Which anti depressant?

[Enigma52]

The time has come, I need an anti depressant before I cave into some kind of depression.

Post menopausal, can't have HRT due to secondary breast cancer ( hormone driven) no ovaries and on hormone blockers. My MH has fallen off a cliff! I'm raging, angry and sad.

I don't want one which causes side effects or makes me feel worse ( I've got to work).

Thanks.

I've read some of your other posts and am really sorry you're going through this.

Will your GP not refer you to a menopause specialist (usually a gynaecologist) to help?

There is also a very new drug out which helps with hot flushes.

I've read and listened to some things online with experts being interviewed and they seem to have a lot more options available than the average GP.

If you are able to access London, there are experts and clinics where you may get the help you need.

Try and see a psychiatrist. They are the experts and will be able to help you find the right drug/s quickly. Most side effects pass very soon and it might be worth taking a short time off work (like a week), to get through that initial phase. Good luck.

I e been on several different anti depressants. The problem is, different people react differently depending on the drug you take so it is a bit trial and error.

@JinglingSpringbells I've gone full circle with menopause specialists. After I had my primary BC, I saw a MS and was prescribed HRT for my symptoms and it worked.

When the secondary diagnosis was discovered last year, that was it, full hysterectomy and HRT quickly withdrawn. I'm now on hormone blockers which make things worse.

I take Veoza for hot flushes ( private prescription) but my mood is unpredictable, can't sleep, irritable and life is just hard. I just want to stay in my bed.

Even VA is flaring up ( systemic HRT and local oestrogen were needed to keep that under control).

I've told my oncologist all of this and they just shrug their shoulders.

My body is screaming for oestrogen. It's like ignoring a starving child when food is available!

How do you find a reliable and reputable psychiatrist?

There are guides about using ADs in menopause.

I left a link a few days ago to alternatives to HRT and it includes the full list of drugs (this is a BMS report) so a gynaecologist who is up to speed should help.

thebms.org.uk/wp-content/uploads/2024/09/04-BMS-ConsensusStatement-Non-hormonal-based-treatments-SEPT2024-A.pdf

thebms.org.uk/wp-content/uploads/2022/12/02-BMS-TfC-Prescribable-alternatives-to-HRT-NOV2022-A.pdf

You know that within the NHS your GP can refer you anywhere is the country to see a specialist?

I'm sorry for everything you're going through - it sounds appalling. I have no experience of the sudden extreme hormone drop you must have had, but when I started perimenopause sertraline was excellent at controlling the hot flushes, sleep and mood. For me it was as good as hrt, if not better for the anxiety and depression. I had a few side effects for a week or two after starting but they passed quickly. I highly recommend it, but as someone else said, everyone responds differently so it is trial and error.

Are you allowed topical oestrogen for the va? If so the cream may be better than the pessaries.

@TreesWelliesKnees thank you. I will get in touch with my GP again I think. What side effects did you experience if you don't mind me asking?

@JinglingSpringbells I will have a good read. Thankyou very much
for the links. I'm sure they will be very helpful.

@Enigma52 It made me very sleepy for a while. I struggled to stay awake. But some people experience the opposite with it. I was also slightly nauseous, but that was manageable. You won't know unless you try. I have been on it twice and the second time I started on half the dose the doctor prescribed - I just broke the tablet. That was much better and I just increased the dose after a couple of weeks with no problem.

I had hormone driven BC and stage 4 endometriosis and adenomyosis ( had full hysterectomy in April) so like you, I'm sudden menopause and no HRT.

My brilliant menopause doctor said there's a specialist HRT clinic in our largest city hospital that treats complex cases like mine with HRT , despite all the obvious barriers.

I'm trying to get through with Mirtazipine and magnesium , but my MH has totally fallen off a ledge lately and I'm going to ask her for a referral. I would maybe ask a local menopause doctor/nurse if there's a similar clinic in your area as you oncologist may not even know. Hope you get sorted, it's really grim.

