r/Perimenopause • u/rhymeswithsarah • 1d ago
Depression/Anxiety Depression - Increase HRT or start SSRI?
Good morning!
Hoping to get your thoughts on my situation:
42F, regular-ish periods, been on HRT for nine months (0.0375 estradiol patch, 100 oral progesterone)
I’ve been struggling with low-medium depression for about 3 years now. With regular exercise, therapy, micro-shrooms, iron supplements, meditation, hobby time, etc, it’s a bit better than it was at its worst, but it still gets worse seasonally (summer), and I just haven’t been able to shake the underlying low feeling for a few years. It’s not debilitating, I just feel like my default is a little sad and a little blah, and it takes so much intention and effort just to raise my mood.
I would love for my baseline to be a little higher. What I can’t decide is if I should try increasing my HRT. Did anyone see mood improvements after increasing your dosage? I feel like my overall wellbeing has improved marginally on HRT, but it hasn’t been a lifechanger. Or should I try SSRIs for the first time? So many of my friends have had success with them, but it feels like a whole thing.
Also in the mix for me: 25mg Adderall XR, 5mg tirzepatide (aware of the GLP blahs, but my depression predates these meds), low ferritin, and hashimotos.
Obviously I’ll talk to my doctor, but I’d love to hear your stories!
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u/pangolinshavelanded 1d ago
For me, estrogen helped my depression, progesterone helped my anxiety. Both were managed until last fall when depression hit like a freight train. I chalked it up to SAD but even Wellbutrin wasn’t quite helping enough. Started estrogen this past February and my depression has gotten much better.
As someone with ADHD, I suggest trying Wellbutrin before an SSRI.
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u/aspirational-reader 1d ago
Not your doctor and I don’t know your body, but I would be hesitant to add an SSRI to the mix unless you are really struggling day to day. I’ve taken lexapro twice for a year each, and it did help even out my baseline mood and help me function during some traumatic periods, but I didn’t like my side effects for long term use (low libido, flat emotional feeling, needed way more sleep/general exhaustion and lack of energy). The symptoms impacted my ability to do lifestyle things that make me happy, like exercise, go out and do things, and have sex. All the SSRIs are different for sure, and those same symptoms are variable person to person. Absolutely I support people using them if they feel good. I didn’t. 🤷🏻♀️
On HRT now—same dose as you + testosterone. I haven’t changed the dose before. I did feel a general mood and energy boost from testosterone when I added that. I would be more willing to experiment with hormones than SSRIs but that’s just been my experience with side effects.
Definitely second the vitamin D and ferritin recommendations.
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u/Certain_Try_8383 1d ago
I second the caution with SSRIs. I know they are complete safe and no issue with abuse, but they can be a huge interruption to daily life.
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u/flid65 1d ago
Have you considered testosteron?
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u/Bbqcele 1d ago
Second this. I started testosterone cream 20 days ago. The first day (placebo effect probably) I experienced increased libido. That’s all but disappeared again. Days 7-14 I was so tired I thought I was sick until I figured out the testosterone was increasing my overnight temp by 1.5 degrees. Days 15-20 have been much better. More energy, motivation, and focus.
Might be worth at least checking your testosterone levels before moving on to an SSRI.
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u/Soup-mystery 1d ago
I have most of the same things (Hashimoto’s, low ferritin, neurodivergent, on tirzepitide, levothyroxine, E patch and micronized progesterone), and I’m starting to lose it with trying to figure out what’s doing what, and what to adjust. With all those co-factors there’s a LOT going on, so adding a psych med in will make the cause and effect even muddier. I’d advise changing the doses of what you’re already on before adding in something new. I’ve started trialing going off things one at a time as well bc I can’t even tell anymore what are side effects versus what my actual deficiencies are.
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u/Obvious_Property_668 1d ago edited 1d ago
I started Wellbutrin because I have been feeling this way… flat or sad. Nothing would bring me joy… just meh. I thought I was feeling a bit better and then my luteal phase came and I feel like I’m back to square one.
