Help! Do't know whether to take anti-depressants?

[Onemoretimeround]

Hello
Hoping some of you lovely ladies can help. I'm 45 and have been on HRT for about a year now. I saw a private specialist in the end because my GP surgery was useless and I felt so alone. She put me on Lenzetto - four sprays - and utrogestan. But I don't feel good still, and she wants me to switch to the patch and try that instead.
Basically, in recent months I've just felt crazy and low. I wake up really teary and struggle through the days, feel such a lack of joy, and just really miserable. I also sometimes feel incredibly angry - outbursts at times that I find hard to control. Overthink absolutely everything and drive myself insane.
I had been taking 5-htp at night which def helped but have stopped now as I read it's not good to take long-term.
So now thinking of anti-depressants - but which one, and I'm a bit scared that once I start I'll never come off them? But also feeling a bit desperate now - my mood is just so meh and I feel my brain is really unmanageable.
Thank you...any thoughts v v much appreciated.
Also - WHEN WILL THIS END? I can't bear the thought that my hormones will make me feel this way until into my 50s.

Or shall I jsut start taking 5-HTP again as that definitely boosted my mood quite a bit? I stopped because I was worried I'd taken it for too long (on and off for a few years now).

You need a good chat with your GP. If they suggest anti-depressants then give it a go, you've nothing to lose and everything to gain. No-one can suggest which one to you as everyone is different.

You'll probably find you feel weird/worse for a couple of weeks when you start taking them but perservere. If, after a few months, they aren't doing anything for you then you can rethink (your GP should want to monitor you at first anyway). If you decide to stop, taper off them very slowly.

Good luck.

To put the other side, NICE says that ADs are not to be prescribed for women in peri meno/post meno until all HRT options/doses are tried.

Ads have their own side effects and often don't work.

You could also consider talking therapies like CBT.

I think my consultant would be suggesting you do other things before even thinking about ADs. For example, diet and exercise.

Are you exercising? Lots of evidence that exercise has the same MH benefits as ADs.

Maybe Lenzetto just doesn't suit you. What about Oestogel?
How much Utrogestan are you using?
Has your consultant suggested you could be intolerant to it- and offered another type? Like a Mirena coil?

There are many options with HRT which less experienced drs are unaware of.
For example, when I started HRT I was allowed to use only estrogen for 12 weeks to get the dose right. Then a progesterone was added in and it was only every 10th week. If you're paying a private specialist, I'd be expecting her to offer similar options but it depends how experienced she is.
Is she a gynaecologist or a GP who's set up as a private meno dr?

Thank you @JinglingSpringbells I exercise every day and have stopped drinking alcohol, and I'm also having CBT. But nothing seems the magic bullet. It helps though, of course. I also eat very heathily. Even taken up cold water swimming!

I am going to try the patch and maybe that'll be better. I think you're right Lenzetto doesn't quite suit me. The specialist is this person and seems good - was recommended - https://www.clairemellon.co.uk/dr-rachel-hines

I am thinking of the mirena coil instead of utrogestan.

urgh, I just don't know what the right solution is!

@JinglingSpringbells I take 200mg of utrogestan for 14 days a month at mo.

Apologies if you may have seen this on other posts - I've cut and pasted my story!

I was prescribed HRT > 5 years ago (already had Mirena coil and have worked through gel, patch and oral oestrogen with reasonably good results). But at the end of 2023, my anxiety, irrational rage, overthinking (borderline paranoia?), brain fog and other utterly shit symptoms just got worse. I was reluctant to increase my oestrogen yet again and my mood was desperately low, despite HRT.

I did some reading and chatted with my GP about trying an SSRI. She was very supportive and prescribed Sertraline. All I can say it that it's been an absolute game changer and I wish I'd done it years ago.

It did take 3 weeks to kick in but I feel like a completely different woman. DH, DD, DM and friends have all commented on how very noticeable the change has been. I am "happy" and myself again after a couple of years, far more able to cope with life's curveballs. I'd not realised how debilitating and draining it had been to feel like crap every single day.

So my story is very positive but I fully realise others will have a different experience.

I hope you feel better whatever path you choose

Also, my lifestyle was good - super empathetic DH and DD, good diet, appropriate exercise, strong friendship groups and my HRT tweaked via my really supportive Gynae consultant and GP.

So for me, it was the "chemical" intervention that seemed to be what I needed.

Why can't you continue with the 5htp?

I think you have to go with the NICE guidance. That says you should try different types of HRT before trying other drugs.

I'd be interested to know how you feel if you took just estrogen because Utrogestan is a very odd drug- some women love it as it makes them feel chilled out and the sleep better, other women hate it.

It's usually the type of progesterone that is the issue with moods etc.

You should also be aware that there are options for a reduced dose (down to 10 days a month) in women who are intolerant, or even a tablet type like Tridestra, which is progestin for 2 weeks out of 12.

@JinglingSpringbells thank you - good info. I find it all so confusing. I initially LOVED the utriogestan - felt so calm and slept better. I still sleep better on the days I take it, but it doesn't have the same affect on my mood now.

@Falifornia that's super helpful and interesting, thank yoU! I def feel pretty paranoid - it's horrible...

@Begby6789 I've read that you shouldn't take it ongoing for years - also it seems to stop working, so sometimes I take a break then start again.

Has your dr suggested using it vaginally?
This is how they mainly use it in France/ Europe and it avoids the nervous system.

I felt like you OP. Dreaded each new day starting. Full of anger, anxiety and sadness. 20mg per day of citalopram and I’m like a new person. Upbeat and cheerful and positive. I don’t take HRT apart from local estriol cream for bladder issues.

I've wondered about ADs on and off for years to be honest. My HRT appears to work reasonably well but have some very down days, especially when I've not slept.

@Cattery thank you - did you consider sertraline? Or just citalopram?

@JinglingSpringbells no - wondering if the mirena is a good option?

@Cattery hi - do you mind if I ask if the estriol has been helpful for bladder issues. I've been using Vagifem for same reason for last 6 months but doesn't seem to have improved.

Hi @dahliaaa I was put on Vagifem initially but was unable to tolerate it. I’ve now been using Estriol cream since March 2023 and it’s changed my life. No more UTIs or bladder issues. Can go 5-6 hours without a wee. Was going every 15-30 mins before. It’s been like a miracle x

The GP offered me citalopram. No other SSRIs were mentioned. I started taking it and I’ve never looked back x

It’s such an individual thing, we all seem to have to do trial and error until we find something that works for us. Lenzetto didn’t work well for me - I'm now on Sandrena gel and that’s working well. I’m also on Sertraline for the horrific anxiety I had, and that’s been a total game changer. Good luck op, there’s hope out there.

It's worth a try. But be aware that some women love it and others hate it.

If you're using private health it's far more flexible than the NHS and private drs have more options to prescribe off-licence.

I was offered a Mirena years ago but decided not to.
Had I gone ahead the idea was to give it a 3-month trial. My understanding from posts here is that it's harder with the NHS to get it removed quickly if it's not suitable (maybe that's not the case but it's what I've read here.)

Thank you @cattery - unfortunately I haven't had any bladder improvements with the Vagifem so may be worth me asking to try the estriol. Glad it's been effective for you.

I found the coil worse for mental health. The day I had it removed and most days since I’ve only felt relief it really was like a switch on removal day. It may have been different if they’d coupled it with something else from the offset but I felt I’d have got to age 51 with 2 coils back to back as the only ‘hrt treatment’.