OCD, depression and the menopause

Content advisory: this podcast contains themes of mental health and suicide.

On this week’s episode of the Dr Louise Newson Podcast, Anna Geldard shares her story of how her mental health was severely affected by menopause.

Anna tells Dr Louise how therapy and medication had helped her successfully manage her obsessive compulsive disorder (OCD) and mild depression symptoms for over a decade. But out of the blue, Anna’s symptoms returned and quickly spiralled. Anna was admitted to hospital, on six psychiatric drugs but still didn’t feel better.

Thankfully, after learning about the impact of hormones on mental health and being prescribed HRT, things changed for the better.

Anna’s top three tips:

1. Have more open conversations, starting from at home with the kids. This will filter through society, making menopause less of an unspoken thing and more of a just another thing about the body.

2. Make sure your resources are evidence based. There’s a lot of information on social media, so just make sure that whoever you’re listening to is appropriately qualified.

3. Advocate for yourself. If your symptoms are hormone related and you’re being told you’re too young or whatever, try again and don’t just give up at that first hurdle.

Anna is on Instagram @Hormones.on.her_mind. Find out more about OCD through charities OCD-UK and OCD Action.Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email jo@samaritans.org

Transcript

Dr Louise Newson: [00:00:11] Hello, I’m Dr Louise Newson. I’m a GP and menopause specialist and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. Today on the podcast, I’ve got someone called Anna with me who I’ve not met in real life, but we have been corresponding. Like with many people now, I seem to have a lot of people that I’ve met through social media or online or various other ways. So I’m very grateful for Anna today, who’s going to share some of the stories about herself and things that she’s learned about hormones. So thanks for coming today, Anna.

Anna Geldard: [00:01:27] Thank you for having me, Louise. Really happy to be here.

Dr Louise Newson: [00:01:30] So do you mind telling me a bit about you and what’s been going on?

Anna Geldard: [00:01:35] Yeah. So I do have a mental health history. Basically in my late 20s, I had some sort of relatively mild depressive episodes, which I completely associated with work. I was working as a paediatric nurse and I just found my job quite stressful. And so I was sort of on and off SSRIs [Selective serotonin reuptake inhibitors, a type of antidepressant].But things didn’t really come to a head until I had my first baby, at 29. And then I just literally, I was so happy, I was so excited about this baby, really looking forward to it. And it was day three, and it literally felt like someone had switched a switch in my brain and everything just went completely black. Really, really dark. And obviously, like, I didn’t know what it was, but you just assume, oh gosh, it’s the real shock of having a baby and you’re exhausted and no one said anything about hormones. And I suppose I must have had some… You are aware that there’s some hormonal aspects, but, you know, you just… I don’t think you really think about it. I don’t think I’d ever thought about my hormones. And so, I did recover but it took a few months, and I did need to go back onto my SSRI, which I had wanted to be off because of pregnancy and breastfeeding. But yeah, so I sort of slowly recovered. And then it wasn’t until we were trying for another baby and I had an early miscarriage and I really struggled with my mental health again. And so at that point I think I decided that I was going to just stay on an SSRI. And, you know, that was just going to be part me. And I had a lot of therapy. I was also diagnosed at that time with OCD. So I was having a lot of kinds of obsessive checking, checking the baby’s okay, really worried all the time that there was something wrong. And so at that point I was sent on the right kind of therapy. I was… I managed to access the correct therapy for OCD, which is really specialised and I had that for a long time. I did it for 18 months and it was really, really… It completely changed my outlook on everything and I really felt confident by the end of that that I sort of knew how to handle these thoughts. And so that was sort of 13, 14 years ago. I went on to have two more babies, stayed on my medication, my doctor supported me to stay on my medication and I had a completely different experience. I was absolutely fine following their births. So I really just thought all that was behind me. I had my sort of medium dose SSRI, I was planning to stay on that for the rest of my life and I couldn’t have ever seen struggling again. I knew how to kind of handle the OCD thoughts if I ever got them. And I didn’t really struggle at all. I didn’t see any doctors or therapists. So it was, skip ahead then to I was age 45, I got COVID and it was before the vaccines. So, I was quite unwell. I wasn’t unwell in a respiratory way, but I had really high temperatures. I couldn’t get out of bed but I was quite poorly for a couple of weeks. And I recovered physically really quickly. I was absolutely fine, just like a bad bout of flu. But I just didn’t recover mentally. I just wasn’t right. And I didn’t, you know, I just thought you know, I’m rundown. It was just before Christmas, it was, you know, a busy time. Obviously, the lockdowns and the social kinds of implications were going on. And there was sort of reasons for me to feel like not quite myself. So I just thought, oh, you know, that explains it. But I just got worse and worse. And I was hit really out of the blue with very, very bad OCD episodes. I had to stop driving because every time I got in the car I was terrified I was going to run someone over or I would get home from having driven somewhere and think, Oh my God, what did I just run, you know, a random person over, even though there was nothing that, you know, there was no reason for me to think that, there was no evidence of that. I started driving back to check and I was like, Oh my God, I’m really struggling with my OCD. Like, what? How has this happened when I’ve been so well for so long? And I, you know, I had all those tools. I knew how to cope with my OCD, and I was just completely flung into this really, really bad place. And I, I knew because I’d struggled with my mental health in the past, I sort of felt like I needed specialised help, that my GP wouldn’t be enough. And so I asked if I could see a psychiatrist. We’re lucky that we’ve got private healthcare with my husband’s work. So I went to see a psychiatrist and I, I said, you know what, I’m really struggling and I haven’t been like this for well over a decade. And he said, Well, there’s COVID and everyone’s stressed, lockdowns, there’s you know, lots of reasons. And I, I agreed with him. I was like, yeah, that’s you know, that sounds reasonable. And he said, I’ll put your SSRI up to the maximum dose, which I hadn’t been on for a very long time. I hadn’t needed that since, you know, sort of 14, 15 years prior. But I just thought great, I’ll be fine then, you know, that’s all I need. I just need that. And I thought, right I’m going to be really proactive. I’ve been poorly in the past so I don’t want this to happen and I’ll contact my old therapist. So I contacted my old therapist, but, you know, he hadn’t seen me all this time. And I said, Can we do some sessions? And he was like, Of course. And I was just like, I’m going to be fine. I’m going to do this. You know, the therapy was so effective for me the first time. I’m going to do a couple of sessions and I’m just going to be feeling fine again. And what actually happened was I just got worse and worse and worse. And it was so frustrating because I was doing all the techniques that had worked for me the first time, I was putting into place, and nothing was working. I was just like, getting worse.

