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[Alex 2024]

Hi Everyone,
This is my first post! And wish I'd found this forum years ago
I'm 53 and have been on hrt for 3 1/2 years, definitely started peri menopause at age 47. I'm in the UK and have struggled with menopause prescriptions the whole time.  I use Everol patches and was using Utrogestan tablets but now have a mirena coil.
I Started taking Citalopram anti depressant at 47 to help deal with anxiety due to marriage break up. Citalopram, yoga, meditation served me well for a long time.
I stopped taking Citalopram in November 2023 as I felt it wasn't making any difference and it blunted my emotions. This was probably a mistake.
In April 2023 I started taking Amitryptilene to help with chronic fatigue. OMG what a mistake!!!! I went from sleeping up to 12 hours a day to chronic insomnia and feeling "wired" and very anxious. The doc advised to up the dose - so I did and suffered another "bump" as I adjusted to the dose for a few weeks and it didn't help. By this time my anxiety is through the roof - I'm in coping mode and believe the doc when she said it would help.
I switched Docs and now always talk to the menopause doctor at the surgery.  She switched me to Sertraline in September 2023 this didn't work either, suffered  a severe bump getting up to a dose of 50mg over a few months, by November 2023 I've written in my diary that I feel suicidal. I was having panic attacks as well. All the while I am in coping mode. Each day is a challenge. I know I need some sort of anti depressant to help but life is hell. The Doc changed me immediately from Sertraline to Venlafaxine. I gradually upped the dose of this to 112.5mg
In December 2023 I changed to the Mirena Coil because Utrogestan tablets made me feel worse around my period time than I ever did before peri menopause. This has only just settled down.
In February 2024  I changed my Everol patch from 75 to 100. Previously doing this had increased my anxiety and a blood test came up as 866 for Oestrogen s I switched back again. Changing up again increased my anxiety and didn't stop the horrendous nights sweats that I started having around 4 months previously.  I had a blood test after 5 weeks and my oestrogen was 566. Which seems a good amount as the upper limit is 800 so I'm still on 100 patch.
I saw a psychiatristrist 8 days ago (something I never thought I'd need to do) and he advised me to cut back Venlafaxine and add in Mirtazapine.
So here's where I'm at right now......
Everol Patch 100
Mirena Coil
Venlafaxine 70 mg (cutting down as of 8 days ago)
Mirtazapine 15 mg (started 8 days ago)
The Mirtazapine knocks me out at night (except for one random night of insomia - got one hours sleep) but I CANNOT wake up in the morning, previously waking up at 5am naturally, now wake up with alarm at 7am but feel very woozy and spend 2 hours drifiting around on the internet before I panic and get up. I'm then in fight or flight mode and feeling tense most of the day until I start relaxing around 8pm when I start my bed time routine.
I should add that I'm a naturally thin person and have very severe reactions to starting anti depressants - I usually need to start on less than half the recommend amount for other people. However, Menopause meant that I gradually went from 8.5 stone to 11 stone 2lbs until I started this hideous anti depressant rollercoaster in April 2023 and lost all the weight back again in around 3 months. I would now like to put on a bit more weight.
My questions are: I "think" my hrt are about right for me at the moment - but if anyone has comments on this I'd like to read them
I really don't think Venlfaxine suits me, but I'm already on it and every change I make puts me though increased anxiety hell yet again. Has anyone had a similar experience to this and what was the outcome?
I will stick with trying the Mirtazapine for at least another week, has anyone tried this with Venlafaxine and what did you think?
A friend said she thought there was a blood test that is primarily used in the USA that tests which anti depressants will work for you and which won't. Does this sound familiar to anyone in the UK? - is it possible to get it here and have you managed to get an nhs Doc to interpret the results for you. Has anyone got a link to this and any advice?
..... I'm really sorry this is such a long and complicated post but as you can tell I've been going through hell for a very long time and am coping (because I always will through sheer determination) but really want to sort out this mess.
Thanks for reading and am hoping you can help xx

[Penguin]

