Anti depressant help

[sickofperi]

I am having the worst time mixed with some terrible luck and wanted some advice from anyone that may have had similar.

It was determined at the start of the year that a lot of the issues ive been having for the last year are perimenopause. One big thing has been my mental health, I really am struggling with low mood which hits hard late in the day, sometimes as early as afternoon but its like a switch flicks and I feel so down.

Ordinarily I would try HRT but I have a large ovarian cyst that needs removing and they suspect I have endometriosis, so the gynaecologist has said I cannot take hormones until they get in and see whats going on, the surgery is on the list hopefully for next year but im awaiting a date.

In the meantime ive tried anti depressants, but apparently I am so sensitive to them that I get awful side effects and my GP believes I was suffering from serotonin syndrome, so I am awaiting advice from the mental health team. I have tried 4 different medications and all really affect me.

Has anyone else had this and has anything else worked? I am really struggling and its now been since January of trying a medication, getting awful side effects, then waiting for that to ease and trying another.

I also have chronic pain and health issues aside from this and honestly the last year and a half my life has been more existing than living and I just want to find something to feel a bit better.

I have asked my GP if they would consider writing to see if they would consider moving up my surgery on the basis of my mental health but not sure yet if she will consider doing this.

I would appreciate any suggestions or advice.

Bumping in case anyone can help

You could try St John's Wort- herbal tablets that are commonly used for this.Check the contraindications if you take other meds.

Another option would be to get a 2nd opinion on the cyst and possible endo.
Neither are always contraindications for HRT. You may need to find a private gynae to get this 2nd opinion.

It's hard to understand why they can't give you HRT. If they thought the cyst was cancerous, it would be removed asap. If it's not, then HRT shouldn't make any difference. likewise, there are ways of using HRT even with endo.

I think you're being fobbed off.

I have asked my GP if they would consider writing to see if they would consider moving up my surgery on the basis of my mental health but not sure yet if she will consider doing this.

You've asked but not had an answer? Can you follow up?

Have you had a diagnosis of what type of cyst and how big?
usual rule is drain/ remove if over 5cms in women post menopause.
Sometimes they go away on their own.

I will look at at John's wort, its worth a try. I read l tyrosine can be helpful so have ordered that.

The gynae didnt say much, just that she thought it best not to take the HRT until they get in and see what is going on in there. It wasnt much of an explanation. But honestly just getting that appointment was a battle in itself and I had to fight to even get seen this year.

Its an 8cm dermoid cyst, it has been checked a couple times. I originally asked the GP to ask about speeding up my surgery and she said she would need a change of circumstances to ask, so I then asked again on Friday when I had another appointment, I asked in writing after this appointment when I thought about it, so im hoping to get a response next week. My only other option is trying to write to gynae myself and asking direct.

My other option is paying privately for the surgery but that involves getting a loan so im hoping I can get help with it, but I feel this may be my only other option as I feel like ive done nothing but battle this year to even get the help ive got so far.

Bumping to see if anyone can offer any advice. Ive wrote to my GP 3 times in the last 2 weeks explaining how much im struggling with the only response being a message to say we have your message and a Doctor will look at it.

I genuinely dont know how to cope with this for much longer and have no clue what else to do. Im trying a perimenopause supplement, l-tyrosine, magnesium plus the usual vitamins in the hope they may help. Diet I eat relatively well as im trying to lose weight (which has also just completely stalled).

My only advice is that if you can afford it, fast track yourself to a private gynaecologist for support.

I would also get a loan and get it done asap, if at all possible.

I think im going to have to, the GP literally just sent me back some links for places like MIND and samaritans.

I am on holiday next week but as soon as im back I think im going to look at private options.

The first step is to get a 2nd opinion on whether with a dermoid cyst you can still use HRT. That only needs an appointment with a gynaecologist, so don't rush into paying for an operation when it's not perhaps needed urgently.

I thought serotonin syndrome only happened when you actually took meds?

