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[Gladys Bananas]

I am 53, on my third merina coil this one has been in three and a half years. I have been on and off Citalopram for the past 15 years,weaned off it by April this year. Started Estorial HRT in May due to tiredness, some flushes and on my doctors advice.
Everything was fine until late September when I went from being okay to suicidal in the space of a couple of days. It came on so quickly I was convinced it was not depression because that usually creeps up on me slowly, but the doctors said I needed to start taking the Citalopram straight away. I'm now on 40mg dose of that, and after two months of being okay the doc said it was okay to come off the HRT as I was convinced that had caused the issue in the first place.
Then at the end of November I started having panic attacks, uncontrollable crying and thoughts about death.  Was prescribed Lorazepam which sorted things out for a week (I only took them on and off when I needed them). Then they stopped working and I was back to crying and panic attacks. On top of that started to get lots of hot flushes day and night. Last Friday the doc prescribed beta blockers so I am now on them and the Citalopram.  He said I can take the lorazepam if I need to, but I find I am taking one anyway just to blank out the day
 Ideally I'd rather take no medication.   I'm so fed up with it all!!!

[CLKD]

 

Lorazepam doesn't stop working!  I have used it successfully on an as-necessary basis for a few years.  I can tell you now that taking it daily won't help, because the withdrawal can be difficult - this happened to me 12 months ago [long story short] - it is supposed to be taken in an emergency.  Maybe take one on alternate days until Fri then miss 2 days etc.?  Your GP will only prescribe it for a short while anyway and you don't want to be feeling worse.

Prior to that I had Valium as necessary but it made me feel ill.

I take a beta-blocka twice a day, Citalopram twice a day and the above as necessary.

Hormones can cause psychosis.  Your GP could refer you to a Psychiatrist in order to discuss the link between hormones and mental issues.  As hormones levels begin to fluctuate we can be over-come quite suddenly and it is really scary. 

When did you have your last period?  Ideally HRT is the way to go, in order to ease symptoms, protect heart and bones.  It can take a while to find an HRT which helps.

[Hurdity]

Hi Gladys Bananas

 

Sorry to hear about all your issues - but taking all those meds! No wonder you poor body is protesting.

It's difficult to know what to advise - except the two most important things and I agree with CLKD here - HRT should help with hormonally induced mood changes and is the first line of treatment, not the other meds, and that the Lorazepam should not be taken regularly as it is highly addictive and very difficult to come off.

I would take a step back and try to work out what caused your problems initially. What has led you to take Citalopram - was this due to depression caused by life circumstances or do you think it was originally hormonal? Were your original problems for example occurring cyclically? I also wonder if the progestogen from the mirena may cause some depressive symptoms but if you had to start taking the Citalopram before you first had one fitted then this is unlikely. The problem with the Mirena is that it often stops periods (and I presume this was the case with you?) so you no longer have a strong cycle to be able to say that hormones are definitely responsible for your mood changes.

However it sounds like your recent issues are definitely hormonal as you are the right age for this - so to give you the Lora... and beta blockers rather than HRT is not the way to go long term and I can understand your frustration with this treatment.

Personally I would try to get off the Lora... asap and if you must, reserve them for emergency use. Ditto the beat-blockers - this is a heart medication so slows you down and your heart, lowers blood pressure etc etc. I mean we shouldn't need these if your heart is healthy!!! There are other non medication ways of dealing with anxiety - lots of strategies - mindful meditation, behavioural strategies, websites like nomorepanic etc which would be preferable.

Re HRT - I haven't heard of Estorial type HRT so maybe you are not in UK? There should be an HRT type that agrees with you - but the problem is as you don't know where you are in menopause (due to the Mirena) then it is difficult to get the dose right and if you are peri-menopausal, then you may well be having dramatic oestrogen surges and plummets. A low dose transdermal HRT might be the way to go - like an oestrogen patch for example ( maybe this is what you tried) but building up gradually. Unfortunately while you are peri-menopausal if your cycle is still carrying on then you willl still experience mood changes but the Citolapram should help with these.

The oestrogen HRT should eliminate the flushes and sweats but I would really try to stop the other meds if you can.

Just to reiterate - oestrogen itself does not cause depression - rather the opposite - but your underlying cycle (where oestrogen drops suddenly) could cause you to feel those symptoms.

Sorry this is a bit of a ramble but hope it has given you something to think about and maybe see if you can try to get off the medication treadmill - which it sounds like you would rather do.

Hurdity x

[CLKD]

 

I take BBs to ease anxiety surges.  Also, do use the Lora for emergency use, I felt awful when I stopped 12 month's ago  : as my GP told me when I confessed, "You won't be doing that again then?"

Keep a diary too!