@Redannie118 Yes it's awful, truly awful. There's no chance of me being able to take HRT ever again unfortunately. My BC is now stage 4 incurable, but treatable. That's why I have to take the hormone blocker.

I feel stuck between a rock and a hard place!

I hope you also get sorted and begin to feel well soon.

@TreesWelliesKnees how long before you felt better? Did it lessen the anxiety and depression for you? Are you still on sertraline?

@Enigma52 I felt calmer after a few days of sleeping well, and then the depression lifted gradually from about three weeks. I stayed on it for about a year and then weaned off it and started hrt, which was fine. Then a year or two later I had another course of it alongside the hrt for a year or so. I'm currently stable but still in perimenopause and I would go back on it without hesitation if I needed to, or if I couldn't take hrt.

@TreesWelliesKnees I've actually got some sertraline which I found in my medicine box. No harm in trying I guess. I'm going to try half a tablet (12.5) to begin with and see how I get on. I might wait until half term though, as I really need to be feeling okay when working at school.

Thanks for sharing.

I was given Femiston and Seroxat. Seroxat for the flushes. Within a week I had gone from physically and mentally not functioning in December to here, October looking and feeling 20 years younger and with a new job, I've bought a horse and met someone lovely and can't describe how wonderful life is. My GP originally said that HRT gives you cancer and that we shouldn't just demand drugs when life is hard. She suggested finding a religion to become less self absorbed. Bitch.

Femeston is HRT @TandyhatesAmanda

I can't have any HRT.

I'm glad you are feeling well again.

@Enigma52 Please watch this youtube by Dr Tina Peers and why she takes HRT after her breast cancer diagnosis.

I know how much distress you're experiencing from your posts. Dr. Peers and/or her team offer private appointments. As you may or may not know, Dr. Peers works very closely with Dr. Nick Pannay and I feel she can be completely trusted.

I'm so sorry for what you're going through.

I think an antidepressant is a good idea, but not necessarily an SSRI. Estrogen (which you're missing and can't have, as I understand) acts on dopamine in the brain too. The best antidepressant I have taken (and have tried almost all of them, including one MAOI) is bupropion. The easiest way to get it is by pretending that you smoke and want to give up. You can even buy it online for smoking cessation. A bit desperate perhaps, but if nothing else is working it's worth a try. I am now prescribed it permanently by my NHS GP. (I used it originally to give up smoking, but that was more than a decade ago.)

Oh I don't feel good at all. Hitting rock bottom fast ☹️ I don't understand how I can feel so awful.

I HAVE BC again. I'm on a hormone blocker. I will NEVER be able to take HRT. It's awful.

It really depends and very individual. Citalopram didn't work for me - Sertraline does. In combination with CBT.

Why isn't your oncologist using a MDT and getting you help via a consultant gynae for all of this?

You sound ignored when in fact your drs ought to be talking to each other to find a solution to help.

Do you have a contact of a specialist nurse you can talk to and ask for a referral to a consultant?

In London the Chelsea & Westminster Hospital used to have a menopause clinic for complex cases like yours- does your team /GP know about it?

@Enigma52 what a shitty situation. I've recently been diagnosed with BC and had to come off HRT and I was bereft, I used to say they'd take it out of my cold dead hands (hollow laugh), it had been the best two tears of my life, it really worked well for me.

I've gone onto venlafaxine and I'm actually ok. It's not as good as the HRT but despite my scepticism it's working. My consultant suggested it and I organised it through my GP.. my moods are steady and I'm functioning.

I'm sorry you're dealing with this, I hope you can find something that will help. It's so unfair x

@JinglingSpringbells I've emailed the breast care nurse and asked how to get a referral to a menopause specialist within the Christie hospital ( where in being treated).

I had been under Dr Paula Briggs ( until the cancer returned) and now she can prescribe Veoza only.

Will ask GP to recommend an anti anxiety drug I think. Part of the problem is that my medication causes many menopause side effects. It's all a mess.

Why can't she prescribe ADs for you? She's a meno specialist.