Anyway I’m ultra sensitive to them and have had a right time on them. I can take 3. That’s it, all the rest turn me upside down. It’s all trial and error.

Have you tried different types? What have you tried?

@sickofperi this might be a wildcard / long shot…. But for me, starting Mounjaro has been life-changing… not in terms of weight loss, but it seems to have shut down an awful inflammatory process that I have been having (and has been worse since I went through the menopause, some years ago). Within three days of taking the lowest (2.5mg) dose, it was like a switch was flicked, and everything feels different within my body - and it has nothing to do with weight loss, or change in diet. I only mention this as you say that you have been trying to lose weight, so I figured maybe you have a bmi of over 30, so could buy they from an online pharmacy? If you look at recent research, it seems that Mounjaro appears to potentially have lots of uses outside of weight loss and diabetes - in terms of inflammatory conditions, neurological conditions like dementia, Parkinson’s etc - and I hope that in coming years clinical trials take place trialling mounjaro with a whole host of different conditions. If I was in your situation, I would give it a go, just for a month (at 2.5mg), and just see if it makes a difference to all of the other symptoms you are having. It seems to inhibit certain inflammatory proteins, so if these proteins are playing a part in whatever is going on for you, then you might find things improve while you are waiting for your gynae appts. And as an added bonus, you may lose a bit of weight :)

Yes, the serotonin syndrome was caused by one of the meds I tried, sorry if that wasnt clear.

So far ive tried venlafaxine, sertraline, citalopram and fluoxitine. They did briefly try amitriptyline but probably too small a dose as it was used more for pain help (I have other health issues) and that didnt help but honestly I dont think it was a high enough dose for mood help. They did suggest mirtazapine I think it was, but given that im trying to lose weight this was not a good idea.

All of the meds gave similar initial side effects which started with excessively tense muscles but my GP said oh side effects usually ease up so try pushing through, so I did and became unwell quite fast. So I imagine if I didnt stop the others as fast, the same would have likely happened.

They now dont know what to try me with as they said ive tried the standard options so each time takes a referral to mental health, who take a month or so to come back with a recommendation. This has been back and forth with meds since January.

Im on mounjaro, my bmi was just over 40 and they didnt want to do the surgery until it was under. With hormone issues etc the weight was not moving so this was my last attempt to try and get it off as in 5 months I had lost a few pounds trying everything.

But I worry the mounjaro is making things worse so im trying to switch to wegovy after this pen just to see.

This is true, although would the GP allow me HRT if the private gynae says yes but NHS says no? Its worth a shot I suppose and if I get nowhere ive had that initial consultation should I need to do the surgery privately.

I dont quite understand how the cyst is stable enough to wait 6 months for surgery and they dont see the possible endometriosis as enough of an issue to do anything to help, yet at the same time concerning enough they wont allow me to at least try HRT. It doesnt make sense to me so I think you are right that a private consultation is worth a go.

The other thing about mounjaro - I have a vague memory that it can slightly impair absorption of things via the intestines / stomach, which can have an effect on medicines taken by mouth (impaired absorption, so they don’t work as well). I think this has been mentioned particularly in terms of HRT, as it can alter whether eg the progesterone is being absorbed (if oral), so problems can occur (with thickening of endometrium etc). I know you are not on HRT, but I was wondering maybe whether the mounjaro is impacting the absorption of all the anti-depressant type meds you have been taking? Maybe one to speak to your doctor about, and take a break from WLI maybe, to allow anti-depressants chance to work effectively?

edited to add - just seen that you are sensitive to anti-depressants, not that they are not working well - sorry! Ignore me - I’ve not read the OP in a while…

If you see a private consultant they will prescribe the HRT for you. (Private prescription.) Many consultants work both in the NHS and privately, so it's not as if they are going to give a different medical opinion just because it's a private appt.

There is guidance on using HRT for women with endo.
It is usually to offer combined continuous HRT (both hormones daily) to prevent the endo growing (because daily progesterone stops that.)