Yes, there is a specific DNA test called Genesight which does exactly that! It maps your DNA against a wide range of psychiatric drugs (around 60 I think, and includes all the main ssris, and Venlafaxine is in that group) and indicates whether you are likely to respond well or not, or if they'll cause you problems. It is a US test but your psychiatrist or any type of functional medicine doctor/ naturopath should be able to order it for you. You can't order it yourself, it is practitioner only. It is about 250 quid I think. I think it's a good idea and am hoping to get it myself when I see a Psych privately in a few weeks. General DNA tests do not give you the information about specific drugs in this way although they can indicate if you have any problems with particular pathways  eg making serotonin or metabolising certain things. If it was me, I'd give Genesight a try x

[CLKD]

Morning.  Did the Psychiatrist give advice on weaning off 'venlerfaxine'?  I can't understand why another drug would be added until you had been 3 weeks into weaning off.

Bounce back anxiety is common when weaning off, it took me 9 weeks however, I can't remember which particular drug  .

Lots are sensitive to the progesterone part of a regime, has the Mirena helped at all? 

Hormone blood tests are reliably un-reliable.  They have to be done at certain times of a cycle and/or HRT regime. 

Could you take the Mirtazapine earlier to avoid the 'hung over' effect each morning?  A friend used this drug with great success after a few problems/truamas.

I have never heard of a blood test or any other examination that would show if a patient is susceipable to drugs, this is something to ask the Psychiatrist about rather than spending money.  Always make sure that the Company charging for the blood tests are not selling a product!

Let us know how you get on.

[Alex 2024]

Thanks Penguin that's probably exactly what I'm looking for, I'll email the psychiatrist and ask about it.... Fingers crossed...
Thanks also CLKD I was also wondering why I was asked to do two things at once... However I've been in such a heightened state of anxiety for such a long time that I now want to make quick changes and find what's right for me asap and if  it means a week or two of very unpleasant adjustment then I'm willing to do it in the hope that finally things will improve.
As for blood tests... I have no idea where I'm at on the cycle because the coil has  changed things so much. I bled every day for around two months.  And I've just finished my first period since having it fitted and yes, I did feel better than when taking utrigestan tablets.
I'm going to continue as I am, email psychiatrist and then see him again in a month.
I just wish I could throw all the meds in the bin and start again but I can't..... Sigh.... 

[Penguin]

Good luck, I think it's definitely worth a try!

Also some drugs you can start cross tapering immediately with and some you can't. Depends on type and known interactions. My brother in law is a doctor and told me that that is why I am better seeing a psychiatrist rather than a GP as these types of drugs is their specialism and they know what can be combined. He also said that sometimes a low dose of two drugs works better than a high dose of one, as happened to my husband with his BP meds.

Please update if you go ahead with the Genesight, or dm me if you'd prefer. I'm really interested in epigenetics and how we can work with our genes.

[Hollyboll]

Hi Alex

Sorry to hear you are having a bad time. 

I think the overlap / confusion between MH and hormonal issues - and therefore the muddles between ADs and HRT - are really common, and the way things work in the UK is that GPs don't know enough about either and specialists in either tend to be blind to the other.  So I hope it helps to ask if you've heard of Michael Craig - he is a psychiatrist who was previously a consultant gyn and therefore one of the few people who does consider in the round.  I've not seen him ... for various personal and historic reasons I am trying to sort out my HRT first, which has been very challenging in itself - but once I am getting anything like stable or appropriate levels of oestradiol, if my crippling symptoms are still there I would try to see him.  My consultant (meno) works closely with him and rates/recommended him.  I think he works both privately (Craig Clinic, if that's an option for you) and in the NHS (Maudsley, Female Hormone Clinic - but I believe it's a national referral so your GP should if you ask, preferably armed with info so give them a call first?).  I imagine both have long lists, especially the latter. 

I'd be interested to know if anyone on here has seen him ...

