#205: Antidepressants in Menopause | Are They Necessary?

Hey beautiful, it's Dr. Tabatha.

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I can't wait to see you in there. Hi, I'm Dr. Tabatha, the Gutsy Gynecologist. I'm a triple board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyn health and your overall And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more Band-Aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome. Hey, so this week I want to talk about antidepressants because the American College of OB-GYNs says that should be first-line treatment offerings for menopausal symptoms. So if you go to your gynecologist complaining of hot flashes, night sweats, mood swings, trouble sleeping, you might even be feeling a little depressed or a little anxious, definitely Where'd your libido go? All the things right associated with perimenopause. They're probably going to offer you an antidepressant, something like Zoloft or Prozac, Paxil, Lexapro, Effexor. The list goes on and on. Ambien to sleep, Ativan, Xanax, all the drugs. And unfortunately, That is the wrong solution. Let me just tell you that antidepressants will make menopause symptoms worse. You will feel worse. I promise you it is not the answer. You have a hormone imbalance. You have a hormone deficiency, most likely, and you need hormone replacement therapy. Why don't I recommend antidepressants for menopause? Because you get new symptoms and new problems. So antidepressants, the main side effects are weight gain, loss of libido, and increase in appetite. Those are the 3 things that you're already struggling with going into menopause. So why take a medication to amplify those problems? So this is what I see with women. You've already gained five, maybe ten pounds from your hormone imbalance and this impending menopause issue, and then you go on an antidepressant and you add another ten pounds. So if you weren't clinically depressed before, you're probably going to feel really depressed now. And if you had any libido left, that is most likely gone. SSRIs completely wipe out your libido, and you're not going to have any interest in your partner. And so your relationship. If it's not already strained, it's going to be strained. It's an absolutely horrible recommendation, and I wish that ACOG and NAMS would revoke it. Like, they really need to evaluate. They based their decision for this recommendation on a study that showed a 33% improvement in patients taking these medications, they had 33% less hot flashes and night sweats. Unfortunately, the placebo group had almost the same effect. So there isn't a huge benefit. It's a small benefit, and it was a small amount of people. And the bigger issue is that there's way more side effects and new problems and issues related to taking those drugs. So I don't recommend SSRIs for menopause or any hormone imbalance whatsoever. You need hormone replacement therapy. That's what you need, and you need an expert who can help you with that. So I'm here to tell you that not all gynecologists are created equally. I didn't understand hormones from my OB-GYN training. I went through North American Menopause Society and became certified in that and became knowledgeable in hormones a little bit more, but it was still very pharmaceutical-driven. It was still very much based on the recommendations of synthetic hormones and just treating clinically with the lowest dose of medication for the shortest duration. There's major issues with that recommendation, you guys. So the smallest dose of hormone replacement to minimize your hot flashes and night sweats, not actually necessarily get rid of them 100% or slow down the aging process and the disease process or get the benefits of hormone replacement, which is protection for your heart, your brains, and your bones. That is not what the lowest dose, shortest duration does. You might need a little bit higher dose, and you definitely need a longer duration. Because here's the thing: as soon as you stop taking hormone replacement therapy, the benefits go away, and those disease processes set back in. The aging process sets in because you are back in a full menopausal state. So there's really no Good evidence that shows that you need to go off of hormone medication replacement at any certain point after any certain amount of time. That recommendation is extremely outdated. It was based on the WHI study, which we've already like ripped apart and debunked and have come to understand that that is not true. Scientific evidence, and it's not factually based on perimenopause and menopausal women of this day and age. If you've listened to my older episodes, you know why that study doesn't hold water. The average-aged woman in that study started hormones at 63. She already had heart disease. She was a smoker. She was obese. And they used synthetic hormones.

We don't do any of that.

And so we really cannot look to that study for best practice. So we need to look at all the other studies, and there are hundreds of them. And we need to continue to do more research and fund more research for women because we're not little men. We deserve to be understood. We have a unique physiology that is dependent on our hormones, and that makes us different. And so I would encourage you, you know, if you see anything politically that you can support as far as women's health research, please, like, jump on that bandwagon. We need more answers. But I promise you that functional— the world of functional medicine, integrative medicine, anti-aging medicine All these academies, they have done the research. They have shown a clear, beautiful standard of care of managing hormone replacement therapy for women through the remainder of their life. I have women in their 80s who threaten me, don't you dare take my hormones away. I will hurt you, because it's what keeps you young and vibrant. It keeps your sex life alive. It keeps your brain working, keeps you mentally sharp. Keeps your bones strong. So many amazing benefits. So I hope that was helpful. I really— if you've been down the path of being prescribed antidepressants and you're still struggling with weight, and now you're feeling even more depressed or anxious, and you're not, you know, getting any hormone relief, We can help. You know, my team and I are licensed in over half of the country. We're licensed in more states than not, and so we most likely can help you and prescribe medications, hormone replacement for you, not antidepressants. And we understand how to interpret labs. We order labs. We follow What's going on in your body with these hormones that you're taking, so that you can do it in a safe way that benefits you and gives you your vital life back. So I hope you found this helpful. Please, please, please, if you could just take 30 seconds to shoot me a review, you know, five stars would be amazing. Apple needs to know that you care about this information, and the only way they know that is if you hit the subscribe. button, if you hit the 5-star review, if you leave a couple words of encouragement, turn on your notifications on YouTube, all the things. Because we— our voices need to be heard. And the only way for us to be heard is to come together and support each other as women and to say, this is important to me. I subscribe to this. I'm turning on my notifications. See this review. This matters to me because that is the only way to gain any kind of power or control over the system. So thank you. I appreciate. I appreciate your time as well, like taking your time to spend listening to me and just take back control of your health and get educated and keep understanding. If you stick with me, I promise. I promise you, you're going to know more than most gynecologists about hormones, which— that's pretty awesome and sad at the same time, right? But stick with me because you can be the master of your own domain. If you ever watched Seinfeld— that's a really old reference— but you should be in charge of your health. You are the CEO. You're in charge. And the more knowledge you have and the more understanding of what's going on in your body, the easier it is to navigate all of this. So awesome. Let me know if this was helpful to you and what else you want to hear about. Go have an incredible week. I love you.