Feeling Down in Perimenopause? Here’s Why Antidepressants Might Not Be the Whole Answer
If you've been feeling a little off lately, more anxious, more irritable, or even downright sad, you’re not imagining things. And it’s not just “life” or stress or aging. For many women, these emotional shifts happen during a specific, powerful stage of life: perimenopause.
This hormonal rollercoaster, which can start in your late 30s or 40s, brings a lot more than hot flashes and night sweats. One of the most overlooked symptoms? Mood changes. Sometimes, even full-blown depression.
So what’s the best way to treat it? Is the answer an antidepressant like Prozac or Lexapro? Or should we be looking at the hormones themselves, the ones that are fluctuating and dropping?
Let’s break it down, clearly, compassionately, and with your well-being in mind.
Wait—Is It Really the Hormones?
Yes, it often is. Your hormones, especially estrogen, do a lot more than regulate your period. Estrogen plays a significant role in how your brain processes mood, stress, and even sleep. So when those levels start to drop or fluctuate in perimenopause, it can affect your emotional balance just as much as your cycle.
You might notice:
Feeling down or flat for no apparent reason
Crying more easily
Irritability that feels “bigger” than the situation
Anxiety or restlessness
Trouble sleeping
Loss of motivation or energy
And it can feel confusing, especially if you’ve never struggled with mood issues before. You're not alone. In fact, this is one of the most common symptoms that women report in midlife, and one that is often dismissed.
So Why Are Women So Often Prescribed Antidepressants?
It’s a great question—and a frustrating one.
After the Women’s Health Initiative (WHI) study came out in 2002, there was a lot of fear around hormone therapy. Doctors backed off from prescribing it, even though newer research now tells us it’s safe and incredibly effective when used appropriately.
With hormone therapy out of the picture, antidepressants like SSRIs became the go-to. And for some women, they do help, especially if there’s a history of depression.
But here’s the truth: If hormones are causing your mood symptoms, treating them with an antidepressant might not be enough. It's like turning off the smoke alarm without checking for a fire.
Hormone Therapy Can Help—And Often Should Be First
We now know that estrogen therapy can have powerful effects on mood—particularly during perimenopause. Several high-quality studies have shown that hormone therapy (like low-dose estradiol) can lift mood, improve sleep, reduce anxiety, and help women feel like themselves again.
Even better? When you address the root cause, your shifting hormones, you’re also likely to see improvements in other symptoms like:
Hot flashes
Brain fog
Night sweats
Low libido
Vaginal dryness
Insomnia
That’s a lot of wins from one therapy.
How Do You Know If Your Mood Is Hormonal?
This is the million-dollar question, and the good news is, there’s a tool for that.
📝 Researchers in Australia developed the Meno-D Questionnaire to help women and their doctors identify menopause-related depression. It’s simple, specific, and designed for what you’re going through, not generic depression symptoms.
👉 Download the Meno-D here and take a few minutes to check in with yourself. It could help you and your provider better understand whether hormones are playing a role in how you’re feeling.
So What Should Treatment Look Like?
At Empowered Wellness, we believe in treating the whole woman—not just her symptoms. Here’s how we approach mood changes in perimenopause:
💡 Step 1: Understand What’s Happening
We begin with a complimentary consultation so you can learn more about your symptoms, medical history, and goals. If mood is part of the picture, we’ll explore whether hormones may be a root cause.
🧪 Step 2: Run Labs
This helps us understand where your hormone levels are and whether we might be able to help with FDA-approved hormone therapy.
💊 Step 3: Build a Plan
If you’re a good candidate, we’ll start with gentle, bioidentical hormones, often in patch or pill form. We personalize this based on your needs, symptoms, and preferences.
SSRIs or other medications are still on the table—but we don’t reach for them first unless they’re clearly needed.
❤️ Step 4: Support You Holistically
We know that healing isn’t just about a prescription. That’s why we include:
Biweekly check-ins with your provider
Lifestyle coaching
Nutrition support (with a registered dietitian!)
Ongoing care via our $50/month maintenance plan after the first 90 days
Want to learn more? Check out our 12-Week Menopause Membership or download our Menopause Empowerment Guide for extra resources.
Still Not Sure? That’s Okay.
Perimenopause is confusing, even for healthcare providers. But you deserve to feel good in your body and mind. If you’re feeling emotionally off and your gut tells you it might be your hormones, trust that instinct.
You're not broken. You're in transition. And there's help.
Let’s Recap: What You Should Know
✅ Mood changes in your 40s (or late 30s) may be hormonally driven
✅ Antidepressants can help—but may not treat the root cause
✅ Hormone therapy, when used appropriately, can be life-changing
✅ Tools like the Meno-D questionnaire help clarify whether your depression is menopause-related
✅ You deserve care that looks at the whole picture—body, brain, and hormones
Ready to Feel Like Yourself Again?
Start with a free consult at Empowered Wellness. We’ll help you sort through the noise, get answers, and take your first steps toward clarity and balance.