Change in Antidepressants with Menopause

[cuppitycakes]

I have had an issue with severe anxiety / panic for over 30 years which much of the time has been managed with a mix of self help / cbt and medication. We’ve never managed to work out what kick started it in the first place (although pnd probably played a part) or what brings about a recurrence. When I’m ok I’m completely fine - but have had to take some breaks from my senior management role.
It’s now 4 years since my last period and the dose of AD I have used several times no longer seems to work and just wondered if anyone else had noticed the same.
(I’m already using HRT.)

Although you have had anxiety pre- menopause, the NICE guidance may still apply.

The first part of that guidance is not to offer SSRIs for psychological issues during peri/ post menopause, but use HRT.

The second part is that if HRT isn't working, it needs tweaking rather than adding in SSRIs.

So...it might be worth considering your dose and type and trying to make some changes- usually that is more estrogen and perhaps a different type of progesterone.

What do you use now?

Thank you for replying @JinglingSpringbellsI’ve seen you offering really helpful advice on this board before. In fact it might have been one of your posts that led me to an HRT review with both my GP and a private menopause specialist about a year ago. This led to adjustments and changes in oestrogen and progesterone but unfortunately it hasn’t helped with the anxiety (although other menopause symptoms improved and under control.)
The specialist was extremely helpful and thought it was worth a try to adjust the HRT but at my last appointment recently she said that because this is a long standing issue which proceeded menopause I need to look elsewhere for the solution. That’s what led me to post my question here.
I should make it clear for anyone else reading this that she only said this after trying a couple of things and taking into account how long I have been affected by anxiety/panic. For many women affected by anxiety or increased anxiety with onset of peri or full menopause HRT can make a real difference.

Maybe the way forward is more talking therapy which you say has helped before..

Have you invested, for example, in CBT? I think you must have from your first post. But practitioners vary and it may be worth seeing someone else, again.

Drugs dampen the emotions, not deal with the underlying issue.

I can't offer medical advice on this really, but I suppose I'd say what happens if you don't take the drugs? Can you not get through the day at work and how is your anxiety holding you back?

Yes I’ve had significant amounts of CBT and other talking therapies over the years. As you say standards vary but many have been very helpful. It never seems to be directly linked to
anything and ‘seems’ to come out of the blue and when it does it is completely debilitating. By far the worst thing I’ve had to cope with health wise in life. When I’m ok I’m the complete opposite.

Sorry you asked a specific question re what happens if don’t take the medication. I go from being a very capable senior manager with a large team, very involved mum, daughter, friend, enjoying life to being unable to leave the house, go to work etc etc. Makes absolutely no sense.
The issue I’ve got at the moment is not about whether to take them or not - I wouldn’t risk not taking them but whether others in similar situations have found that they need to take higher doses with menopause (Generally I have taken low doses and used things like cbt on top of that.)

Sorry you asked a specific question re what happens if don’t take the medication. I go from being a very capable senior manager with a large team, very involved mum, daughter, friend, enjoying life to being unable to leave the house, go to work etc etc. Makes absolutely no sense.

You might think this is a weird thing to ask, but when you feel like that - unable to leave the house- could you push through it and go out? Has CBT given you strategies to overcome those emotions? To rationalise what it is you're afraid of?

What would happen if you forced yourself to go out?

I don't know the answer about increasing your dose.
I do know that Dr Louise Newson says SSRIS etc don't work for menopause-driven anxiety and that the treatment is usually more estrogen.

Hi yes that’s what I do - ie use the cbt techniques over a number of weeks to be able to go out but that still doesn’t get me to a point where I can do my job (which I can normally do with ease even when it’s very challenging.)
It’s so difficult to understand - and even though it’s something I’ve faced a number of times it still makes very little sense to me but I guess that’s the nature of it. The CBT etc has really helped me with everyday normal challenges but when the panic is severe it’s just not enough. I always describe it that it feels that someone has a gun to my head and is about to pull the trigger but there is no one there. Anyway thank you for replying - really appreciated.

Sorry I can't be of more help.

You may have done this already but would it be worth seeing another doctor privately? Not for menopause but for the anxiety? Have you ever been referred to or seen a psychologist or a psychiatrist?

Hi OP I feel for you & having similar difficulties with anxiety & panic that can be debilitating despite AD’s & HRT. I suffered with anxiety & depression prior to Peri/Meno but never panic attacks or debilitating anxiety which (unbeknown to me all during peri) was hormonal & very much improved by HRT. However I’m finding that it is returning with a vengeance, with palpitations & horrific panic /doom/feeling completely unable to function, while they occur (usually at 4am & on waking but also other times). I also have terrible insomnia.

I’ve yet to increase my estrogen to the maximum amount - mainly bcos it will necessitate a corresponding increase in progesterone - which I’m wary of, given my disposition to low mood & depression & possible progesterone intolerance. But I am now prepared to give it a try in the hope that extra progesterone may actually help me.

Prior to starting on HRT & believing all my difficulties were solely MH based, I went on a combination of Escitalopram & Mirtazepine & this really alleviated the panic & distress. I had to come off this combination due to other medications & the need for different medical treatment. And once I started HRT it was like a miracle cure & thank god the anxiety subsided).

For me, I therefore know that if my HRT stops helping me - or at least there is a ceiling effect with it & that despite self help coping strategies, relaxation, CBT, nutrition, sleep hygiene etc - I could always return to this combination (although I don’t really want to).

I don’t know what AD you’re on - for me increasing an SSRI alone had little impact. But if you are on the highest dose of HRT, it may be worth trying?

And then like I say there is always combination therapy - which is usually used when first line AD treatment has been found not to be effective.

I’m not overly pro AD’s btw (horrific withdrawal, other side FX) & would much rather be able to cope with hormonal therapy alone. But I recognise when it’s not sufficient on its own. Just my experience though. Good luck 💐

Hi @JumpinglambIm really sorry that you have had similar issues. I’m very similar with ADs - would much much rather not use them (and have spent too long at times avoiding them.) I really hope your HRT tweak works well for you .
@JinglingSpringbellsyes I’ve seen both privately. I seem to have spent a fortune over the years but I know that I’m lucky that with some saving I’ve been in a position to do that.