It is often the psychological symptoms of menopause that have the most far-reaching impact on daily life, as depression or anxiety can affect sleep, which increases fatigue that often then leads to unhealthy eating and a lack of exercise. A lack of exercise and a poor diet can contribute to feeling low, and so the cycle continues. It's so easy to get caught up in a net of connected symptoms and then not know how to break out of it. Often, our GP will suggest antidepressants as a way to ease the root of these problems, but this isn't always the right course of action. The various acronyms thrown around also make it hard to know what's right for us.
SSRIs (selective serotonin reuptake inhibitors) stop the brain from reabsorbing serotonin (the happy chemical) too quickly, allowing it to remain in our systems for longer, therefore lifting our mood. SNRIs (serotonin and norepinephrine uptake inhibitors) do a very similar thing and are also used to treat anxiety with depression. HRT (hormone replacement therapy) replaces some of the hormones that we are not producing naturally anymore, and because oestrogen plays such an important role in regulating mood, HRT can be a really effective therapy for depression and mood swings.
So, when should we use HRT and when should we consider SSRIs or SNRIs? Clinical guidelines issued by NICE (another acronym – National Institute for Health and Care Excellence) state that HRT should be prescribed as a first line treatment for depressive disorders in women of menopause age. If there's no history of depression or anxiety, it is much more likely that changing hormone levels are the cause of this first episode of mood problems, so antidepressants shouldn't be prescribed without first investigating HRT as a treatment. People who have had previous periods of depression may benefit from antidepressants if they've worked in the past.
CBT is a non-pharmaceutical intervention that is also recommended by NICE as a treatment for low mood and depression associated with menopause. CBT stands for cognitive behavioural therapy, and it focuses on understanding the reasons for depression and negative thoughts while equipping you with new tools and strategies for dealing with these episodes. Some of the breathing and distraction techniques can even ease the experience of hot flushes.
Another benefit of CBT and talking therapies is learning mindfulness and acceptance techniques to help you deal with the many changes taking place. Group therapies can be really helpful for coping with menopause related mood changes because hearing about the experiences of others, and providing empathy for them, enables us to have empathy for ourselves. We are often so used to taking on responsibilities (childcare, grocery shopping, cleaning, emotional labour, work, hobbies, caring for relatives etc.) that it takes someone else's viewpoint to make us see that we need to be much kinder to ourselves. It's OK to slow down and delegate some of these things when we're going through menopause – we would never expect a loved one to work themselves past the point of exhaustion, but we often feel that we need permission to do this for ourselves.
There are so many acronyms to understand that the decision to try HRT, CBT or SSRIs gets quite difficult. Whilst awareness of menopause symptoms and presentation is improving, it is always wise to ask to speak to the GP at your practice who specialises in menopause. They will be much more knowledgeable about the various treatments and therapies on offer and can help you to navigate your way out of the net. HRT, CBT and SSRIs all have their benefits so seek advice about what is right for you right now and be open to trying other things if and when they are helpful. Menopause is a time of change, so it follows that the things which help you can change with time too.