Has anyone chosen to take antidepressants instead of HRT ?

[KangarooKenny]

I’ve very recently started HRT, but am very conflicted about it. My biggest complaint is not wanting to do things I used to like, such as holidays/days out/gigs. I’d rather not have the hassle and stay at home, where I like being. My dog is here, I’ve got a nice garden, country walks from my front door etc. And I know people have felt like this post covid, so I’m really not sure if it’s that, or peri.
So, has anyone taken antidepressants instead, what were your reasons for doing so, and how do you feel ?

Anti depressants do have side affects, should be avoided for long term use unless you have severe and enduring mental health issues (eg schizoaffective disorder) and are, for some people, very unpleasant to come off with lots of difficult withdrawal issues. Though for some it is a breeze to come off. Some people also experience worse symptoms when starting a course. There are many side affects that become increasingly common for longer term use.

anti depressants (SSRIs which are most commonly prescribed) work by altering the serotonin pathway in the brain, that’s it. They are not a cure, they only work on the serotonin pathway while you are taking them. They don’t permanently change the brain structure that we know off to date. In people with depression, that is caused by transient issues, this allows people the time and space to get help in eliminating the root causes . This could be therapy/counselling or just coming to terms with whatever triggered it, or changes in lifestyle.

in other words it is like a plaster. It helps with healing but is not a cure in itself.

if your mental health issues are caused by peri or menopause, you’re going to be in for a longish haul. In my case 14 years and still counting. Taking antidepressants for that amount of time is not likely to be the best approach, it will not cure the problems associated with hormonal changes, just cover one set of symptoms.

Surely the best approach is to first try to deal with the root cause and replacing those missing hormones with HRT? one type of HRT does not fit all, you may need to try a few and I understand some GPs are reticent to do this. Also some drugs are still on back orders.

GPs used to prescribe antidepressants as first port of call for menopausal and peri women who attended with mental health issues..even those that didn’t but were complaining of not being able to deal with physical symptoms. That is because of the scare stories around HRT during 1990s. Much of that data came form one, now debunked, study. Read up about this if you are concerned about HRT risks. Some GPs still think prescribing antidepressants is a better route than HRT unfortunately..they are neither HRT experts (there is little mandatory training on menopause for doctors) or pharmacists who have the training to understand more on the mechanism of drug therapies

I didn’t take HRT. I was scared off by GP. I’ve been on 2 courses of antidepressants over the last 15 years. They worked well for getting me through some difficult periods but I came off at 1 year in both cases knowing the long term issues. I still do get all the symptoms of menopause despite being theoretically “menopausal “ for last 6 years and now approaching 60. Not as often, but every now and then my ovaries are still putting up a fight 🤣. I do wish now I’d taken HRT to help me through the worst years. I gave up work and retired early because of the issues it was causing. Looking back I really was in a pretty bad way.

Read up the latest treatment recommendations on NICE . National institute for clinical excellence. They’re the ones that review all latest studies and make judgements on best treatments for NHS.

Here is link. It clearly states to avoid SSRI In 1.4.3 and 1.4.7explaims there is no clear evidence SSRIs work with low mood associated with menopause

www.nice.org.uk/guidance/ng23/chapter/Recommendations#long-term-benefits-and-risks-of-hormone-replacement-therapy

They are licensed still because when these drugs were first registered by MHRA in uk, in the early 1990s, HRT was being discredited and it was a useful alternative based on research at the time. The drugs are now “off patent” and made by generic companies and remain registered for all sorts of indications. I know this as I used to work for company who developed and manufactured SSRIs.

It doesn’t mean they are recommended by clinicians or in latest research. Your GP Is a bit out of date/ill informed to state this unless you’ve a history of depression. Just because it is registered doesn’t mean it’s the best approach for most menopausal women . It will be best approach for women with previous history of depression. See NICE guidelines.

I don't take ADs, no @KangarooKenny, but when I went to discuss HRT with my GP she tried to convince me that low dose of ADs would be a good idea. She said they would help with my anxiety and insomnia, and even help with hot flushes (which I don't really have).

