Many women in their 40s and beyond are prescribed antidepressants like SSRIs (Selective Serotonin Reuptake Inhibitors) or SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) for symptoms related to perimenopause and menopause, often without any conversation about alternatives like menopausal hormone therapy (MHT).
Hot flashes? Here’s an SSRI.
Mood swings? Try an antidepressant.
Insomnia or anxiety? Must be depression.
But is this really the best solution for midlife women? Or are we masking hormone imbalances with medications designed for something entirely different?
In this article, I’ll break down why SSRIs may not be the right first-line treatment for menopause symptoms, what the long-term risks are, and what questions you should ask before filling that prescription.
Why Are Women in Menopause Being Prescribed Antidepressants?
When women report symptoms like anxiety, irritability, poor sleep, or brain fog, many providers default to diagnosing depression or generalized anxiety disorder, especially if they haven’t been trained in how hormonal changes affect mental health.
But here’s what’s often missed: estrogen, progesterone, and testosterone don’t just regulate your cycle. They play a major role in brain function, mood regulation, metabolism, and sleep.
If those hormones start fluctuating (which they absolutely do during perimenopause), your brain notices. But instead of looking at your hormone levels or menstrual cycle history, too many clinicians reach for the prescription pad.
SSRIs may provide some relief, but they don’t solve the root issue.
The Risks of Taking SSRIs for Hormone-Related Symptoms
SSRIs and SNRIs can be helpful for women with true clinical depression, but when used to treat menopause-related symptoms, they can come with significant downsides. Here’s what women should be aware of:
1. Feeling “Flat”
SSRIs can numb emotional highs and lows. Over time, many women report feeling detached, less engaged, or “flat.”
2. Sexual Side Effects
Nothing wrecks your libido like an SSRI. Up to 70% of SSRI users experience sexual problems such as delayed orgasm or complete loss of sexual desire, compounding what’s already a common midlife challenge.
3. Weight Gain and Insulin Resistance
These drugs are linked to increased appetite, fat storage, and metabolic shifts—especially problematic when hormones are already slowing metabolism.
4. Bone Loss and Fracture Risk
Long-term SSRI use has been associated with decreased bone mineral density and an increased risk of fractures, something estrogen naturally helps prevent.
5. Gut Disruption
SSRIs can interfere with the gut-brain axis, leading to bloating, digestive issues, and changes in gut motility.
6. Withdrawal Symptoms
Tapering off SSRIs (especially Effexor or Paxil) can be difficult and lead to discontinuation syndrome which can include dizziness, insomnia, brain zaps, and anxiety. No thanks!
7. Depriving Women of What They Really Need
The biggest problem? These drugs can cover up symptoms that are often hormone-driven, leaving women medicated, but still feeling unwell.
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What to Ask Your Doctor Before Starting an SSRI or SNRI
Before you head down the antidepressant road, ask these key questions to ensure you’re being treated appropriately:
- Could this be related to perimenopause or menopause?
- Have my hormones been tested or evaluated?
- Are there safer or more targeted non-drug options I can try first?
- What are the long-term risks of taking this medication?
- What’s the plan to monitor or taper off if it’s not helping?
What to Do Instead: A Root-Cause Approach to Menopause Symptoms
If you’re experiencing mood swings, anxiety, brain fog, poor sleep, or low libido during perimenopause or menopause, a more comprehensive approach is warranted. This includes:
- Evaluation of lifestyle
- Hormone testing (including DUTCH testing for patterns over time)
- Functional lab work to assess nutrient status, gut health, inflammation, and thyroid function
- Evaluating stress, sleep, and cortisol patterns
- Considering bioidentical hormone therapy (or non-hormonal alternatives like adaptogens)
- Supporting brain health, not just mood symptoms
SSRIs might help some women, but they should not be the default solution when there’s a hormonal root cause at play.
Final Thoughts: Antidepressants Aren’t Bad, But They’re Often Overprescribed
SSRIs aren’t evil. They can save lives when used appropriately. But when they’re handed out as a shortcut to avoid deeper evaluation of hormone imbalances, they can create a new set of problems.
Midlife symptoms are your body’s way of sending a message. Instead of silencing that message with medication, let’s learn to interpret it and respond with care, strategy, and science.
You deserve more than symptom suppression. You deserve a plan that addresses the whole picture.
References
- Kulkarni J. (2018). Depression as a side effect of the contraceptive pill and hormone replacement therapy. Journal of Menopausal Medicine.
- Cummings SR, et al. (2005). Use of SSRIs and risk of fractures in older adults. Arch Intern Med.
- Serretti A, Chiesa A. (2009). Sexual side effects of antidepressants. J Clin Psychopharmacol.
- Brown KW, et al. (2005). Antidepressant-associated sexual dysfunction. CNS Drugs.
- Chien IC, et al. (2017). SSRIs and metabolic syndrome. J Clin Psychiatry.
- Achari V, et al. (2020). SSRI-induced gastrointestinal symptoms. Front Psychiatry.
Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Dr. Anna is the author of Perimenopause: The Savvy Sister’s Guide to Hormone Harmony. Order your copy at www.perimenopausebook.com.
Dr. Anna is available for 1-1 consultation. Find out more at www.drannagarrett.com/lets-talk
