When it comes to menopause, the conversation typically centers on the changes in the hormonal levels, particularly estrogen and progesterone, and the symptoms these hormonal shifts can cause. While hormone replacement therapy (HRT) remains the most effective way for addressing a variety of physical and mental symptoms, it’s crucial to consider the role of antidepressants for perimenopause and menopause.
Menopause and Antidepressants: What Women Should Know
The hormones that regulate menstrual cycles and menopause also play a role in balancing brain chemicals linked to happiness, calmness, and well-being. As menopause approaches, hormonal shifts can disrupt these chemicals, potentially leading to stress, irritability, anxiety, and even depression.(1)(2)
Throughout life, women experience various hormonal changes — during puberty, the menstrual cycle, pregnancy, postpartum, perimenopause, and menopause. These fluctuations make women more susceptible to mood disorders than men, with studies indicating that women are twice as likely to develop depression.(2)(3)
Perimenopause, which marks the beginning of hormonal decline, often triggers mood shifts that can make everyday challenges feel overwhelming. If left unaddressed, these mood changes can progress into more serious conditions, such as depression.
Although menopause is not a medical condition that requires treatment, its symptoms can be difficult to live with. In some cases, antidepressants prescribed by a medical provider can offer relief, particularly when combined with HRT. These treatments address underlying hormonal imbalances and may help women feel more balanced, rested, and healthier during this stage of life.(1)
Menopause and Mood Disorders
The transition from perimenopause to menopause usually starts around age 40 and can last two to eight years — a period that significantly raises the risk of emotional symptoms. These mood disruptions are often intensified by sleep disturbances frequently caused by hot flashes or emotional stress. Since poor sleep is closely linked to mood shifts, improving sleep quality is essential. Both HRT and antidepressants have shown effectiveness in managing sleep issues and reducing mood disruptions related to sleep deprivation.(4)(5)
This stage of life often also coincides with significant life changes, such as children growing up, caring for aging parents, or increased career demands. These external pressures, combined with the physical changes of menopause, can take a toll on mental health. Women between the ages of 42 and 52 are particularly susceptible to emotional dysregulation. Unfortunately, suicide rates among menopausal women have increased by over 30% in the past 15 years, highlighting the critical need for awareness and support during this time.(1)(6)
Recognition and Treatment
Psychological symptoms of perimenopause can start showing up as much as five years before women notice any physical changes. This early phase often goes unnoticed, making it easy for women to overlook how these mental shifts affect them. As a result, many women only come to understand the depth of their struggles after some time has passed. It’s important for those in their late 30s and early 40s who are feeling anxious or depressed to pay attention to these signs, as they could be early indicators of perimenopause. Fortunately, effective treatments are available.(1)
Many women find relief with HRT or a combination of HRT and antidepressants, even if their symptoms don’t match the formal criteria for depression or anxiety. The journey through perimenopause and menopause can stretch over a decade, and without intervention, depression often doesn’t get better on its own. This underlines the need to take perimenopausal depression seriously.
Why Doctors Prescribe Antidepressants for Menopause
HRT is the primary treatment for vasomotor symptoms such as hot flashes and night sweats and is generally more effective for managing menopause-related symptoms. However, it may not be suitable for everyone due to underlying medical conditions or personal preferences. In such cases, antidepressants can be a viable alternative. With an established safety profile, antidepressants are commonly used to treat menopausal symptoms beyond vasomotor issues, including anxiety and mood disturbances.(5)(8)
While the precise way in which antidepressants relieve menopause symptoms — like insomnia, anxiety, and depression — isn't fully understood, their effectiveness in addressing menopause-related conditions is well-established. By regulating mood and alleviating depression, these medications can provide significant relief for many women during this transitional phase.(8)
Sexual Dysfunction and Menopause
Many women experience sexual dysfunction during menopause, with concerns such as pain during intercourse (dyspareunia), reduced libido, and difficulty achieving arousal or orgasm. Addressing these issues often requires a holistic approach, where both HRT and antidepressants may play a role in improving overall quality of life.(8)(7)(10)
Combining HRT and Antidepressants
It’s important to note that it is possible to take HRT and antidepressants together. For women experiencing severe symptoms of menopause, this combination can be particularly effective. HRT works to correct hormonal imbalances, while antidepressants target mood regulation and other menopause-related symptoms that may not be fully relieved by HRT alone.(1)
However, consulting with a healthcare provider before starting either treatment is essential. Certain antidepressants may interfere with the metabolism of hormones, like estrogen, potentially impacting the effectiveness of HRT. A physician can provide personalized guidance to ensure medications work together safely and effectively.(8)(9)
Best Antidepressants for Menopause Symptoms
Choosing the right medication depends on several factors, including individual symptoms and medical history — there is no one-size-fits-all. Low-dose antidepressants are an off-label option for women going through menopause who experience mood changes, hot flashes, or anxiety but cannot take hormone therapy. Medications like venlafaxine or paroxetine are often prescribed at lower doses than what is typically used for treating mood and mental health issues, which helps minimize side effects while still providing symptom relief.(8)(17)
Antidepressants for Hot Flashes
Several antidepressants, prescribed off-label, have been shown to help alleviate hot flashes. Among them, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are particularly effective. These medications help maintain the body’s temperature control system, reducing the frequency and severity of hot flashes. The following are the most commonly prescribed options:(5)(8)(11)
Citalopram
Escitalopram
Gabapentin
Paroxetine
Venlafaxine
These medications are often prescribed as an off-label, non-hormonal option for managing a range of menopausal symptoms.