So I do take issue with the PP who said:
To use ADs, you would need a diagnosis of depression and also contraindications to HRT. It's not a case of asking for ADs.

I don't have depression, nor was there any reason for me not to have HRT, which I did get.
It seems ADs are often offered to women as an alternative to HRT, even if that's not that poster's experience.

Also, @KangarooKenny I'm getting to be a bit the same about going out and doing things... just thought I was getting old and grumpy, didn't link it to menopause!

I have never had HRT ( at the time, not advised as I had breast cancer), and have never had AD'S.
However, my lifestyle and choices have changed over the years. Very similar to you, I went from guys and manic lifestyle to loving walking the dogs, wandering around NT properties, doing my garden and baking bread.
I still love walking the dogs, butI now swim in the North sea every day, travel north and south in my camper van and volunteer as a countryside ranger.

We change throughout our lives. It's great 😁

I didn't go from guys ( well, I did, but that's another story) I went from GIGS 😁

I have a similar story to @ViscountessBridgerton , I had a bout of really terrible anxiety and it seemed it might be menopausal but no tests were done and I was put on HRT but it didn't suit me and after several experiments with different types, a low dose anti-depressant has proved very effective. It also does seem to help with the hot flushes associated with anxiety and panic attacks, I'm not sure they were hot flushes on their own if that makes sense. I don't regret trying HRT at all though because my GP was doing what was in the current guidance and it could have worked, but for me, the side effects were unpleasant, even on lower doses and the anti-depressants have made me feel more 'me' again. I don't think you can tell from the outside which route will suit you.

So I do take issue with the PP who said
To use ADs, you would need a diagnosis of depression and also contraindications to HRT. It's not a case of asking for ADs

@IAcceptCookies It's the guidance of NICE. Not 'a poster who said...'

If you read the whole thread there are several posters quoting NICE guidance. GPs are supposed to follow this.

I and other posters left links to NICE and quoted the guidance for both use of (or not ) ADs and HRT.

As a PP did say, ADs were prescribed decades ago for menopause symptoms. There is an ongoing education programme for GPs to try to bring them up to date on this. Sadly, many are not confident on the prescribing of HRT or aware of the NICE guidance.

Factual medical guidance is being perceived as 'opinion'. The NICE guidance is now 7 years old. It took years to develop. GPs are supposed to be following it.

@JinglingHellsBells in your post at 07.53 (part of which I quoted) you didn't mention NICE... I do appreciate that that is where you got your info from though, as you later demonstrated. I may have misunderstood you somewhat, as I thought you meant that OP was wrong to think that anyone would be offered ADs by their GP in lieu of HRT. Apologies if I seemed snippy.

My point was that it does seem that ADs are indeed still bring suggested to peri women without diagnosed depression.
It's depressing how little the average GP seems to know about treating peri and menopausal symptoms 😒

OP just doesn’t want to hear anything that contradicts what she feels is ‘right’. Really not sure why she posted.

Was 48 when started most recent ADs now over a year on them. All the shit I described I was going through before I was given them the Doctor couldn’t decide if I was depressed or it was start of menopause.

today I’ve not had a period for 46 days, get the occasional hot sweat and now sleep at night. Before ADs I was amoody stroppy bitch , hot sweats and not slept for more than 3 hours ever night

OP is I think asking that since her symptoms are currently confined to “mental health” type symptoms, she’s conflicted as to whether they are normal and related to changes in life, are hormonally driven, or related to depression that isn’t hormonally driven.
OP I would say you are going to have to wait at least 3 months to see the impact of the hrt and then reassess.
I do know what you mean about reduced drive to do stuff, but this doesn’t necessarily mean depression. Have you tried completing the depression scale? It doesn’t sound like you would meet the criteria.

So many posters have missed the OPs point that there is no indication as to the cause of her symptoms. She and the GP do not know if her recent lack of interest in things she enjoys is associated with menopause or with mental health. It could be either as posters have pointed out.

