Antidepressants for peri/menopause?

[Crankylanky]

Doctor has offered me escitaprolam for anxiety and depression. I’m peri menopausal / menopausal . Been researching and some sites say antidepressants don’t help hormonal related mental health. Others do. (And actually it may not just be hormone related- think I’ve always had anxiety and at times depression, just never been treated before). What I’m confused by is the fact that SSRI’s really seem to help with PMDD . And that is obviously a hormonal condition. So following on that logic , surely they’d be beneficial for peri menopause too? Anyone on them and thinks they help?

I can only speak from my experience.

I have taken Fluoxetine (SSRI) for about a decade for PMDD. I have upped my dose since perimenopause hit, as my mood was so low, BUT I only did this after starting HRT and feeling like I still needed more help with my mood.

Too many GPs offer SSRIs first before discussing HRT with women - the NICE guidelines are clear that this shouldn’t happen.

For me, the combination of HRT & SSRIs has been helpful for my peri symptoms (which included low mood).

I was given sertraline along with my hrt, it has really helped to even put my moods, I was at times completely vile and just couldn't do anything about it. I'm much easier to get along with now:)

@YellowMay did you take fluoxetine continuously for pmdd or the 2 weeks before period ?

Continuously - 20mg daily, which is a fairly low dose. Worked like a charm until perimenopause started in my mid 40s. I now take 40mg daily, alongside HRT.

I was offered first Prozac (fluoxetine) and then Citalopram for my peri-menopause related anxiety and depression. Did not do a single thing.

Estrogen patches on the other hand made me feel 100 times better.

I’m in your situation. Sleep deprivation and perimenopausal hormones can cause poor mental health. I started HRT first and while it helped , taking citalopram in addition to this has made a big positive difference

I developed awful anxiety as a result of menopause and went on Sertraline. A while later I went on HRT for other symptoms. The combo defo helps me.

Thanks , good to hear it offered a benefit in addition to hrt.

@Crankylanky NICE guidance stated categorically in 2015 that ADs are not to be used for depression linked to menopause.

Sadly, some GPs are now 8 years out of date.
NICE

Psychological symptoms1.4.5
Consider 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)

They don't help and drs like Dr Louise Newson has a LOT to say on this on her website.
[[https://www.newsonhealth.co.uk/wp-content/uploads/2021/07/Antidepressants-and-menopause-v21-02.pdf

And it's against medical guidance now.

There is also - as of 2 weeks ago- a massive drive within the NHS to stop over-prescribing ADs to everyone.

I hope that the posters here who are using it will re consider and challenge their GPs as it is not advised. HRT and getting the right dose is the treatment.

I've had a GP appt about the same thing this week. I've been on SSRIs for several years already for the anxiety, but they're not cutting it now for the sweats and insomnia.

She's suggesting going BACK ON the contraceptive pill, for the estrogen rather than trying HRT.

What did women do 70 years ago? Just go insane?

Mind you I guess many women didn't live as long previously. Or we just didn't matter.

Thanks .I am aware of this but sometimes I think medication may be needed additionally. I have always had anxiety , but menopause and various other life events are amplifying it.

Absolutely not appropriate treatment for peri/ menopause. Ask for Oestrogel and Utrogestan- that’s the gold standard treatment.

CBT , mindfulness, or counselling to help with anxiety and HRT for peri.

There is a huge placebo effect with ADs as recent research has shown hence the advice to GPs to cut back on prescribing.

Don't have depression/anxiety but unable to take HRT due to oestrogen +ve breast cancer. Prescribed citalopram due to debilitating hot flushes. Now on venlafaxine due to supply issues. Wish there were non-hormonal alternatives for the other symptoms!

I started on fluoxetine initially but found it made my anxiety worse.
I'm on sertraline 50mg now alongside HRT (patches and tablets) and it's really helped.
I take the sertraline all the time.

I was briefly on HRT which was great. Diagnosed with breast cancer, so had to stop, which I was gutted about at the time. Started sertraline due to anxiety that I have always had but had increased with peri and it's helped enormously.

Interesting , do you know why she’s suggesting the pill, rather than hrt?

I hope you’re coping x

Fit as a fiddle, didn't want to derail. Best of luck to you finding what works for you x

Fluoxetine for menopausal anxiety has been a game changer for me.
I don't want hrt and I'm happy to stay on Fluoxetine forever if need be.

What I’m confused by is the fact that SSRI’s really seem to help with PMDD . And that is obviously a hormonal condition. So following on that logic , surely they’d be beneficial for peri menopause too?

There are other specialists who think the exact opposite.

The late Prof John Studd was a pioneer in this and he advised women with PMDD using estrogen as yes, it is hormonally driven. [[https://www.studd.co.uk/pms-effective-treatment.php#:~:text=The%20most%20effective%20treatment%20is,coagulation%20factors%20in%20the%20liver

Your GP ought to follow NICE guidance which is not to use ADs as first line therapy, but use HRT and work on your finding the right dose.

Personally I’d try the HRT before ad’s
too many gp are turning to ad’s when it’s an hormone depletion problem

I wish I’d of known then that I know now, many gp’s are clueless
if your not on antidepressants before perimenopause then you should try HRT
if your already on ad’s then increase dose to see if it alters you

I was definitely peri at age 38, when I had sleep related anxiety. The doctor said I was too young and prescribed Sertraline.

Fast forward 6 years I’m now on HRT and am probably the other side of menopause. I first started with Oestrogen (merina coil also) and had hoped it would help my insomnia, but when I try and come off sertraline it kicks right back in.

I’ve now started testosterone and once I’ve been on that for six months or so I’m going to try and come off sertraline again.

The sertraline definitely helps with anxiety, but I am hopeful that getting my hormones sorted will also help. I would like to come off sertraline as it does affect my libido but it is a bugger to come off and will probably take me about 18 months to do it properly.

If I could go back in time, I wish I could have had HRT then with testosterone to see if it helped, before starting ADs. Sertraline has been great for me, but I would have liked to have tried HRT first.

I tried HRT for perimenopausal anxiety and depression. Due to ongoing hormonal issues with PCOS I was referred to a specialist to get the right dose. We never managed to get it right despite trying all kinds of combinations, does and products. In desperation my GP asked me to try Fluoxetine, which I agreed to. I’m not exaggerating when I say that stuff saved my life.

This thread is really interesting. I guess one size does not fit all.
My GP went down the line of HRT first including a gynae referral with someone good who wants to get my hormones right but I’m desperately anxious .
I have had anxiety/ depression in the past.
I’m also having CBT. The citalopram has made me feel better in a short period of time.

It’s really difficult to be early 40s with normal bloods to tease out how much is perimenopause and how much is anxiety.