Depression Breaking Through During Monthly Cycle

Reader’s Question

I am 45 years old, female, and suffer anxiety, depression for the past 20 years. I have been on Seroxat for the best part of this time. Lately I notice that I have a few bad days prior to my monthly cycle. I fear my 20mg of Seroxat is not working for me.

Do antidepressants lose their effect over a long period of time?

From Mrs. Breakthrough — Ireland

Our Consulting Clinical Psychologist’s Reply

Seroxat (Paxil) is a very popular antidepressant. It’s very commonly prescribed by nonpsychiatric physicians, typically family physicians and/or OB/GYN. A very common experience when nonpsychiatric physicians prescribe antidepressants is using the medication at a low dose…as in your case. While I’m not a physician, I’ve worked when patients on antidepressant medication for over 35 years — and you’re on a “starter dose” of Paxil/Seroxat. By being on the starter dose, several things can happen.

First, the depression may never fully leave you. It may improve and your mood may elevate, but it may just move from “severe” to “moderate” depression. This will cause an increase in depressive symptoms when you experience the body chemistry changes related to your monthly cycle. Second, being on a lower dose of an antidepressant medication often ignores the other symptoms of emotional distress that may be present — such as anxiety. We have medications for depression, anxiety, and depression and anxiety. You may be receiving a medication that doesn’t address your anxiety symptoms.

Lastly, when we’ve been on a low dose of an antidepressant for several years, we actually develop a lifestyle that accommodates that level of living — a type of depressed life. You may take something else for sleep, avoid people, and change your lifestyle so the depression and anxiety symptoms are not as active — but then, you’re not as active as you should be.

I would recommend consulting your physician about

1. an increase in the medication,
2. a change in medications to one that effectively deals with both depression and anxiety such as Lexapro or Effexor (in the US), and
3. consider adding a counselor or therapist to your treatment program.

I’d also recommend reading information about depression on this website as well as an article on depression on my website at www.drjoecarver.com. This situation is easy to fix.