Increase HRT or SSRIs- depression

[Orangesandlemons77]

I'm 47 and have a long history of quite severe, recurrent depression. I also had PND.

Last couple of years my helpful GP has increased my fluoxetine from 20mg to 40mg and I'm also on 5mg Olanzapine and a pain med for neuralgia.

Last year after hot flashes started I started HRT patch after 3 months going from 0.25 to 0.5 and have progesterone 200 two weeks on and off.

I was getting panic attacks and fast heart rate with the hot flashes and this has improved although still sometimes waking wit a racing heart, feeling tired in the day

I'be been really low and tearful last few weeks and wonder whether to ask about increasing the fluoxetine or the oestrogen. Any advice welcome.

I can't afford a menopause clinic although the GP is good and pro HRT.

Medical advice is to increase estrogen. (I know you have a history of using ADs but these info sheets refer to general use of ADs v HRT.)

50mcg patch is quite low and you could go higher.

You could also ask about long cycle HRT which NICE says is suitable for women who find progesterone affects their mood.
Long cycle means 10 weeks of estrogen only and 2 weeks of progesterone.

https://thebms.org.uk/wp-content/uploads/2022/12/09-BMS-TfC-NICE-Menopause-Diagnosis-and-Management-from-Guideline-to-Practice-Guideline-Summary-NOV2022-A.pdf

https://www.themenopausecharity.org/wp-content/uploads/2021/05/Antidepressants-and-Menopause.pdf

Thanks that is really helpful, I think I will get in touch with the GP again and ask about this. He's really good and pro-HRT so I think he will be helpful, he said I could get in touch anytime

Sorry for repeating myself! Argh- memory!

How does the ten weeks / two weeks of progesterone work with the menstrual cycle? Or is that for people who have stopped having periods? Thanks PS if there is any link to this I can show my doctor that would be great.

Sorry about all the odd bullet points here . I've edited the info you don't need but the main points are here and the full text is in the link.

https://cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/

• Regimen
• The hormone replacement therapy (HRT) regimen used depends on whether the woman is perimenopausal, postmenopausal, the route of adminstration, and the woman's wishes.

• For perimenopausal women, monthly or 3-monthly cyclical regimens may be used.
• A 3-monthly regimen may be more suitable for women with infrequent periods or who are intolerant to progestogens. See the section on adverse effects for more information.
• A monthly regimen produces monthly bleeding whilst a 3-monthly regimen produces a bleed every 3 months.
• A continuous combined regimen is not suitable for use in the perimenopause or within 12 months of the last menstrual period.

Probably should have asked first but I changed patches yesterday and put on two of the 50 ones to see if any difference. Still happened this morning but maybe too soon to see. It's BH so can't contact the GP, might try this week.