease

Sadly that is not true. I could link to a top rheumatologist's website (John Stevenson, if you want to look) where he says that exercise doesn't help bones much at all and it's estrogen that counts.

How many different types of progestin did you try? And what mode of delivery? patch, gel, tablets?

TBH 4 types is not very much. I'm only saying this as I'd hate women reading to think there was no HRT to suit them after trying only 4 types.

There are countless combinations, including at least 4 types of progestin, doses of estrogen ranging from low - 25mcgs daily- to 100mcgs daily- and so on. I think my gynae with an equal amount of experience may have found more options for you to try.

OP can I ask what AD you are taking? I have increased my dose of citalopram (been on ADS nearly 30 years) to help with horrendous anxiety which seems to have a hormonal link. I tried hrt recently for 9 weeks but then got completely spooked by the thought of the progesterone as I was seeing some decent improvements with the ADS. So I've stopped the patches. But these week, even before I removed the patch, my physical anxiety is back and as I am getting period pains I think it may be related. I'm wondering if I need to increase my Ad dose . I was an inpatient at a psychiatric hodpital just before Xmas and it's been a horrendous few months. I can't bear the thought of staying like this, or even feeling like this before every period.

Sadly that is not true. I could link to a top rheumatologist's website (John Stevenson, if you want to look) where he says that exercise doesn't help bones much at all and it's estrogen that counts
And my local rheumatologist says differently. I had a dexa scan done a few years ago and my results were excellent. My grand mother and mother never took her despite an early menopause and have/had very strong bones.

My MIL who is still taking hrt at 20 suffers from osteoporosis, so although I don't dismiss the benefits of oestrogen on bones as a whole, it doesn't mean every women should take it as a preventive measure.

TBH 4 types is not very much. I'm only saying this as I'd hate women reading to think there was no HRT to suit them after trying only 4 types
Why oh why would I keep trying it when each time I felt much worse and now 7nder antidepressants, I feel really good and almost 109% back to my old self! To make it worse, my last try left me with a very thick lining despite taking the recommended dose of progesterone and worrying hospital investigations. So no thank you. It is quite side for you would need to try 5, 6, 7 different regimes, each time giving it 3 to 6 months to wait for a benefit, feeling dreadful for potentially years, when ultimately, another treatment might make them feel much better in a few weeks.

I posted because this board is very pro hrt and dismissive of antidepressants. This is absolutely fine as indeed hrt is a life saviour for many. But not everyone.

If I hadn't been coming on this forum regularly, I expect I would have tried antidepressants sooner so just wanted to share my experience for others who might be in the same position I was.

@SameKeyThough, I take Paroxetine. I was on it briefly in my 20s and tolerated it well so decided to go back in it rather then try one of the newer ones.

I'm sorry you are struggling so much. I can't imagine what the menopause must be lack when you are already suffering from chronic anxiety. I hope you find the right treatment for you, whichever works best or in combination.

@MiddleAgedLurker, I'm glad cetirezine works for you. I have been in it day for over 20 years now due to a chronic dustmite and mould allergy and sadly had no impact on my insomnia.

It's been about a month now that I've rediscovered the pleasure of sleeping and I am gradually starting to get the benefit of long term good sleep. It's so amazing. Chronic insomnia is horrible and the worse vicious circle. It's poorly understood and not even considered a disability even though it does leave you very disabled in every day life.

@vivainsomnia

They have very bad press here. Many complaints about how GPs just prescribe them as soon as menopausal symptoms are mentioned instead of discussing HRT.

I was lucky, my experience was the opposite. GP suggested HRT before I had even considered that my symptoms were due to the menopause. It took a year or so for symptoms to get worse to decide to go on it. As recommended, I stuck it out for 3 months + and it was a disaster all around and just felt worse.

This led to trying 3 more HRT regimes, the last one under the care of the local hospital gynae consultant. Still no benefit and only feeling worse. I even try a drug normally given to people suffering from ADHD but can help with the menopause. It only made me feel awful with the side effects, no benefits at all.

Finally, 5 years later, living like a zombie through the chronic insomnia, I relented and decided to try an antidepressant. Didn't believe in it all, I just took it to tick it off the list and justify that nothing helped at all.

