When Prozac met perimenopause
Diving into the swirling vortex where mental health and women’s health collide
Come along with me, while I tell you a tale of anxiety and night sweats, SSRIs and hormones. It’ll be just like a carnival funhouse, which is to say not fun at all and mostly just flummoxing and “WTF”-inducing.
It started sometime in 2021, I think. The anxiety, I mean. Or rather, the increase in my anxiety. I didn’t notice it right away; it crept up on me like a Seinfeld sidler.
Looking back, I think I’ve struggled with depression since adolescence, going through depressive episodes here and there but managing to get by, mostly due to distracting myself with alcohol, boys, and achievement striving (aka perfectionism). But when my son was born, it feels like my brain decided that I didn’t have the luxury to be depressed anymore, so it shifted that energy to anxiety instead. I know this is not actually how depression and anxiety work, but this is how it felt to me:
Depression: Oh hey, a baby, wow. Okay, you’ve got bigger things to think about now. You can’t be SAD and MOPEY all the time anymore. We’ve had a good run, but it’s time for me to take a hiatus and pass the baton to my counterpart. Maybe I’ll be back one day, you never know! P.S. Try to mix up some color in your wardrobe; babies don’t like all black.
Anxiety: What’s that? Did I hear that you birthed from your own physical body a helpless creature for whom you and you alone are completely responsible for not just literally keeping alive but also for flourishing and thriving, all while you slay at your full-time paying job, look youthful and pretty, and appear to hold it all together? This is my jam! Put me in, coach!
This anxiety manifested itself in my need to control everything. On the heels of a divorce and a career change, I refused to show any cracks in my facade. I was determined to be the best mom I could be, a superstar professionally, a one-in-a-million girlfriend, and to come even close to doing all these things, I needed to control it all. I couldn’t relax, I couldn’t let anything go. I strived strived strived, and I worried worried worried. The anxiety served me well for a long time. It fueled my ability to get shit done. It motivated me.
But then sometime in 2021, it changed. I began obsessing and ruminating about little things that I couldn’t control to the point that I literally couldn’t sleep at night. I had started a new job remotely and would go from Zoom to Zoom all day while being hounded on Slack, and I felt like I couldn’t breathe. My son was back at school in person, but that was precarious to say the least. My romantic relationship at the time was faltering. I was exhausted, strained, pushed to the edge. I felt like everything was out of my control, which was terrifying. At night after my son went to bed, I’d quiet the voices in my head with wine, and then wake up (if I slept) and do it all again the next day. I quit drinking in early 2022, and for a few months, it seemed like the anxiety improved. Until it didn’t.
One day in early 2023 I had a panic attack at work (aka my kitchen table). Every day it felt like I would beam into my laptop and live my life on Zoom and Slack, waiting for the next ping like a Pavlovian dog. That morning the Slack pings kept coming and coming and coming, in staccato bursts asking about where some deliverable was and why did I do something in some way and when was I meeting with that person, and well, I just couldn’t anymore. I couldn’t breathe and I started sobbing uncontrollably. I slammed my laptop shut and sat there, wondering what the hell was wrong with me.
Was it the pandemic? Or maybe it was a decade of single parenting? Perimenopause? My own dysfunctional chemical makeup? Who knows what precipitated this bump in anxiety, but there was no denying it.
Sometime soon thereafter, I had dinner with a friend who told me she’d been on a low dose of Prozac for the last year and it had done wonders for her. I’d never taken any SSRIs before. I told myself it was because I just hadn’t needed it and of course I didn’t look down on people who chose to take them and of course I didn’t think it was a personal failing or inherent weakness, but that is, of course, exactly what I thought. At this point, though, I was willing to try anything.
I am a mental health genius
I asked my therapist (who is not a psychiatrist and cannot prescribe medication) what she thought.
“I think it’s time to try it,” she agreed. She recommended a psychiatrist.
I met with the doctor and she agreed that Prozac was worth trying. So in February 2023, I started taking the lowest dose available of Prozac. For the first couple of weeks, I felt … weird – fatigued, bloated, dizzy. And then it started to settle, and a few weeks after that, I started to feel … good. Really good. After about six weeks, it seemed to have fully set in. And I was in love. In love with this miracle drug.
No matter how hard I tried, my brain wouldn’t fixate on something. I couldn’t obsess or ruminate on things even if I wanted to. My brain simply couldn’t hold onto it, but in a good way. I was able, for what felt like the first time in my life, to let things go. I didn’t feel the need to control every last freaking thing or person in my life. I was able to let things roll off of me, a quality I’d always envied in other people in my life. I was a freshly waxed car in a rainstorm – the water drops beaded up and rolled right off me. And I still felt like myself, which was something I’d been scared of losing.
“You’re Nikki, but without the low ceiling,” said my therapist.
