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[Cathh3110]

Hi my consultant wants me to start a course of Escitalopram due to anxiety and hormonal depression (crying all the time). I just wondered how I can expect this to affect me in the beginning? I have heard that antidepressants can make you feel worse until they get into the system.

I have also had a mirena coil and going to have course of prostap injections. I am still considering a hysterectomy but put that on hold for now as I don't think I am in a fit state to cope with the recovery.

Thanks in anticipation

[babyjane]

Hello Cath, I have taken this medication for 18 months now.  Yes, the first 5 days were very difficult and I almost stopped, but after speaking to the pharmacist I persevered and after the forst 5 days the side effects did not get any worse.  It took about 3 - 4 weeks to start to see the difference but now I am glad I persevered because it is a good medication for me.  It is gentler than the sister drug Citalopram. 

I am sensitive to meds so if I can adjust to it then I am sure you could.  What dose have you been given?  I am on 5mg now but I started on 10mg.  there is another member who takes this and hopefully she will also have words to advise you.

Other members are of the opinion that HRT is the better way than ADs, did your doctor mention the possibility of HRT to you at all?  It is not something I chose to take but just to let you know there are some quite strong opinions both ways.

[CLKD]

Hi!  I've taken ADs for years (since 1988) and had to discard any that made me feel poorly until my GP found a few that really suit.  Not a cure but they do allow me to get out of bed each morning.  This particular drug has served me well and I don't remember any odd symptoms when I first started it, over 10 years ago.  I take 5mg in the morning and 10 at night, my GP allows me to self medicate dependant on how bad the depression is. 

Sometimes, even if a person knows that the low mood/depression/anxiety is hormone led, they need to try an AD initially to allow them to see the wood for the trees.  I would suggest that you keep a mood/food/symptom diary to chart how you are feeling, making lists focusses that we actually do survive!

Browse round the Forum.  Make notes.  Some GPs feel that unless a lady isn't having periods and/or hot flushes, she isn't in menopause  .   He/she should request hormone tests including thyroid function and VitD levels. 

Take a list of queries to the Consultant should your GP refer you re hysterectomy advice, remember: you don't have to make an immediate decision regardless of what the Consultant suggests.  Many dismiss their patients after surgery without any discussion about HRT requirements!

If you are still having periods you will need certain types of HRT medication.  You may find that an AD is enough unless you opt for hysterectomy.

I don't understand "prostap" 

Let us know how you get on!

[Cathh3110]

Hi  thank you for your quick responses. It is good to know that you have adjusted to the meds. My dosage is 10mg and I am going to start taking them tonight.
Were you able to drive? and what about work? I work full-time and so far have only had an odd day off. I know my Dr thinks I need to take some sick leave but part of me thinks that I need to structure of getting up and coming to work, although I have been bursting into tears a lot lately which is embarrassing.

HRT has been mentioned and last year I tried tablets and also patches but they didn't work (continuous bleeding from December). So I now have a new Mirena coil which the consultant wants to see if it kicks in and does its job, so going to also have prostap injection to stop the bleeding and see how I go.

[CLKD]

If you feel you need a few days off to adjust to medication then do so.  Is your med 10mg tablet, if you find it too much initially maybe cut it in half and take 1 with breakfast and 1 an hour B4 bed.?  Sometimes I feel 'hung over' but it's far better than the awful depression when I was unable to get out of bed.  I continued working.  The depression grounded me, when I felt unsafe to drive I stayed at home.  The drug has certainly enabled me. 

You could of course start them at the weekend i.e. Friday night if you have the opportunity to potter for a couple of days?  I would also take a large box of Kleenex and say to colleagues "I'm really weepy so will be carrying these tissues for a while, an occasional hug would be useful too" then open up as much as you want to if someone asks.  Don't hide in the loo!

[babyjane]

I found the side effects would be worse if I took the tablet on an empty stomach and it can be better if taken with food.  I take mine after my breakfast 

[Hurdity]

Other members are of the opinion that HRT is the better way than ADs, did your doctor mention the possibility of HRT to you at all?  It is not something I chose to take but just to let you know there are some quite strong opinions both ways.

Babyjane - it is not the "strong opinions" of members as you put it - it is medical opinion and NICE Guidelines that recommend that HRT should be used as first line of treatment for women with menopausal symptoms, not anti-depressants.

So Cathh3110 - I cried buckets when peri-menopausal - this is normal - due to hormonal fluctuations! You have been prescribed an anti-depressant for what is hormonal depression rather than your specialist helping you to find the right hormonal treatment but I presume there is a reason for this in your case, as this is contrary to recommendations? Has your gynae consultant prescribed this just for a short period of time prior to your prostap injections (these suppress the cycle - yes?) after which you will be given oestrogen and a progestogen (instead of ADs) as recommended for hormonal depression?

How long have you had the Mirena and have you experienced any bleeding? If your lining had thickened or if your periods were heavy then this is likely at first. I can't remember where you are in menopause but if you have been given a Mirena - which is excellent at controlling bleeding after the first few months, then actually you are in a perfect position to try oestrogen patches perhaps, again without worrying about the bleeding?

Have you also considered that you may be experiencing side effects from the Mirena coil? Some women get pms type symptoms from some of the synthetic progestogens so would be a pity for this to be the case and then have to take ADs to counter something you have been given for bleeding?

