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[Briony]

It's hideous isnt it? I am afraid I now get a bit preachy if anyone I know is thinking of taking it - but only because I dont want them to become a member of the "head zapps club"!   

[lisa789]

It's hideous isnt it? I am afraid I now get a bit preachy if anyone I know is thinking of taking it - but only because I dont want them to become a member of the "head zapps club"!   

Lol!! 'Head Zapps club' so you know exactly what I meant. Isn't it horrendous? I was worse coming off venlafaxine than the cymbalta.

It scares me when I read people saying that they've been prescribed them, I think should I warn them as I don't want to scare them. The doctors definitely need to explain how hard it is to come of these drugs before prescribing them. I don't think they fully appreciate just how hard it is. Psychiatrists might have a better understanding but I've found GPs to be clueless.

[dangermouse]

If you think about serotonin, it's also a hormone like thyroxine, epinephrine (adrenaline) and cortisol. Hormones interact with each other, switching them on and off.

Oestrogen volatility will, hence, have a knock on effect with these hormones and can cause anxiety and depression.

I get the GPs point that as the sex hormones are so up and down during peri that it's hard to control them, so controlling the hormone that chucks out the symptom could be a simpler way.

As Briony says about your symptoms improving briefly with the pill, the cause is likely to be oestrogen surges but if you are struggling to control this with HRT/the pill, then ADs alone might be the way forward until you reach menopause when HRT will hopefully work better - if you choose it.

Don't get too attached to NICE guidelines as, although in the HRT ones published recently it's good for us, they tend to have their own financial agenda.

I could surmise that ADs are more expensive than HRT, but I won't as that would be very cynical of me.

[Hurdity]

I know that NICE now don't advocate prescribing ADs as first line treatment for peri menopause symptoms.

But, does anyone know if this is still the case, even if a woman doesn't exhibit hardly ANY physical symptoms of peri menopause?

What I mean is, if you are in your 40s and suddenly start suffering with anxiety and depression (like me) but still have very regular periods, no hot flushes, no VA etc does NICE still advocate HRT rather than ADs?

I just think that if you do start to suffer with anxiety and depression in your 40s, then why can't it just be treated the 'regular' way with ADs?

Or is (probably) hormonal anxiety/depression somehow different to regular anxiety/depression and won't respond to regular ADs?

You have rasied a complex issue GypsyRoseLee! The point is (from memory) NICE defines peri-menopause according to the STRAW criteria based on (for the majority) on changes in cycle length combined with age and physical symptoms of the menopause. They do not refer to the time before peri-menopause ( which many refer to loosely as peri-menopause) - which is mostly the late reproductive stage/phase but when hormonal changes begin but ovulation still occurs and cycles are still regular or shortening. This is the stage when pms becomes much worse for many women due to extremes in hormonal fluctuations which seem to occur (highs and lows of oestrogen, not sure whether progesterone peaks too?) - and this is more difficult to treat from what I gather - and Panay and Studd seem to understand this phase more than many docs.

Standard HRT is most successful for women in the true peri stage when cycles have become lengthened and oestrogen levels have fallen - as I understand. I think the BCP may well work better (for many women) in this earlier phase because it controls the cycle?

Hurdity x

[Tempest]

GypsyRoseLee, I just wanted to say that I've read back on your previous posts over time here as I suspected what you're going through is very much the same as my experience of peri menopause, and it is! I went through almost a carbon copy of what you're experiencing right now. I didn't try HRT though, as I had serious allergies to multiple medications and my GP and Consultant Gynae. didn't want to risk it at the time.

I actually had a TAH when I was 36, and it didn't really affect me much. But just a year ago aged 46 after suffering all of what you describe for 3 years, I had to have surgery of bilateral oopherectomy which then put me into surgical menopause. My symptoms DID change after the surgery - my anxiety was much, much less but now I am faced with a new set of challenges such as depressed mood, hot flushes, severe joint pain, weight gain etc. I have HAD to start HRT as I could hardly walk! This surgery is drastic and I wouldn't advise losing your ovaries unless it is for disease.

I also tried 3 different anti depressants during peri, and for me SSRI'S made the anxiety much worse on start up so that I couldn't continue. If you are able to tolerate beta blockers and/or diazepam, your GP can supplement those to get you through the first few weeks (I was unable to take either - drug allergy and the beta blockers interfering with the action of my epi pen if needed to use it).

You've had a really rough time of it with experimenting with the HRT, haven't you? My personal theory is that for some of us who swing wildly hormonally in peri, HRT can aggravate the times when our estrogen levels spike, causing the anxiety to go completely bonkers. I think if you can coast on anti depressants until you enter menopause proper, you may settle down enough to try HRT again then if you would like to.

It can be trial and error with the SSRI's too. Don't be afraid to tell your GP if one is not suiting you and if you'd like to try another.

[MIS71MUM]

Hi Briony & Lisa789!

I'm a Duloxetine girl! Dreading coming off them but I got myself off Venlafaxine in the past so if I can do that, can do anything.....fingers crossed.

Yesterday I tried a 30mg Duloxetine currently on 20mg and I had totally forgotten how flat and down they make you feel. Yes my mind quitened down a bit but couldn't think of anything and made me tired. The problem with that med is that it isn't slow release. Not sure whether to consider a very slow bead counting method once my HRT is sorted.