Is this how other people’s brains are all the time? Do other people just walk around feeling like this every day?
I wanted to be on this drug forever. I regretted that it had taken me so long to try it, and I congratulated myself for finally doing it. I am a mental health genius, I thought. PROBLEM SOLVED, NIKKI 1, ANXIETY 0.
All sweat, no sleep
Here’s where the fun starts.
Sometime last spring, I started to wake up in the middle of the night pretty sweaty. I didn’t think too much about it at first. At some point, though, I noticed it seemed to be happening a lot. Didn’t this happen last night? And the night before? Wait a second, it’s been almost every night for a few weeks now. WTF.
At 47 years old, I had no doubt that perimenopause had started to come for me. My poor hair, never my crowning glory but still normal hair, was lackluster and limp and … less. My increasingly soft jawline was the site of full-blown adult acne with the biggest zits I’ve had since maybe ever. My periods, usually every 28 days on the dot, were now anywhere from 23 to 38 days apart, and each one was a horror movie. Brain fog had settled in, and I sometimes couldn’t think of the right word I wanted. One day I was leading a meeting at work and asked who had added two items on the collaborative agenda, only to realize after the meeting that I had actually been the one to add them a few days earlier. Oops.
It couldn’t be a coincidence that my anxiety had been spiking in the last few years, as increased anxiety is a common symptom of perimenopause. My body’s wildly fluctuating estrogen supply was the likely culprit, wreaking havoc on all my systems.
And it seemed that the night sweats had now entered the chat. I wasn’t having any hot flashes, just these night sweats. And omg I mean night sweats. I would wake up every 2-3 hours drenched – drenched! – in sweat, my tshirt soaked through, drops of sweat rolling down the backs of my legs, hair wet, sheets sopping. I’d get up, change my shirt, move to a dry spot on the bed, and try to sleep again.
I did all the things the internet told me to do for night sweats. I invested at least $1,000 in fancy new sheets, bedding, and pajamas for “cool sleeping.” I reduced my spicy food intake. I quit caffeine for six weeks (thankfully that had no effect; I’m not sure if night sweats or coffee-free mornings are worse). I took cold showers before bed. I took hot showers before bed. I took supplements from perimenopause start-ups. I drank all kinds of herbal and medicinal teas. I tried everything. And still I sweated.
Finally late last summer, I went to see my gynecologist and told her about the night sweats. She asked some questions about my period and other symptoms, and recommended that I start taking a low-dose estrogen birth control pill (of course not covered by my insurance) to regulate my perimenopausal hormones. This should help, if not eliminate altogether, the night sweats, she said.
I hadn’t been on hormonal birth control since before my son was conceived, and I had no desire to go back on it. But at this point I’d do anything. I was desperate for sleep.
My doctor said she recommended that patients who are having perimenopause symptoms take a low-dose birth control pill until they’re 50.
“What happens then?” I asked.
“We take you off the pill, and we see what happens,” she said.
“That sounds fun,” I said. “Am I going to gain weight on this pill?” (Getting older has not immunized me from the diet and beauty culture we all swim in.)
“On this pill? No. But menopause…” she said. “Menopause sucks. It just does.”
Cool cool cool.
I started popping the Loestrin, and after a few months, my periods became more normal. But the night sweats persevered. Every night. Zero change from the pill.
I despaired. I was so tired.
I play detective
One night in the wee hours after changing my tshirt and finding a sliver of a dry spot left in my bed in which to sleeplessly scroll through my phone until the sun came up, I googled “non-hormonal causes night sweats.” And there it was on my tiny screen in my dark room – SSRIs can cause excessive night sweats.
I thought back to when my night sweats started. I’d begun noticing them around April maybe, roughly eight weeks after starting the Prozac. Holy shit. I emailed my psychiatrist right then and there to ask for an appointment that week.
When I told her about the night sweats, the ineffectiveness of the estrogen pill, and my deductive hunch that it must be from the Prozac, she nodded.
“Yes, increased sweating can be a side effect of SSRIs,” she said.
“Okay, but this isn’t just ‘increased sweating.’ I am drenched, every night. It is horrible. I’m so tired,” I said.
“Hmmm, that does sound uncomfortable,” she said noncommittally.
“Um, yes, it’s very uncomfortable,” I said. “Have you seen this before? What can I do about it?”
“I’ve only really heard about it,” she said. “I mean, we could try to switch you to a different SSRI, but chances are you’d have the same side effect. I could prescribe an anti-sweating medication.”
“No, I don’t want to just keep piling on medications and more side effects,” I said.
“Hmmm,” she said. “Let me look into this a bit and get back to you.” I did not have a ton of confidence.
Later that week I got an email from her that said “Has the sweating improved? [I’m not sure why it would have suddenly improved out of nowhere after six months of it.] Do you work out in the evenings? If so, you might want to try exercising in the mornings instead, maybe that will help.”
