Why Antidepressants are Not Menopause Treatment

And why you deserve better

I want to start by being very clear: antidepressants save lives. Many women need them to treat legitimate mental health conditions. Full stop. Zero dispute.

But they are NOT a treatment for menopause symptoms. They don’t restore declining hormones or address the root causes of hot flashes, sleep disruption, low energy or mood changes. They do nothing to address brain fog, cognitive decline, vaginal dryness, pain with sex, overactive bladder, or low sex drive. Nor do they protect against bone loss, Alzheimer’s disease, cancer, heart attack and stroke risk.

At best, they can mask some symptoms. But in many cases, they can actually make things worse, piling on side effects that compound menopause issues.

Only hormone replacement can resolve those issues, and I’m convinced that millions of women are prescribed SSRIs and similar medications when what they really need is hormone replacement therapy—estrogen, progesterone and testosterone.

Even the Menopause Society has been very clear:

“Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fracture.”

So, why the SSRIs?

I know so many women who have gone to their doctors practically begging for help to deal with their menopause symptoms (many don’t even know menopause is what’s causing them). The mood swings, malaise, exhaustion, anxiety, hot flashes, and just not feeling like yourself can be debilitating. They’re desperate for an answer.

I was one of them. My PCP NP offered me an anti-anxiety med, buspirone, which caused me bizarre dreams and disrupted my sleep. No thanks! I already had sleep issues—I didn’t need anything to make it worse.

My GYN offered an antidepressant. BUT I WASN’T DEPRESSED. I had no reason to be. I have a great family, a solid career, financial stability, plenty of friends, an active social life…

Plus, it wasn’t just my brain that felt off. It was my body too. Achy all over, bladder control issues, dry skin, itchy ears, I was getting weaker despite working harder in the gym, and just so many other weird things.

Unfortunately, most doctors don’t recognize these as menopause symptoms and instead focus only on the hot flashes and night sweats.

It’s true that several SSRIs and SNRIs have been shown to reduce the frequency and severity of hot flashes for some women by 30-60%. In fact, one of these medications—low-dose Brisdelle/paroxetine—is even FDA-approved specifically for this use.

They work by basically tricking your brain and “rewiring” your body’s thermostat—they do nothing to fix the underlying hormonal deficiency that causes it.

Then there are the side effects…

Antidepressants are psychiatric medications—they’re designed to alter your brain’s chemistry. And, like any medication, they have trade-offs. Some of the most common side effects are:

• Nausea and GI upset
• Insomnia or sleepiness
• Headaches
• Weight gain
• Emotional blunting—you just feel….nothing.
• Sexual dysfunction occurs at very high rates. About 72% of women report desire problems, 83% have arousal issues and 42% experience anorgasmia (inability to orgasm). For women already struggling with libido, this is a DISASTER.
• Bleeding risk—SSRIs and SNRIs can interfere with platelet function and reduce blood clotting ability, which can lead to intestinal bleeding, especially when paired with NSAIDs or aspirin, which many women ALSO take for the chronic pain associated with menopause. In fact, paroxetine, Zoloft (Sertraline) and Prozac (Fluoxetine) have the highest risk.
• Heart arrhythmias. Some SSRIs can cause water retention, fatigue, confusion, dizziness or changes in heart rhythm. They can also lengthen the electrical “reset” time of the heart, particularly Celexa (citalopram) and Lexapro (escitalopram).

See how this creates a compounding cascade of symptoms and side effects? We already know that menopause causes insomnia, fatigue, weight gain, low libido and heart palpitations. So we’re treating it with medications that ALSO cause those symptoms? Make it make sense!

Not to mention, a growing body of evidence links SSRI use to lower bone mineral density and higher bone fracture risk. And declining estrogen already causes bone density loss and a higher fracture risk. So again, we’re COMPOUNDING the menopause issues by prescribing SSRIs.

“Women (and men) using SSRIs were about 2½ times more likely to have a hip fracture compared to non-users.” https://actaspsiquiatria.es/index.php/actas/article/view/1560

“Daily SSRI use nearly doubles the risk of hip fracture in people over age 50.” (The Cleveland Clinic Journal of Medicine published this in 2016! So we’ve known about this for almost a decade, yet the practice of prescribing SSRIs for menopause still persists).

Meanwhile, HRT treats the cause.

Because HRT replaces the hormones that are at the root cause of these symptoms, it can relieve hot flashes more effectively, improve sleep, and protect bone, plus resolve the dozens of other symptoms that antidepressants can’t touch.

Given that suicide risk among women increases sharply in midlife, it’s natural to ask: Shouldn’t we use antidepressants more? I can see how this would be a logical conclusion, and for many women, it may be absolutely necessary.

But research also shows that increases in suicidality among women are directly linked to decreasing estrogen. In other words, suicidal thoughts are yet another symptom. So again—instead of treating the symptoms, why not treat the underlying cause: low estrogen?

And then there’s testosterone…

Testosterone plays a key role in:

• Energy, motivation, drive and confidence
• Muscle and bone strength
• Cognitive function
• Sexual desire and arousal

And there is clear evidence that replacing testosterone at normal physiologic levels for a woman can improve energy, muscle and bone strength, brain function, sexual function, mood, and vitality. Yet because it’s not FDA-approved for women, most doctors refuse to prescribe it, or worse, call it “dangerous.”

Clinicians who do prescribe testosterone must do so off-label—just like all those SSRIs for hot flashes. Hmmmm….

So, if we’re comfortable prescribing psychiatric medications off-label to mask the symptoms of menopause, why are we not comfortable replacing the natural hormones the body is missing?

Especially since the side effects are far less, and they don’t carry nearly the risks that psychiatric meds have.

Besides, it’s just the principle of the thing: doctors used to “treat” menopause by putting women in insane asylums. And there’s a reason it’s called a “hysterectomy”—from the root word “hystera” aka “hysteria”—because they thought removing the uterus would “cure” our issues!

WE ARE NOT CRAZY. Our brains and our bodies are just deficient in critical hormones. The answer isn’t to medicate us into a state of unfeeling. The answer is to replace what we need.

The resistance to HRT isn’t about science—it’s about outdated narratives around women, hormones, and sexuality. If I put on my “tin foil” hat, it’s not hard to see that:

1. The dozens of medications used to treat the symptoms of menopause can make far more money than cheap, generic hormones, so there’s a clear financial incentive to push those over HRT.
2. Giving women antidepressants keeps us quiet, meek, and feeling flat, like Stepford Wives: compliant, good girls, rather than confident, motivated, empowered, and vocal—you know, all those admirable leadership qualities that men have…by virtue of their testosterone!

Again, I want to reiterate: antidepressants may absolutely be necessary for some women. I’m not denying that whatsoever. And there’s no shame in taking them, if that’s what you need.

But it’s worth questioning/discussing whether that really IS what you need, and if hormone replacement (including testosterone) might be the better (and safer) answer.

I am SO hopeful that the FDA’s announcement this week to remove the black box warning on HRT products will start to unravel some of this and the decades of misinformation and misplaced fears.

In the meantime, don’t be afraid to speak up for yourself. Insist on better options, and don’t just take the word of one doctor as gospel. The education around menopause and treatment is sorely lacking, but there ARE educated providers out there. You owe it to yourself to find one who will listen.

**This is not medical advice, and I am not a doctor. The information here is based on my personal experience and research.