[lisa789]

Hi Mis71Mum,

Don't be worrying about coming off them while you still need them. As you said you got off venlafaxine so you'll get off duloxetine if you need to. I found the venlafaxine withdrawal harder than duloxetine.

Sometimes I don't know what the pharmaceutical companies are thinking of. All anti depressants should have the slow release option so you don't get that crash feeling. I found duloxetine was the worse and had to make sure I took it the exact time as my body let me know if I was late taking it.

Good luck and I hope things settle down for you soon xx

[GypsyRoseLee]

Thank you for all your replies, everyone is so helpful and supportive as always.

If you can remember everything suddenly went really bad for me toward the end of February. I was trying Femoston 2/10, and while fine on the oestrogen only tabs,  only 3 days into the combi tabs and my anxiety and low mood was intolerable. So I stopped them and applied a 50mg Estradot patch until I saw Dr Annie 2 weeks later.

But the patch did nothing, and I quickly got worse and worse and my anxiety was through the roof + very dark suicidal thoughts (somehow I knew I would never act on them, but it was still so distressing to have them). I had always assumed I had been at my lowest when I had PND, but this was worse.

Dr Annie's HRT regime did nothing. So after a few weeks I started taking Trazadone. But I felt so desperate I also went to see Prof. Studd. His regime didn't seem to be helping either, and my anxiety seemed worse.

I have now been Trazadone for the last 8 weeks, and it's only these last 10 days that I have started to notice improvements. I also stopped HRT just over a week ago.

I stopped, because looking back over last year when I was on various HRT I still always got lots of days per month when I felt dreadfully low and anxious. And these bad days weren't tied into my withdrawal bleed or taking Utro. I now think it was my own hormonal surges that I was responding to, and that the HRT sometimes helped but also really hindered too.

Like Hurdity points out, because my own periods are still very regular (though lighter and slightly shorter cycle) and I don't have any other physical symptoms, then I may not even yet be truly peri menopausal! In which case taking HRT just might not be appropriate yet, and might actually kill more than cure.

For the time being I am just going to stick with my AD (now that it finally seems to be kicking in) and just keep an eye on how my periods are over the next few months. Early menopause runs very strongly in the women of my family so I am hoping that it shouldn't be too far away for me?

[walking the dog]

That's interesting about the trazodone  gypsyroselee I'm on my second week of it but not feeling the benefit yet but looks from your experience it could take s few weeks more

[CLKD]

Every night B4 my bleed began I would cry.  Buckets.  Once the period began that crying would stop.  Depression set in at a later date.  It became a problem in 1988 and was treated intermittently with ADs until a Psychiatrist who visited at home because my GP was concerned, could see a cycle - and advised taking ADs for Life.  Took some accepting, I can tell you!

Peony - what don't you like the idea of: ADs or HRT ……….  .  I now accept that if a medication is likely to work for me the I'll give it a go  - after all, that bus might be along 2-morrow! 

I believe that symptoms should be treated.  If a lady presents in Surgery crying then depression and any associated anxiety should be treated for 4-6 months, enabling her to see the wood for the trees.  By keeping a diary: food, mood, hormones: she can then chart any changes that make her feel worse.  That might be meno related. 

It really can be Trial and Error which is tiring 

  GRL!

[MIS71MUM]

Oh that's great news GRL, really hope that you continue to see the light at the end of the tunnel.

Very pleased to hear that you are improving and keep posting.
 
All the best xxx

[Briony]

Have to be very careful of what I say here for fear of outing myself, but by pure coincidence, I came across something interesting today: a teenaged girl who has crippling anxiety which has got worse over the past few years. Now at a severely worrying (and potentially dangerous) point. She has seen all sorts of counsellors, tried a low dose AD and even been sent to a paediatric psychologist. No one has questioned anything but her mental health. However, recently, following a string of blood tests, it was revealed she actually has a severe hormonal imbalance and that her acute depression and anxiety are caused by this. I had assumed the pill would have been prescribed, but instead the consultant has placed her on an incredibly high dose of AD as he said it will achieve a better result. When I heard about it today, I immediately thought of this thread.

[Tempest]

That's really interesting, Briony! And just goes to show that there is NO understanding out there about how hormone's can cause severe mental health problems. Professor Stuff is about the only one out there who acknowledges this. Yes, I also got tarred with the 'you have an anxiety disorder' thing when I was in peri. Except I didn't, as for the most part my anxiety cleared up after I had my BSO. It was almost instant! I was rather on top of the world for about 3 months after my surgery with no HRT, and then the depression started. No estrogen, don't you know!

[CLKD]

All that work that Dr Kath did in the 1990s for nowt then! 

 Are you able to send a note to the Consultant concerned?

[lisa789]

I definitely think hormones are the driving force behind my anxiety.

Over the years I've had diagnosises of PTSD, depression, social anxiety and the current one is panic disorder with agoraphobia. I definitely think it's hormones driving my anxiety and causing me to have panic the whole time wondering when the next panic attack is going to strike.

For the short time i was on Evorel patches for the first time in years the anxiety felt numbed. I couldn't tolerate the progesterone tablets I was given so couldn't stay on oestrogen alone. I've since been moved onto continuous BCP so I'm hoping that improves my anxiety.

What us women have to put up with!