Antidepressants for Perimenopause Anxiety
Hormonal fluctuations in perimenopause can lead to increased anxiety and depression. SSRIs and SNRIs are commonly prescribed to help regulate mood and anxiety symptoms during this time. Among the most prescribed options are the following:(5)(8)(11)
Citalopram
Sertraline
Fluoxetine
Venlafaxine
Antidepressants for Menopausal Weight Gain
While antidepressants are not used as a direct treatment for weight gain, certain medications may have an impact on weight during menopause. Some SNRIs can potentially help stabilize weight by improving mood and reducing stress-related eating. However, not all antidepressants are equal — some, like certain SSRIs, have been associated with weight gain in some individuals.(5)(8)(12)
It’s important to note that while these medications may improve mood and reduce menopausal symptoms, lifestyle changes, such as diet and exercise, are essential for effectively managing weight during menopause.
How Antidepressants Support Menopause
The exact mechanism of how SSRIs and SNRIs decrease menopausal symptoms is not yet fully understood, but doctors and patients alike stand by their effectiveness. Some studies on SSRIs and SNRIs have demonstrated that around 50% of women taking these medications experience improvements in hot flashes and night sweats.(1)(8)
When estrogen levels decline during menopause, endorphin production also decreases. Endorphins are key chemicals in the brain that help manage stress and regulate body functions, including temperature. A significant drop in endorphin levels can cause the body's temperature to rise, while an excess of endorphins can lower it.(13)(14)
As hormonal fluctuations occur — mostly a decline in estrogen — the body's internal "thermostat," located in the hypothalamus, may become confused. It might mistakenly interpret normal body temperature as too high or too low. This miscommunication can trigger an exaggerated response, such as a hot flash or night sweats, even when the external environment hasn’t changed. The body's thermostat is essentially misfiring, leading to intense sensations of hot or cold. SSRIs and SNRIs help manage how the body responds to this miscommunication by supporting the production of endorphins, serotonin and dopamine(8)(14)(15)
Side Effects of Antidepressants for Menopause
Off-label antidepressants for menopause symptoms can be effective both with or without HRT, but it’s important to be aware of unwanted side effects like hypotension, hypertension, and dizziness.
SNRIs can potentially elevate blood pressure, so regular monitoring is needed. Because of the variable effectiveness and adverse effects of SSRIs and SNRIs, if any one of these drugs is not effective or well-tolerated, another may be prescribed.(8)
Sexual Side Effects of Menopause and Antidepressants
Women in perimenopause and menopause may already experience sexual dysfunction due to reduced hormones. The addition of SSRIs can introduce additional sexual side effects that include the following:(2)(8)(10)(16)
Less sexual desire
Trouble achieving and maintaining arousal
Difficulty achieving orgasm
Depression can be both a cause and a result of sexual issues. About 50% of people taking SSRIs report some degree of sexual dysfunction, but some SSRIs cause fewer sexual side effects than others. Certain SSRIs may even help increase sexual drive and arousal in some women.(2)(8)(10)(16)
Drug Interactions and Antidepressants
Antidepressants can also cause drug interactions that should not be taken lightly. Individuals should always consult a physician before taking, adjusting, or stopping any prescription medications. This is a delicate balancing act, so any changes in antidepressant therapy or dosing should be done only in consultation with a healthcare provider.(8)
Finding Balance in Menopause
Antidepressants can play a valuable role in managing menopause-related symptoms, especially when hormone replacement therapy may not be suitable or effective. These medications have demonstrated efficacy in addressing mood disturbances, anxiety, hot flashes, and other symptoms that arise from hormonal fluctuations during menopause. While antidepressants offer relief for many, it’s essential to consult with a healthcare provider to ensure a personalized and safe treatment. Understanding the potential benefits, side effects, and interactions can help women navigate their menopause journey with greater comfort and support.
