I was wondering how you were as well
This isn't NICE related, but was produced by NAPS/Nick Panay - there's reference to anti depressants towards the end. This is with regard to PMS, rather than peri-menopause, but I think it's still very relevant (especially given your lack of physical symptoms):
http://www.pms.org.uk/assets/files/guidelinesfinal60210.pdf
Selective serotonin reuptake inhibitors (SSRIs)
There is increasing evidence that serotonin may be important in the causality of PMS. A number of SSRIs
have been used to treat severe PMS/PMDD. There are also data suggesting improvement of physical symptoms
with SSRIs though this is probably due to the improved perception rather than genuine reduction in
symptom severity. A meta-analysis of all available randomised controlled trials involving SSRIs used in
premenstrual syndrome confirmed superior efficacy compared with placebo.
The Commission on Human Medicines endorses the view that SSRIs are effective medicines in the treatment
of depression and anxiety conditions and that the balance of risks and benefits in adults remains positive
in their licensed indications. Prescribing should be restricted to those health professionals who have a
particular expertise in this area. Randomised studies have now shown that half-cycle SSRI treatment is as
efficacious as continuous administration. The results of a recent trial showed that the total premenstrual
scores were lower in the luteal-phase dosing group in each of the three treatment months but the differences
were not statistically significant from full-cycle dosing group. Further analysis of each of the symptoms
showed significant differences (P < 0.05) in favour of luteal-phase dosing for mood swings, nervous tension,
feeling out of control and confusion.
The importance of this is that PMS sufferers are less likely to develop dependence on this regimen, benefit
is immediate and women are more likely to accept the treatment as it can be regarded as being different
from the regimens used for psychiatric disorders. In the author‟s opinion, the optimum regimens for PMS
are half-cycle citalopram or escitalopram, 20mg per day from day 15 to day 28 of the cycle. This regimen
appears to be effective even in women whose previous SSRI treatment has failed. Severe PMS also improves
significantly with either luteal-phase or symptom-onset dosing of escitalopram with good tolerability.
Recommendation A:
In view of their proven efficacy and safety in adults, SSRIs should be considered one of the first line
pharmaceutical management options in severe PMS.I can see the logic that, regardless of the cause, you need to treat the symptoms to get some relief (especially short term) in which case ADs - if you can find the right one to suit your needs - can really help. This was certainly the case for me (tried a few until I got the right one). However, in your case, it does seem that the cause is still hormonal, despite your lack of physical symptoms, and that ultimately, it's your hormones that need to be tamed.
Rememberer how well you originally responded to the pill:
"But just to say, still feeling really good on the BCP. This has been one of the best weekends I have spent in years. I am going for hours and hours now actually forgetting that I have been so ill with my hormones these last 2 years. There was a time where it was all I could really think about because it loomed over everything and anything. My skin is really good too, so soft and smooth. No libido though. But I am hoping this might come back a bit in time?
I took my last tablet last night and have decided to give myself just a 4 day break. Hopefully enough to give me a bleed and enough to stop a build up of too much progesterone? But not long enough to give me too much of a withdrawal dip from the oestrogen either? It's going to be a bit of trial and error. I have decided not to update my diary every day from now on. I hope what I have posted has been useful.".
- If it was solely a psychological problem, you wouldn't have responded so positively to the pill at first, surely?
The reason I am saying this is maybe you need to consider a two pronged approach. Treat the psychological symptoms with ADs, then where you're feeling ready, try a hormonal route as well as the AD. I needed the AD to give me the confidence to stick with a hormonal treatment longer term, if that makes sense? I would never have persevered with different pills if I hadnt had the initial boost from ADs.
Reading this through, I am not sure I am making much sense .... but hope it just may be helpful!
B xx
