Unsure if menopause or depression ?

[mumof2teentoddler]

I reached out to my GP after contemplating going on AD - I was in them previously but came off after 2 years but from last Oct time I’m just feeling off and not myself

I’m 43 almost 44

lately im having a few health issues, life stresses, money worries, house upheaval, viral infections but I’m left feeling sad, tearful, depressed, lost joy in anything I used to, can’t switch off, irritable and just don’t feel like myself at all, so did an econsult, spoke to a lovely GP who suggested I go back on them.

I’ve been on HRT since Jan only but no change in symptoms yet - still unsure if I’m peri my GP said it’s 50/50 and worth a trial

but now I’m so tired with fatigue, absolutely wiped out shattered, bloods have come back normal all but one which I’m retesting in a month

even off work at the moment which again is so unlike me. My symptoms are there all the time - feel depleted no ups/downs which is why it makes me think it may be AD I need

I'm in the same situation as you, except we're approaching it from different ends. I'm already on anti depressants, but despite an increase in dose, they're not effective in tacking the on/off insomnia, bleak low moods or days of increasing anxiety. So I've now added hrt into the mix. It's been six weeks but they have had absolutely no impact on my mood yet. I'm going to be patient and try and get through the three months. I've suffers with depression and anxiety my entire adult life, but this feels different - more hormonal and the mood swings are wild. I have a week or so of feeling ok, but then I'm back to a dark pit of despair. I don't think you have anything to lose by trialling antidepressants though, for some of us it's the only way.

@TimeVoidsorry to hear you are going through it too. It’s horrid and I just didn’t think menopause could be this truly awful

It is horrid and you have my full sympathy. No one warns you that menopause could be this destructive. Ask for the antidepressants op, you've given the hrt a good shot but clearly you're still suffering. It doesn't have to be forever.

It doesn’t have to be one or the other. It could be both.
I would just take the ADs and see if they help.
Sending lots of sympathy. I’m in the same boat x

You possibly need a review of your HRT and increase the estrogen.
What sort are you on and what dose?

The guidance on HRT is a review after 3 months anyway- so you're just about there and after around 10 weeks it's very early days to decide HRT isn't working.

42 is young to be on HRT (not saying that it's wrong at all, but an early menopause is before 45) so if your own periods are on the way out, the chances are you need a lot more estrogen than someone of 60 who's on HRT.

It is actually NICE menopause guidance that for psychological issues of menopause, HRT is tweaked first before SSRIs (because they are often ineffective. anyway for hormonal issues.)

Yo u might also want to think about CBT (you can do it yourself with some online courses) or privately, or counselling if your low mood is directly related to circumstances around money and anything else going on.

They don't help.
There is a lot of evidence that they don't work for hormonal moods and NICE guidance says not to use them, very clearly. The medical guidance is to change the HRT either the dose or the type.

You can have pre-existing mental health problems like depression plus peri symptoms.
They don’t take you off antidepressants because you’re in peri menopause and experiencing difficult symptoms.
The OP was on ADs previously and therefore could be experiencing low mood from the pre-existent depression. It is best to treat this with something that has previously helped asap.

But there is no ' test ' to determine if the depression is hormonal or circumstantial! I'm not sure it's helpful to dissuade someone clearly in distress that antidepressants aren't the answer. The OP very well may need both.

There is research. So there are 'tests'.

It is helpful to discuss medical guidance that is written by menopause specialists.

This is not my own opinion but I'm quoting what I've read on medical sites.
Also, if this is NICE guidance, it ought to be followed and GPs have been told very strongly not to offer ADs until hrt has been tweaked and enough time for the changes to work.

This isn’t applicable when there is a pre existing need for anti depressants though.
In the case that someone has previously suffered from depression and taken antidepressants for it, GPs are absolutely not advised to hold off on resuming treatment until they have tweaked the HRT. What if the patient went into a severe depressive episode in the meantime?
The guidelines you’re referring to are in regard to treatment for perimenopause symptoms only. They don’t apply here.

But as a pp pointed out, a gp doesn't take every woman with pre-existing depression off anti depressants and on to hrt as soon as they hit peri menopause! Or prescribe hrt as a first line defence to a depressed, bereaved widow who happens to be over the magic age of 45! Anyway, I don't want to detail the ops thread, but I beg to differ.