Except that it did. It took 2 months and I did struggle the 1st 6 weeks, but almost 4 months on and I'm a different person. I am finally sleeping again. Not sleeping but enjoying sleeping. Going to bed knowing I won't be awake at night, waking up in the morning feeling all comfy and getting up without feeling dizzy and sick.

I wish I'd had a crap GP, one who'd put me on antidepressants from the start. It would have saved me 5 years of hell.

HRT works well for a majority of ladies who need medical help. If it doesn't though, don't dismiss antidepressants. Somehow they might work for you. Through it all, I felt utterly exhausted and frustrated but never depressed so didn't think it could help me. It certainly did. I'm so relieved to be starting to be me again.

Thanks for sharing your experience. You are right that this particular forum is pro-HRT to a fault. Many women likely continue to suffer because of this, thinking the problem is them and not that perhaps it's just that a different alternative better and more efficiently suits them.

I was very anti-antidepressants before I learned what I know now. I have read hundreds of medical articles, research studies and personal testimonies to understand why and how ADs help perimenopausal women. Much of what I've seen says thar HRT plus a low dose antidepressant is the prime combo for many women.

The reality is that HRT only means estradiol and progesterone/progestin (and occasionally testosterone). The levels customarily prescribed are pretty conservative, which means that the neuroendocrine issues spawned by perimenopause may still go undertreated.

The women here should know better than the ever say never. Like you, too many have to find out the hard way due to the "HRT or nothing" crusade.

You are right that this particular forum is pro-HRT to a fault.

No, this forum is repeating what is stated in the NICE guidance 2015.

Psychological symptoms

1.4.5Consider HRT to alleviate low mood that arises as a result of the menopause.

1.4.6 Consider CBT to alleviate low mood or anxiety that arise as a result of the menopause.

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).

This guidance is sound and evidence-based medicine. It may be different in other countries (like the US) but it's the guidance here in the UK. The US has a history of being behind the times with HRT, especially in their use of equine estrogens.

balance-menopause.com/uploads/2021/09/Antidepressants-and-menopause.pdf Another medical report.

It has taken decades to stop GPs offering menopausal women ADs as the solution.

I am pleased the OP has found something that works for her. But the guidance is that unless a woman has had previous depression, or can't use HRT for other reasons, ADs are not first line treatment.

This is not a personal opinion so it's not being pro anything. It's medical guidance in the UK.

@Sharonz, exactly what you said. I too was against antidepressants. I wasn't even depressed so why would I go on it. And yet...

@JinglingHellsBells. My issue was never about low mood. I suffered from depression for a few years in my early 20s. I know what depression is like. This was never my issue during peri and after.

My issue was a constant feeling of hyperness, not able to relax no matter what, feeling that my body was rushed with adrenaline and nothing I did helped. I had removed all stress in my life. I did cbt, meditation, yoga. You name it, I did it and nothing worked. HRT made me feel much worse.

This thread is mot to advocate antidepressants instead of HRT. It's to give some other options if anyone is on the same situation than I. That antidepressants could help them when everything else has failed.

I don't understand the biochemistry behind it but OMG do I feel better on them. Not in terms of mood but in terms of anxiety and sleep. A life saviour.

This is not a personalopinionso it's not beingproanything. It's medical guidance in the UK
But I don't disagree with that. Nowhere did say it should be first line treatment. I said that it is worth as another treatment.

I didn't say ADs should be presented as first-line treatment, but in cases where HRT attempts have failed or provided only partial relief, they can help. Also, what good is it to undermine a woman's self-reported improvement when using them? Everyone's biochemistry is different. I would never tell a woman who's tried four types of HRT to keep struggling and suffering with different combinations for months or years when something else may help more expediently. In addition to the hundreds of medical articles I've read about this, I've also read dozens of medical books that address this in part. Literature from all over the world. I didn't understand how or why they could help until I did this level of discovery.

Women need to do whatever safely helps their symptom remediation and quality of life at this time. Nothing is without potential side effects, even HRT.

Women need to do whatever safely helps their symptom remediation and quality of life at this time. Nothing is without potential side effects, even HRT
Exactly that.

I spent hours trying to find narratives of women going through the same experience as me to try to find a remedy. That's what we all do.

If it helps just one other person, then it's worth posting.