Meantime that blood test sounds interesting as ADs do seem hit and miss.  venflaxine is one of the hardest to come off (shortest half-life), and is available in liquid form to help this but you probably should do it under expert advice - and much though I sympathise with wanting quick fixes, that's just not how withdrawals work ...  and for all SSRI/SNRIs it's the lower doses that cause the issues with w/d ie people are much more likely to have a problem at the last stages than going from a high to medium or very high to high dose so all advice is to take it slowly.  There's a lot of info about this now - if you want to google have a look at the work of Horowitz, Heal(e?)y, or a website called Surviving antidepressants.

But it's probably best to do this from expert advice, much though everyone here (me included) would love to help you - it's highly individual and challenging stuff. 

Hope that helps and you get some relief and help soon xx

[orrla]

Testosterone!

I liked Evorel 100 + Mirena combination but wish now I knew about Testosterone much earlier. Only it helped with that scared/weepy/weak/anxious/fearful state my meno put me in and I could not shake off until I tried Testo. ...but, later, lowering oestrogen helped to get rid off an idiotic anxiety I had to..washing machine and wind..
I know nothing about combining all with ADs..Sounds to me, too much of it all at once..?

[CLKD]

I've had many ADs as well as Valium - initially it was 5 mg x 3 times a day then 5mg as necessary: I found it useful to take the night B4 an Event I was unable to get out of [visiting his family]. Knowing that I could take another 5mg during that day however, I never required it.  I had about 3 days benefit each time.

In 2002 my GP prescribed 'propranolol' a night to ease the early morning anxiety surges.  I would wake, terrified.  The betablocka really helped me but it sends my neighbour into a heightened state of agitation.

Some find that keeping a mood/food/symptom diary of use to chart progress and note if any symptoms might be cyclical. 

Let us know how you get on!  Lots of good advice here. 

[Penguin]

Hi Alex

Sorry to hear you are having a bad time. 

I think the overlap / confusion between MH and hormonal issues - and therefore the muddles between ADs and HRT - are really common, and the way things work in the UK is that GPs don't know enough about either and specialists in either tend to be blind to the other.  So I hope it helps to ask if you've heard of Michael Craig - he is a psychiatrist who was previously a consultant gyn and therefore one of the few people who does consider in the round.  I've not seen him ... for various personal and historic reasons I am trying to sort out my HRT first, which has been very challenging in itself - but once I am getting anything like stable or appropriate levels of oestradiol, if my crippling symptoms are still there I would try to see him.  My consultant (meno) works closely with him and rates/recommended him.  I think he works both privately (Craig Clinic, if that's an option for you) and in the NHS (Maudsley, Female Hormone Clinic - but I believe it's a national referral so your GP should if you ask, preferably armed with info so give them a call first?).  I imagine both have long lists, especially the latter. 

I'd be interested to know if anyone on here has seen him ...

Meantime that blood test sounds interesting as ADs do seem hit and miss.  venflaxine is one of the hardest to come off (shortest half-life), and is available in liquid form to help this but you probably should do it under expert advice - and much though I sympathise with wanting quick fixes, that's just not how withdrawals work ...  and for all SSRI/SNRIs it's the lower doses that cause the issues with w/d ie people are much more likely to have a problem at the last stages than going from a high to medium or very high to high dose so all advice is to take it slowly.  There's a lot of info about this now - if you want to google have a look at the work of Horowitz, Heal(e?)y, or a website called Surviving antidepressants.

But it's probably best to do this from expert advice, much though everyone here (me included) would love to help you - it's highly individual and challenging stuff. 

Hope that helps and you get some relief and help soon xx

That is so true re the overlap, I feel like I'm chasing my tail knowing whether my MH issues are actually MH or hormonal.  And just when I think I have it figured, something changes.

I am very interested in the psych / gynecologist you mentioned and going to look the Craig Clinic up. I'm seeing a private psychiatrist mid April but it would be amazing to see someone that understands both.

OP, this sounds like a great route to explore as well, someone who can look at the whole picture for you! Perhaps mention him to your Psych when you email him about Genesight?

I also agree with pursuing liquid form of drugs to taper down with, that's what I'm going to try and get for my citalopram. Your psychiatrist should be able to prescribe this for you. My GP says just to cut the tablets or alternate days but I don't think that is the safest way to do it, and you can get much smaller doses with liquid.

