What You Should Know About Antidepressants & Perimenopause

April 14, 2020.

Depression is a common symptom experienced by women in perimenopause. And while there is little scientific evidence suggesting that perimenopause causes depression, doctors and scientists alike are well-aware that hormonal imbalance can cause depression in women. Even though depression is one of the symptoms of perimenopause, it does not mean that you have to suffer through it without help. Some women feel much better with antidepressants. Others report that antidepressants have not helped their wellbeing. Here is a look at what you can expect with antidepressants & perimenopause.

What do antidepressants do?

Antidepressants balance neurotransmitters (chemical messengers) in your brain. Much like hormone replacement therapy can balance your sex hormones, antidepressants can balance neurotransmitters that are linked to mood and emotions. The primary neurotransmitters that antidepressants aim to balance are:

  • Norepinephrine – “Fight or flight” neurotransmitter

  • Dopamine – “The Rewards” neurotransmitter (It creates positive feelings when you are rewarded for something)

  • Seratonin – “The feel-good” neurotransmitter

Each of these neurotransmitters plays a key role in how you feel. When neurotransmitter levels are too low, it can lead to depression. What causes low levels of neurotransmitters in the first place is a question that remains to be answered. 

Antidepressants work by increasing your neurotransmitters. Examples of classes of antidepressants include:

  • Selective serotonin reuptake inhibitors (SSRIs) – Prozac and Zoloft, two common antidepressants, are in this class of antidepressants

  • Tricyclic antidepressants

  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)

  • Atypical antidepressants

  • Monoamine oxidase inhibitors (MAOIs)

Are antidepressants right for perimenopause?

The effectiveness of antidepressants varies from person to person. Some women in perimenopause find that the right antidepressant, at the right dose, is just what she needs to treat her perimenopause depression. Other women find their symptoms do not improve and may even worsen. It is important to dive into the root cause of why you are depressed. Certainly, low levels of neurotransmitters are the biochemical reason behind depression (along with erratic hormone levels), but you should also consider if there is something nagging at your subconscious or past trauma that is contributing to your depression.   

Can doctors sometimes be too quick with antidepressants for menopause?

Yes, absolutely. Just like any treatment option, sometimes antidepressants can be recommended before other strategies are explored and tried. Some doctors may push antidepressants on their patients more than others and there are a variety of reasons behind this. However, most doctors have seen many of their patients improve after being on antidepressants for some time once they have found the right dose and medication.  

The best thing you can do is educate yourself and learn about your options. Antidepressants can be very beneficial for some women, and perhaps you will be one of them. For other women, antidepressants may cause more harm than good. There are many things you can try to treat your depression along with, or separately from, antidepressants.

  • Cognitive Behavioral Therapy (CBT)

  • Counseling

  • Exercise

  • Self-Help Groups

  • Improve your sleep hygiene (This for sure can be hard in perimenopause)

  • Get more vitamin D

  • Hormone Replacement Therapy

  • Try natural supplements such as St. John’s Wart or 5-HTP

  • Avoid alcohol and caffeine

  • Get a grip on stress

  • Improve your diet with mood-boosting foods

  • Identify negative thought patterns and triggers and learn to reframe your thinking

  • Socialize 

Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.

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Julia Walker
perry expert Julia (RN, BSN, BA) is a registered nurse based in Colorado. Julia's nursing background in women’s health has ranged from neonatal and postpartum care to labor and delivery, to outpatient gynecological medicine for both adolescent and adult populations. She specializes in helping women optimize their health during perimenopause and beyond.

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