Anyway - whatever happens I hope you feel better soon!

Hurdity x

[Cathh3110]

Hi
Thank you all for your replies, it is really good to get answers to questions from people who have been through this.

I think the AD's are going to be for a short period of time, and yes the injections suppress the cycle. I have been constantly bleeding since having a mirena coil fitted in December - very heavy periods every 2 - 3 wks prior to that. The specialist changed the mirena in April as she thought it might be "faulty" so periods are starting to ease up, but as its the bleeding getting me down and I feel so low she thought that the injection might stop the bleeding for a while and the AD would help give me a "lift" and help me to feel a bit better.

Hopefully this will all work out and I wont need an operation.
Thanks again x

[CLKD]

Hurdity - that's a typical response from you!  Regardless of whether it's a NICE recommendation - which quite honestly is an opinion, probably put forwards by people who have NEVER suffered symptoms! - depression has to be addressed.  People die from depression that is not treated.  Whether it's hormonal or not: I have suffered both: the symptoms of this illness needs treating. 

Dr Dalton did a lot of research into pre-menstrual syndrome which helped many girls.  Lots of advice on the NAPS web-site too!

As a long-term sufferer - a word I don't use lightly - I would not be here without ADs and anti-anxiety medication, it has never mattered why the illness took hold - the important issue is to ease those symptoms.  I have both organic and clinical depression, the former getting worse prior to each bleed.  We don't know what this lady presented with at Surgery and the GP has prescribed for what is probably the 'easiest' symptom to treat.

[Peroxideblader]

Well said by you all..I must admit when I had my breakdown 4 years ago escitalopram was my life saver I started off on 20mg and now on 10 it just keeps me from falling off the edge..I also think looking back this all started same time as my peri so yes it could be hormonal depression but at the time I just needed to get my life back a little and AD was the only choice offered. When I stopped afterms 15 months thinking I was better I hid rock bottom again and went back on escitalopram and now that's me for life if I was diabetic I'd take insulin well my brain is missing something or wrongly wired so my AD is my insulin..I'm not ashamed anymore by people who say they don't need no tablet just buck up chin up etc..the ones who say that have never had proper clinical life changing depression. If you feel better on them stay on them at least a year or so it takes 6 to 8 weeks to be fully effective and yes the first week was awful the sude effects were terrible but they were even worse slowly coming off..never again..me on them for life even when I start hrt.

[samweller161]

Hi there, I take HRT and Escitalapram - there are no side effects that I know of, it does take a while to get into the system - I have gone up and down in dosage over the years, during very challenging times I have had to increase.  I work full time and drive etc and yes I agree, it is meant to be one of the kinder types of AD.  Please don't worry, you would take meds for any other condition so if you have to take these, then it is what it is 

Good luck!

SP x

[Hurdity]

Hurdity - that's a typical response from you!  Regardless of whether it's a NICE recommendation - which quite honestly is an opinion, probably put forwards by people who have NEVER suffered symptoms! - depression has to be addressed.  People die from depression that is not treated.  Whether it's hormonal or not: I have suffered both: the symptoms of this illness needs treating. 

Dr Dalton did a lot of research into pre-menstrual syndrome which helped many girls.  Lots of advice on the NAPS web-site too!

As a long-term sufferer - a word I don't use lightly - I would not be here without ADs and anti-anxiety medication, it has never mattered why the illness took hold - the important issue is to ease those symptoms.  I have both organic and clinical depression, the former getting worse prior to each bleed.  We don't know what this lady presented with at Surgery and the GP has prescribed for what is probably the 'easiest' symptom to treat.

... and that is a typical response from you CLKD!!!!

Just to clarify - the NICE Guidelines are not just opinion - they are a considered clinical judgement after months of scientific scrutiny of the evidence by an expert panel.(the Menopause Guidelines Development Group).

Anyone who is interested can read all about it here:
https://www.nice.org.uk/guidance/ng23

There are sections on the detailed evidence (which is a huge document - what we normally quote on this forum is just a summary based on that detailed evidence), and history of their development including membership of the panel. You do not need to have experienced something in order to study or make recommendations on it - otherwise no doctor would be able to practice! Guidelines and treatments are all based on evidence from trials and will also include subjective assessments where appropriate.

Hurdity x

[babyjane]

That does not mean that in some cases an anti depressant cannot help and can probably used in conjunction with HRt if appropriate.

I think the point these ladies are making is that ADs are not the enemy of the menopausal woman whatever the cause for their anxiety and depression and if they wish to use them it does not always mean their GPs are useless or the women weak in any way for not taking HRT if they don't want to.

[Butterfly22]

I'd be lost without AD's, I'm also a long time user and help me so much I was on one for about 14 years but not effective towards the end so spent a few months finding a new one and one that helped.

I'm now settled on venlafaxine and they really help although in the beginning my side effects were quite strong but the only one I get now I'd say is a little anx first hour of taking.
I'd go with it keep a diary of how you feel and symptoms ect.

Good luck xx

[breeze]

My son takes this for his anxiety condition. He managed to go on a short train trip recently. This is something he has not been able to do for years.

Definitely having a good effect.