[Hollyboll]

Hi. 
I'm very nervous about being taken to give advice here, I'm not a doctor!  But: alternate days are a GP fallacy and one of the  WORST things to do, especially with short half-life drugs.  That puts you in and out of withdrawal on alternate days.  And if you cut eg slow-release venlaflaxine into pieces, you interfere with the slow-release mechanism and therefore are also in and out of withdrawals too. 
Like HRT, this is just way over most GPs' knowledge.  And far too many psychs around have "closed their minds" to hormonal issues ... those were words I heard Nick Panay say in one of his Diane Danzebrink videos, and seems very true!! 
HTH xx

[CLKD]

 Several years ago that was how I withdrew by alternate days.  Then every 5th day etc..  I made sure that I could rest and fortunately my symptoms eased within 24 hours each time.  It took my head a couple of weeks to get round that the bounce back didn't make me feel worse!  I was worried that the bounce back would cause me to restart but I stuck it out. 

[Penguin]

Hi. 
I'm very nervous about being taken to give advice here, I'm not a doctor!  But: alternate days are a GP fallacy and one of the  WORST things to do, especially with short half-life drugs.  That puts you in and out of withdrawal on alternate days.  And if you cut eg slow-release venlaflaxine into pieces, you interfere with the slow-release mechanism and therefore are also in and out of withdrawals too. 
Like HRT, this is just way over most GPs' knowledge.  And far too many psychs around have "closed their minds" to hormonal issues ... those were words I heard Nick Panay say in one of his Diane Danzebrink videos, and seems very true!! 
HTH xx

Totally agree, same with alternating days on hrt. But he was just suggesting it for citalopram which has a long half life and isn't a slow release one (at least mine isn't that type). However, the 10mg which I'm on doesn't have a cut line in it so you don't even know quite what you're getting in dose anyway, and they arent designed to be cut. I think the key is to go to an expert when trying to taper if you can as it is SO important to do it safely and every drug is different, so a taper programme for one won't necessarily work for another. I really hope my Psych isn't of the closed mind variety!!!

[Hollyboll]

Penguin - have sent you a PM xx

[Penguin]

Penguin - have sent you a PM xx

Thanks, got it 😀

[Alex 2024]

I think the overlap / confusion between MH and hormonal issues - and therefore the muddles between ADs and HRT - are really common, and the way things work in the UK is that GPs don't know enough about either and specialists in either tend to be blind to the other. 

Thanks Hollybol I completely agree with what you've written above and actually agree with everything you wrote.
I didn't know Venlafaxine was so hard to cut down - that's interesting .... if not good news for me!

I simply can't afford to go private - if I get the go ahead for the Genetic blood test it will be out of my rainy day money and will have to be a one off unfortunately.

My experience is, like you,  that all this is beyond a GP and I'm hoping the psychiatrist has taken my menopause prescription and problems on board - he certainly seemed to be listening but I'm not convinced because I've had such bad experiences and lack of continuity of care through this whole journey.

Orlla mentioned testosterone. I had an "interesting" exerience with it. I started taking it in June 2021 and felt so much better within two days! - I had confidence like I had never ever had in my life before!!  However...... I didn't pay enough attention when the gel packets changed from 50 to 40 (because I was anxious and struggling with attention and to be fair to me it would have been nice if the pharmacist or someone had flagged up the dangers) and accidentally started to overdose with it... guess what.... my anxiety started to increase and I started to get very hairy which really upset me. Around September 2023 I had a blood test and had 20 times the recommended amount of testosterone. So I stopped it immediately. I was told the hairiness would go and it has died back but not completely.  So although I think a v small amount of testosterone would benefit me, until it can be prescribed more accurately and in very small doses I am not going anywhere near it.

Thanks to everyone for advice so far - it's all been very helpful and it's really good to find a supportive and knowledgeable place.

I know there isn't a magic bullet for all this ... but it doesn't stop me from wishing there was one xx