Are Antidepressants Overused in Menopause?

During perimenopause—which can last up to eight years—women are up to 40 percent more likely to experience mood changes, anxiety, or depression than in their premenopausal years (1, 2). Menopause hormone therapy (MHT) can address the declining hormone levels that are often at the root of these symptoms. Yet, when women seek help, many are prescribed antidepressants instead—despite The Menopause Society guidelines saying these medications shouldn’t be the first-line treatment for menopause-related mood issues.

A recent study in the Journal of Affective Disorders suggests that menopausal women in the U.K. may be over-prescribed antidepressants but under-prescribed MHT or hormone replacement therapy (HRT) (3). The researchers found that nearly half of women ages 45 to 54 who received a mental health diagnosis during the menopause transition were prescribed antidepressants, compared to just 42 percent of men in the same age group. Fewer than three percent of women within that age range were prescribed MHT (4).

It’s not just happening in the U.K. In the U.S., physician Gowri Rocco, M.D. believes menopausal women are frequently prescribed antidepressants for mood-related symptoms rather than MHT. “I often see women who were prescribed antidepressants before considering hormone therapy, even though their symptoms were more closely related to hormonal shifts.”  Rocco suggests that while antidepressants can be valuable for treating clinical mood disorders, MHT is preferred for mood disturbances directly related to menopausal hormonal changes. 

The correct treatment—antidepressants, hormone therapy, or both—depends on your specific needs. However, finding a provider equipped with the knowledge to help you navigate this decision can be challenging: A 2022 survey found that only 31 percent of providers received menopause education during residency, leaving many unfamiliar with the nuances of menopause care (5). 

About the Experts

Catherine Hansen, M.D., M.P.H., FACOG, is a board-certified obstetrician-gynecologist and certified menopause practitioner. 

Shamyra Howard, Ph.D, LCSW, is a certified sex therapist who helps women navigate menopause.

Gowri Reddy Rocco, M.D., is a doctor certified in family medicine and regenerative anti-aging medication. She specializes in helping people maintain sexual function and hormone health as they age.  

The Pros and Cons of Antidepressants for Perimenopause 

Serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are common antidepressants used as a first line of defense against mental health issues (6). They increase mood-boosting neurotransmitters—serotonin and norepinephrine—in the brain to create a sense of calm and stability (6). 

These medications can be helpful for women with pre-existing anxiety and depression whose symptoms ramp up during menopause, Rocco says. Research also shows certain SSRIs and SNRIs—specifically, desvenlafaxine and paroxetine—can help treat major depressive disorder in peri- and postmenopausal women (7). 

Antidepressants can also help women with menopause-related mood symptoms who prefer not to take hormone therapy, or are advised against it because of their family or personal health history, Rocco, says. 

But for many women, an underlying mental health condition isn’t the root cause of mood changes—their menopause symptoms are the culprit. “Sexual issues that can accompany menopause, such as decreased libido, vaginal dryness, and discomfort during sex, can put a strain on relationships, create feelings of shame and inadequacy, and leave people feeling alone or otherwise disconnected,” sex therapist Shamyra Howard, Ph.D. says.

Headaches, hot flashes, brain fog, and other perimenopause symptoms can also lead women to feel anxious or depressed, Rocco says. Antidepressants don’t alleviate these symptoms. The one exception: Low-dose paroxetine, under the brand name Brisdelle, is FDA-approved to treat hot flashes (8). 

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The Case for MHT—And Why It’s Overlooked 

“The gold standard treatment for women with perimenopause symptoms, including mental health symptoms, is menopausal hormone therapy (MHT),” certified menopause practitioner Catherine Hansen, M.D. says.

She explains that declining estrogen levels are the main cause of mental health symptoms during menopause. Hormone therapy can replenish those levels and improve your mood (9). Research supports this approach: A 2024 study in the journal Menopause found that just three months of MHT significantly improved depressive symptoms (10). Another 2024 study echoed those results, concluding that MHT can effectively treat mental health symptoms in perimenopause (4). 

Despite these benefits, MHT remains underutilized. Many doctors lack sufficient knowledge about hormone therapy to prescribe it confidently. “Most medical schools and residency programs don’t focus on women’s midlife health at all,” Hansen says. Practitioners often have to seek menopause training on their own time and dime. Currently, fewer than 3,000 providers in the U.S. are certified by the Menopause Society, leaving a significant gap in knowledge about MHT’s safety and efficacy (11). 

Another barrier is the lasting influence of the 2002 WHI study, which suggested hormone therapy significantly increased breast cancer and heart disease risk, Hansen explains (12). Although dozens of studies over the past 20 years have found that the benefits of hormone therapy outweigh the risks for most women, outdated concerns still shape many doctors’ perspectives, hindering women’s access to adequate care. 

Can HRT and SSRIs Work Together?

In some cases, combining hormone therapy with an antidepressant can be helpful. 

If you were prescribed an antidepressant for anxiety or depression before perimenopause, you should continue taking it, Hansen says. Your dose just may need to be adjusted, she explains.  Your provider may add hormone therapy if you begin experiencing menopause symptoms, Rocco says. This drug combination can be hugely beneficial: The SSRI will continue to help your anxiety or depression, while the hormone therapy will target symptoms caused by hormone changes, she explains.  

It’s also possible that you weren’t previously diagnosed or treated for depression or anxiety before menopause, but you and your doctor both feel like you should have been. In this case, you may also benefit from taking both drugs. Speaking with a psychiatrist or another mental health professional could offer additional support. 

Getting the Right Support

Finding the right provider is key to managing menopause effectively. Start by researching and seeking out a practitioner who specializes in menopause. You can use the Menopause Society’s online directory by entering your zip code to locate a Menopause Society Certified Practitioner (MSCP) near you. If you already have a trusted doctor, ask about their experience treating menopausal women.

When you connect with a physician, share any mental health challenges, along with other symptoms like brain fog, vaginal dryness, hot or cold flashes, changes in urinary frequency, and menstrual irregularities or spotting. 

Keep your doctor updated on what is and isn’t working in your treatment plan. They can suggest alternatives or adjust the dose of your MHT if needed. Most importantly, don’t hesitate to get a second opinion if you feel dismissed or unsatisfied with your current doctor’s options (13). There are physicians who understand menopause and can help you find the right treatment.