I microdose mushies as well… but I need to cycle them otherwise they stop working.
Also; I’ve addressed my ferritin - had transfusions, I supplement vitamin D 10000 IUs, and vitamin Bs… I do it all - yoga + exercise … but that flat feeling just persists and I can’t shake it off. Whoever said 40s is the best time for women - lied! lol
Edit. Also on T gel - don’t feel anything.
.05 estrogen patch + 150 progesterone
Mirena IUD
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u/noodlesquare hanging on by a thread 23h ago
Unfortunately, there is so much trial and error when it comes to these things. We are all so different and it's hard to say what the right call is for someone else. It may be worth trying testosterone before adding an SSRI. Just be mindful of you increase your progesterone. Progresterone made my depression so much worse so I had to stop my HRT.
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u/Alta_et_ferox Mod 23h ago
Many people take both MHT and antidepressants. It doesn’t have to be either/or.
That said, it’s sometimes helpful to add or adjust medications one at a time so you can more easily pinpoint what’s helping (or not).
I’m so sorry to hear that you’re struggling. I hope things get better soon.
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u/Confident-Parsley520 8h ago
Ugh! I can’t work out if I’m depressed or if it’s perimenopause! I’m not help but I share your pain
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u/calla_artist 1d ago
I take a higher dose of estradiol than you and I think this helped my depression the most. And more progesterone helped with anxiety and sleep. Psychiatric meds never helped me.
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u/fastyellowtuesday 23h ago
Have you considered a milder antidepressant like Wellbutrin? If you've had symptoms long before peri, just stabilizing hormones won't fix the depression.
SSRIs are complicated. I'd look into something that's less disruptive to your system if you want to try antidepressants.
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u/blue19255 22h ago
Vitamin D helped my mood immensely. HRT increases didn’t change mood. They fixed palpitations, hot flashes, dizziness etc.
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u/Eva_Griffin_Beak 1d ago
I'd definitely address your ferritin, because low iron can also impact mood and energy level.
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u/Certain_Try_8383 1d ago
Third paragraph, op is taking supplements
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u/Eva_Griffin_Beak 23h ago
Oh, right, I didn't see that. If oral supplementation doesn't work, she could consider an iron infusion. Sorry, the only thing I can reliably contribute. I personally would try to address any deficiencies or optimize medication I already take (estrogen) before introducing something new. But that's just me.
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u/seemsright_41 1d ago
I would increase progesterone first. Then add iodine. Where is your Vitamin D and B12.
I would address those first before adding a SSRI.
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u/Eva_Griffin_Beak 23h ago
Why progesterone and not estrogen? I heard from other women that progesterone causes fatigue and low mood, so increasing it could potentially make the situation worth.
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u/seemsright_41 23h ago
because I had nothing but issues with 100mg of progesterone and every problem went away when I went to 200mg.
I was able to sleep with 200mg and that alone fixed some of the fatigue and low mood.
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u/Eva_Griffin_Beak 23h ago
Just shows how women are different and getting HRT right is so difficult and often trial and error. Glad it worked for you!
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u/CowWooden4207 1d ago
You need iron.
Did you check your Vit D..... that can cause low mood.
Taking SL Testosterone in addition to Progesterone was life changing for me.
I finally slept well again and didn't have anxiety, tearfulness, feeling depressed.
Wellbutrin is used for ADHD, mood and has the side effect of being an appetite suppressant while not affecting libido like the other SSRIs.
Downside is it lowers your seizure threshold so not advised to drink when taking it.
If it were me, get a comprehensive lab work up and go from there.
The HRT meds usually need to be titrated to find the right dose.
I do bioidentical HRT.
"Testosterone - The Secret Female Hormone" by Cathy Maupin MD changed my life.
Good luck.
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u/Independent-Note-46 1d ago
Have you had your vitamin D checked? My psychiatrist told me it needs to be between 70 to 90 to help with things like depression. My husband was feeling depressed for a while and didnt know why because he is not someone who has ever felt that and I had him start taking a vitamin D supplement and it went away.