From what you've posted, it seems as if you have never had a proper diagnosis of endo anyway, as it's only possible through surgery (taking a look inside.)

Dermoid cysts should be removed and I don't know why they are delaying.
Has your GP explained why? Is it because of your weight (you mentioned that above.)

So when it was originally found it was smaller and my bmi was higher so because it was under 4cm they decided to leave it. Then it was scanned again as ive been getting a lot of pain and it was found to have got larger, so I was re referred.

The delays are now literally just waitlist times. The initial appointment to see someone was a year and then the surgery wait list is approx 9 months.

No the endo is suspected, not diagnosed as yet.

i suffer from chronic depression so I am responding more from that perspective as I don’t take HRT although I am in the right age bracket. By chronic depression, I mean it’s a condition I have to manage, although it comes and goes in levels of severity.
My question would be what the rest of your life looks like. For me, gym and swimming and any other exercise outside massively help my mood to the extent I make sure and do something every day non-negotiable. Friendships - again, I don’t have many friends due to work and being a single parents but I make sure and catch up with my close friends regularly and when I am not meeting up, still take myself to the coffee shop to work if I am WFH. Also, I would add vitamin D to your mix. Has your GP also checked your iron levels as I was anaemic and that made it worse? Have you been able to access any therapy?
As you say the depression hits in the afternoon, what can you do to make sure that you have something positive going on, and what can you look forward to? I did a lot of travelling and days out over the summer, some of them just myself as I don’t have a partner and honestly, just being away doing new things and writing in my journal about them made a difference.
You already have got a lot going on with the weight loss and waiting for surgery and trying to get HRT, so adding self-care into the mix might sound daunting, or you might be doing all of this already, I don’t know. I am not saying don’t keep pushing for HRT, the reason I don’t take it is because progesterone makes my moods way worse and I can’t face any more mood issues whilst I try to get the balance right as it sounds like you have to.
good luck anyway.

I think you need to keep pushing for the surgery via your GP, as well as getting a 2nd opinion on HRT from someone privately. They may also write to your GP to emphasise that you need surgery more quickly.

I ended up doing what you suggested in January as I had some extra money and ended up seeing an endometriosis specialist. They have said that they are happy for me to have HRT and have sent the GP a medical plan. They found adenomyosis and endometriosis, so hopefully this is going to help with a surgical plan knowing the location of the endometriosis (as its around the bowel area). But he was happy to say I can have HRT and also to give a treatment plan for my pain too.

I originally posted earlier last year (I think it was under a different username) and it was you who suggested asking about endometriosis which led me to asking when I finally saw gynae and they had agreed it was a possibility, which gave me the push to try a private specialist. I am so glad you did as I feel like ive not only got answers but a treatment plan that doesnt leave me waiting 6 months ( thats the expected wait still for me to be offered surgery). I booked in to see my GP and apparently there are no appointments until the end of February but at least that should be when I can get some form of HRT.

I am not sure if this will change the surgery plan at all but at least they have the extra images and the report from the specialist.

I'm not qualified to comment on a lot of this, but did want to mention that the severe perimenopause symptoms and extreme antidepressant sensitivity are things common to neurodovergent people.

A lot of previously undiagnosed women only find out they are neurodivergent when their ability to cope with life goes down the toilet with the onset of periomenopause.

Just wanted to pop that in there! (And to say absolutely see a menopause specialist because your gp is fobbing you off).

Whoops, old thread! Good result OP :-)

It is something thats been in the back of my mind but my Daughter has ADHD and is Autistic and I dont recognise the same issues, but I do see some similar struggles. I honestly just assumed that my hormone issues were just mirroring symptoms of neurodivergence but can definitely see how someone undiagnosed could be pushed over the edge of coping with hormone imbalance on top. My Sister has also recently been diagnosed as having ADHD and is in menopause so its an interesting correlation.