I think OP, you should try one or the other- HRT or ADs and see which works best for you and compare the relative risks of them based on your individual health profile. The only thing I will say is that many people do take ADs long term, it is entirely possible to take them for decades.

Low dose Ads can be prescribed for hot flushes, I'm thinking of trying them. I can't tolerate progesterone well at all so while some more Oestrogen would be good I don't feel like putting myself through the horrid symptoms I get from progesterone (my own natural Progesterone as well as that in contraceptives etc.).

The point is the many women are being offered AD's when they should be being offered HRT. This is well known. GP ignorance.
But, If you want AD's then rock on!

This isn’t true. Losing interest/joy in things you used to enjoy and isolating yourself (being antisocial) are two symptoms of depression. And you don’t need a diagnosis of depression these days to try ADs as GPs can prescribe in cases of suspected mild depression nor does a menopausal woman need to have contraindications for HRT to be prescribed ADs for suspected depression. We are more than a walking womb! Not every ill we suffer is caused by hormones.

From NHS (I have bolded the symptoms the OP has reported)

The psychological symptoms of depression include:

continuous low mood or sadness
feeling hopeless and helpless
having low self-esteem
feeling tearful
feeling guilt-ridden
feeling irritable and intolerant of others
having no motivation or interest in things
finding it difficult to make decisions
not getting any enjoyment out of life
feeling anxious or worried
having suicidal thoughts or thoughts of harming yourself

Physical symptoms

The physical symptoms of depression include:

moving or speaking more slowly than usual
changes in appetite or weight (usually decreased, but sometimes increased)
constipation
unexplained aches and pains
lack of energy
low sex drive (loss of libido)
changes to your menstrual cycle
disturbed sleep – for example, finding it difficult to fall asleep at night or waking up very early in the morning

Social symptoms

The social symptoms of depression include:

avoiding contact with friends and taking part in fewer social activities
neglecting your hobbies and interests
having difficulties in your home, work or family life

Thank you. The GP did offer it as an alternative as I said I didn’t really want HRT, she said it is licensed for it.

Thank you. I guess I should accept the change rather than push against it.
And travelling around the country in a motor home is on my ‘to do’ list, it’s just not very rock n roll 🤣

In short, yes. I tried HRT but had a few issues and after trying a few variations, decided it wasn't worth it. I am now on Fluoxetine and it has made an enormous difference. Your post was very interesting to me in that I think I am now in a much better position to say no to things and accept I am who I am and actually like myself. I felt a lot of pressure to conform and be someone I wasn't and have now let that go-I am a home-bird, happy in my own company or with a very small circle of friends. It doesn't make me bad or wrong, it is just me and people can like it or lump it!

If you read the title you can see I was clearly asking for examples not about HRT, which some people have kindly replied to.
Not sure why you posted.

I am not depressed, but thank you.

I was on HRT for a year, mainly because of anxiety, which was bought in by Covid and not working. I came if it a few weeks ago as I was just feeling worse, my hormones, feelings, thoughts were all over the place.I only had anxiety, no other symptoms like hot flushes etc. anyway, came off it a few weeks ago and went in AD's so far I feel so much better, but it is early days. I'm also convinced the HFT was making my hair fall out.

I hope you continue to feel better. Thanks for sharing your experience.

Yes, I took half a Citalopram each evening which dealt with my night-time hot flushes. I read an article about it and showed it to my lovely GP, who prescribed it off license. It doesn't work if you are already taking it for depression, oddly.

Travelling round the UK in a motor home sounds like an adventure. It may not seem very ‘rock n roll’ but if it’s very you, or even the new you, maybe that’s the point?I booked tickets to 2 outdoor music events which were rolled forward from the pandemic and when it came to going this year I just ducked out as just didn’t fancy it. I’m not booking any more.

I had tickets to a gig that I sold this year.I wasn’t up for sitting through two warm up acts, dashing for the last train, then paying for a taxi at the end.
We need gigs that finish early enough to be home and in bed by 10pm !