Can You Take HRT and Antidepressants Together? | Stella
6 mins

Can you take HRT and antidepressants together?

byDr. Lucy Wilkinson

Menopause can be extremely challenging on your mind and body and many people suffer from anxiety and/or depression around this time. Antidepressants are a common and sometimes life-saving treatment for both these conditions and others, such as chronic pain. They can usually be taken alongside HRT. Read on to learn which menopause symptoms antidepressants could help, and which ones they might make worse.

What are antidepressants?

Antidepressants are a group of non-hormonal medications used to treat depression. The name can be misleading as antidepressants can also be used to treat other conditions, including some menopause symptoms.

There are multiple different ‘families’ of antidepressants, all of which work in slightly different ways. The most commonly used include:

  • Selective serotonin reuptake inhibitors or SSRIs, such as sertraline, citalopram and fluoxetine
  • Serotonin and norepinephrine reuptake inhibitors or SNRIs, such as venlafaxine and duloxetine
  • Tricyclic antidepressants, such as amitriptyline, nortriptyline and dosulepin

Another group of medications called atypical antipsychotics are also sometimes used to treat severe depression as well as other mental health problems. 

Why are antidepressants used during menopause?

Hormone replacement therapy (HRT) is generally recommended by doctors before antidepressants. 

Antidepressants can be used for some menopause symptoms – or to treat other medical problems. 

Read more about menopause and depression here.

Antidepressants for menopause symptoms

Antidepressants can be useful in menopause, particularly if you prefer to avoid hormonal medication or can’t take it for medical reasons. Here are a few symptoms that may be improved by taking antidepressants:

Mood changes

It is normal to feel low or more worried during menopause. Depression and anxiety disorders are common and antidepressants are an effective treatment for both.

Hot flushes

Some antidepressants can reduce the severity of hot flushes. These include paroxetine, citalopram, escitalopram, venlafaxine and desvenlafaxine. However, not all antidepressants have this effect. Sertraline, fluoxetine, and other antidepressants have not been found to help.

Poor sleep

Research has also shown that some antidepressants help with sleep problems during menopause.

Antidepressants for other medical problems

Antidepressants can work well for medical problems including:

  • Depression
  • Anxiety
  • Obsessive compulsive disorder (OCD)
  • Chronic pain
  • Irritable bowel syndrome (IBS)
  • Prevention of migraines

An improvement in your menopause symptoms might be a welcome side effect if you already take an antidepressant for one of these conditions. If you already take antidepressants, your doctor might suggest simply increasing the dose before trying HRT.

Can you take antidepressants and HRT together?

Yes, antidepressants and HRT can be safely taken at the same time – many people take this combination of medications. Your doctor will advise you on the best combination of medications for you.

Are there any risks to consider?

It’s always important to think about your cardiovascular health, especially if you are taking an atypical antipsychotic like olanzapine, quetiapine or aripiprazole. We know that this type of medication can increase your risk of certain types of cardiovascular disease, including heart disease.

You have an increased risk of cardiovascular disease after menopause, and some kinds of HRT can also increase your risk. It’s vital to keep up with regular health checks even if your doctor is happy for you to be on both HRT and an atypical antipsychotic. These should include regular checks on your cholesterol, blood sugar and blood pressure.

Like all medications, antidepressants and related medications come with side effects of their own. Check the leaflet carefully and discuss what to expect with your doctor before starting a new prescription.

Can antidepressants cause hot flushes and night sweats?

Yes. Sweating, fevers and poor sleep are common side effects of SSRI and SNRI antidepressants, such as:

  • Sertraline
  • Fluoxetine
  • Citalopram
  • Venlafaxine

These side effects have also been reported with other types of antidepressant, but we don’t yet have enough data to know how common they are.

When to speak to your doctor

For many people, these side effects wear off or decrease to a bearable level when your body gets used to the new medication. If you are still struggling after a couple of months, speak to your doctor.

It can be difficult to determine if these side effects are down to medication or menopause symptoms, such as hot flushes and night sweats. Your doctor can help you work out what’s going on. 

When to seek urgent help

High temperatures, abnormal movements, changes to your heartbeat and other new symptoms should all be taken seriously if you are on any kind of antidepressant or atypical antipsychotic. This is because rare yet potentially life-threatening side effects known as serotonin syndrome and neuroleptic malignant syndrome can present in this way. Always read the information leaflet in your medication pack and seek an urgent medical review if you have any worrying symptoms.

Final word

Antidepressants can be taken either alone or alongside HRT and they’re not just for treating depression – they can help many conditions. It’s important to be aware of their possible side effects and seek medical help if you have any concerns.

Find out more about menopause on our blog or in our symptoms library.