My head almost exploded. I only ever work out in the mornings. This was not a solution to the problem. Prozac has been on the market for more than 30 years, and a recommendation to change my workout time is the best fix we have for a pretty terrible side effect? One that I wasn’t even warned about? I didn’t respond to her.
The next week I had a follow-up appointment with my gynecologist. I filled her in on my hypothesis that the night sweats were from the Prozac, not my haywire hormones.
“But your periods are better now, right?” she said.
“Yes, but that’s not the main reason I started taking this pill. I really can’t deal with these night sweats. I’m so so tired,” I said, starting to feel panicky and desperate.
“Hmmm, maybe try a different SSRI?” she said. “Although you’re likely to still have the night sweats if that’s how your body is reacting to the Prozac.”
I went home, dejected and dreading another night of sweaty not-sleep, and sick of hearing doctors say “Hmmm” to me.
Now what?
So here I am, stuck at the intersection of mental health and women’s health, trying to regulate the chemicals in my brain and the hormones in my body. In an effort to treat my anxiety, which was surely intensified by perimenopause, I started taking a medication that actually caused a different symptom of perimenopause, but which can’t be successfully treated by the hormones that would treat it if it were indeed caused by perimenopause.
Ain’t life a trip sometimes?
What’s a tired girl to do? As I see it, here are my options:
Continue as is. Sweat my ass off and just deal with it I guess.
Stop taking Prozac and hope that the estrogen pill I’m on helps with the hormonal anxiety.
Try a different SSRI. This sounds like a long, annoying, and likely futile exercise.
Consider full-fledged HRT. I don’t think I’m far enough along in the perimenopause journey for this yet. Even if I am, I have a lot of breast cancer in my family, and I’m going to have to make the HRT decision carefully.
Find a new doctor. Hahahaha – when’s the last time you tried to find a doctor in New York that takes your insurance and is also accepting new patients? Not to mention one you vibe with and who will actually listen to and help you?
Capitulate to the burgeoning perimenopause-menopause industrial complex and spend thousands of dollars on unproven serums and supplements.
Go live in the desert where the sun can dry me out every morning and no one can hear me screaming into the void every night.
Mostly I just wonder how we live in the most advanced time in human history, in the richest country in the world, and we know so little about mental health and women’s health. Could it be because we simply care so little about mental health and women’s health?
Research is significantly lacking around perimenopause and menopause; there are more unknowns than knowns. As Susan Dominus wrote in her widely read NYT menopause piece, we are left “wondering, worrying, waiting for more high-quality research.” Oodles of start-ups have sprung up to fill the gap of scientific research and medical treatments, and surely to cash in on this moment of increased awareness of that vacuum.
I cannot be the first person in the history of womankind to have perimenopause-induced anxiety, to have night sweats as a result of a medication to stop said anxiety, to feel utterly at a loss. Yes, we are finally talking about perimenopause and menopause, and that is a win. I don’t think I would have written this essay five years ago. I love that celebrities and others are using their platforms to help normalize a natural part of life for 50% of the world’s population. But we deserve more than snake oil sold with a side of meditation and protein shakes. We deserve scientific and medical research to address legitimate scientific and medical conditions.
Making a buck off of women is not the same as giving a fuck about women.
Tell your representatives that you support the Menopause Research & Equity Act. And let me know if you want to move to the desert with me – I’m gonna get lonely out there.
What’s got my attention this week
In appalling-yet-not-surprising news, most teachers in the US don’t get paid maternity leave. For a profession dominated by women (76% of all teachers are women), this is inexcusable.
Anti-abortion conservatives are having a hard time saying they’re “pro-family” with a straight face.
Great episode about Moms For Liberty – ugh. Did you know there is a Christian right cell phone company??
I mean, I guess a more collaborative, less competitive Scrabble could be fun? Nah.
WAL woman of the week
A woman out there in the world, being A Lot
I love reading about women in science, such as Dr. Lisa Kaltenegger, alien hunter and director of the Carl Sagan Institute at Cornell University. I think there’s a misconception that scientific facts and creativity cannot coexist, but I see an incredibly inspiring, rich abundance of imagination here.
Out of the mouths of babes
“I have always wanted to tell my story – or, more to the point, my side of the story.” Faith Ringgold, from her memoir We Flew over the Bridge. Faith Ringgold died at 93 last week. RIP.
What a conundrum! I feel for you, Nikki. I wish I had something helpful to say.❤️
I’m so sorry you’re going through this. My gyne just told me about a non-hormonal med called Veozah that specifically targets hot flashes and sleep. It works on the brain and is supposed to be very effective. But if your nights sweats aren’t due to menopause, it may not be the right fit. Hope to hear this hellaciousness is solved soon!