Perimenopausal depression and suicidal thoughts; help needed.
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Anonymous
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I'm 49 and somewhere in the midst of perimenopause. I don't have a uterus because I had a hysterectomy following a complicated birth 10 years ago (so I'm not sure if I would still be having periods or not). I do have my ovaries.
I started HRT (started on oral estrogen 1m/daily and currently on 2mg/day) about 18 months ago for hot flashes, mood changes (anger and depression) and insomnia. It's prescribed by my PCP. The depression was pretty bad--very dark thoughts and constant thoughts of suicide as a relief from the dark thoughts. If you haven't been there, it's just relentless--unable to ever stop feeling dark, pointless, down. KNOWING intellectually that it's depression and that your kids/husband/friends need you but never, ever being able to shut off the mental dialogue of darkness. Things were quite a bit better for most of the 18 months since starting estrogen--with some very isolated weeks here and there where I was dark. In fact I would say that my mood was consistently better than it's been for most of my adult life!! Fast forward to the last 3 months or so and the relentless darkness is back with very little respite from it. Occasionally brighter days. But it just pounds away. I can't think myself out of it. I can't exercise out of it or do things to get away from it (a day with my husband/kids, a conversation with a best friend, a good meal, sleep, etc). Nothing stops it. I share that just to share what my mental reality is like. Do you have any thoughts on what I could do or try? I have tried anti-depressants about twice in my adult (16-49) life but on both occasions I never took them for more than 6 months. I would have side effects (feeling jittery, weird, whatnot) and both times didn't feel like the meds did much to help my depression which was mostly hormonally related and pretty mild. Should I ask my doctor to start progesterone? I was not prescribed this as part of the HRT because I don't have a uterus. I don't think there is a medical negative to taking progesterone without a uterus but it's just not medically necessary. However, I've read that progesterone has a calming effect on mood. Are there supplements that I can try? I'm on no meds (for anything) but the estrogen. Should I start meds? (an SSRI?) I am really struggling here. Thank you so much for any thoughts. |
Anonymous
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My first thought is that you might not be absorbing the oral estradiol very well.
Have your other, non-psychiatric symptoms of low estrogen resolved completely? Hats off to you realizing that this is likely hormonal in nature!! Hormonal changes is likely the suicide risk for women between the ages of 44-55 is so high, and it’s easy to get to such a dark place that you don’t realize what’s going on. |
Anonymous
| PP again. Also if the hormone amount was working for over a year, it could mean that your ovaries are now producing less natural estradiol, as you get closer to menopause. Or you might be in menopause. You probably need a higher dose. |
Anonymous
| See a psychiatrist. This warrants intervention by a mental health specialist. |
Anonymous
| Antidepressants didn't help me; estradiol and progesterone did. YMMV. |
Anonymous
My psychiatrist was useless. I only got help with this when I found a pcp who has a strong interest in treating peri/menopause. |
Anonymous
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Look into trans cranial magnetic stimulation therapy. It’s not cheap but insurance covers in most circumstances if you have a history of refractory depression and an inability to maintain SSRI therapy due to side effects.
I was profoundly depressed- just as you describe - for a number of years during perimenopause thanks to years of insomnia and health issues which impacted my career and life in general. I went to a psychiatrist who was head of department at a hospital near me and we discussed ECT, which I knew about but was very concerned about the side effects as most people I know who have had it lost a lot of memory. He told me about TMS and referred me to a local facility - he’s trained in the therapy himself but the hospital had not yet launched treatment protocol. I ended up doing two rounds about a year apart - my brain was really fried so I think I needed extra recharging. But the treatment is very easy to tolerate, no side effects to speak of, and is highly effective in a large % of patients who complete it. It saved my life and my brain is so healthy now (doing all the self care to maintain, sleeping, sunlight/lightbox daily, good diet, exercise, etc.) that it is hard to believe how much I wanted my life to end not so very long ago. Highly recommend! |
Anonymous
PS - forgot to say that HRT restored my sleep and alleviated a lot of other perimenopausal symptoms that were distressing my life, but by itself it wasn’t enough to kick a profound depression. That’s why I got the TMS. |
Anonymous
| ketamine worked for my colleague in this situation. |
Anonymous
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MDMA therapy, Ketamine, Mushrooms, CBD, etc.
Amazing groundbreaking research at Hopkins, etc. |
Anonymous
| SSRIs didn’t work for me either but have you tried an SNRI? Also in perimenopause and Effexor has been a game changer for me. |
Anonymous
| Have you gone back to the doc who originally started you on HRT? Or do you have a new GYN you trust? Since your depression seems hormonal in nature, I would start there. Maybe you up your dose and/or add progesterone. I would also see a therapist for emotional support and coping while you are pursuing the medical route. And a psychiatrist could be good for a consultation, as there are always new depression treatments coming out. But to me it seems like you need as much support as possible. The treatment is going to be trial and error, but the more support you have the more likely you get through this period unscathed. I also suffer from brutal hormonal depression and anxiety, and SSRI’s have not helped me, plus I don’t tolerate hormonal birth control so that’s been fun. Currently I rely on light therapy, exercise, talk therapy, and a bit of medical marijuana for sleep, but I am only 43. I am prepared to throw a whole lot more at this issue as I get older. Hang in there, you sound like a really self aware and frankly amazing and strong person. I really am rooting for you to feel better soon! |
Anonymous
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Lots of bad advice here. Bottom line is you need to ask doctors not DCUM. If you’re really suicidal, you need psych.
1. Psychiatrists are as a group pretty terrible at diagnosing and/or treating hormonal depression. However if that’s what you have then an SSRI may help you. Try Lexapro. Start low and go slow to minimize side effects. 2. You need to see someone who specializes in hormonal treatment of menopause only bc you are having such serious symptoms. 3. Unopposed estrogen is questionable. It increases the risk of breast cancer not just endometrial cancer. Please see an endocrinologist or someone more knowledgeable about risks and benefits than your PMD may be. Good for you for recognizing how powerful hormonal effects can be. I really hope you find physicians who can help tune you up. |
Anonymous
| You absolutely need to see a psychiatrist and I would ask about ketamine as I have so many friends in this stage of life on HRT, antidepressants, seeing a therapist and ketamine infusions were a life saver for them. |
Anonymous
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I’m 54 and never used HRT. It’s not needed by many women.
I got depression with various birth control pills. Supplementing hormones can really mess you up. |