Dr Louise Newson: [00:07:12] How old were you then?

Anna Geldard: [00:07:13] 45.

Dr Louise Newson: [00:07:14] And had you, were you having periods or had they changed?

Anna Geldard: [00:07:18] Like nothing had changed my periods at all. Like, well, that I kind of noticed. Like in terms of, they were so regular, not even out by a few days. The only thing looking back, they probably were getting heavier and shorter. But in the space of 15 years, I’d been pregnant four times. I’d done four years of breastfeeding. You know, things had changed around.

Dr Louise Newson: [00:07:42] Course.

Anna Geldard: [00:07:42] It wasn’t kind of unfamiliar for things to be slightly different, and I certainly didn’t pick up on it, and I just didn’t know. I didn’t know that I was old enough. I, in my head, I thought menopause was something happening in your sort of late 50s and I don’t know where I’d got that idea from, but I had no idea at all, which I’m quite… I look back now and I’m quite shocked at. Why didn’t I know? Especially, you know, I was a healthcare professional, I was a nurse, and yet I still, you know, I really didn’t know. And I thought it was all about having these terrible hot flushes. So when I got to, you know, late 50s I was going to have all these hot flushes, my periods would stop and that would be that. I had no idea it could affect your mental health. So I, I just got worse and it was just awful. And I was so unwell in the end, I got into bed and decided I wasn’t getting up and I didn’t get out of bed for three weeks. By that point I was on a lot of medication. They started a second antidepressant, quetiapine, so antipsychotic. And then I saw a different consultant because I thought the consultant I’d seen didn’t know enough about OCD. So I thought, I know what, I’ll find a consultant who specialises in OCD because I sort of thought that was where the real issues were coming from. So I saw a second consultant, and interestingly, she was a menopausal-aged woman, and she didn’t say anything about hormones at all either. I think she changed the medication again. And then I saw a third consultant psychiatrist because I saw the person that I’d seen originally who diagnosed me. And when this had all started to happen, he wasn’t available, he had like a year waiting list or something. And out of the blue he emailed me to say that he could see me as an emergency if I wanted to. So I said, Oh, brilliant. You know, I finally got the real expert. So I saw a third consultant psychiatrist and he decided I needed to be admitted to hospital. So I got admitted to hospital. It was a private hospital and I don’t necessarily know I would have got admitted in the NHS. But I was very unwell, I couldn’t get out of bed. I’d been in bed three weeks by that point, my brain was just completely switched off. I just couldn’t focus on anything. I didn’t want to see my kids. My kids are everything to me, like they’re so important to me, and I didn’t even want to see them. I just thought, what good am I to them like this? Like. And so, yeah, I was then admitted to hospital. They increased my medication. So by that point I was on six psychiatric drugs. I was on two depressants, antipsychotics, sleeping pills, benzodiazepines and propranolol for anxiety. I couldn’t eat. I lost two stone. My anxiety was… I’d never had anxiety, ever. And I started to develop a tremor. I was shaking, physically shaking. You could see my clothes moving. Yeah, and I just kept saying to them… They kept… There was all this therapy which, you know, private hospitals offer. And they kept saying, you really need to engage in the therapy, you really need to do the therapy. And I kept saying, but I’ve got nothing to say. I really like my life. I love my husband. I love my kids. I’ve got a great life. What am I going to say? And I honestly would sit there, thinking what can I make up that, so I can say something because I don’t know what to say. And when I said, Honestly, I’ve got nothing to say, they would sort of say, Well, you’re not being truthful, are you? You can’t be in a psychiatric hospital if there’s nothing wrong with your life. It just doesn’t make sense. And I was going, Yeah, I know it doesn’t make sense, but that is the situation. And yes, it was just awful. Awful. I can’t describe how low I felt. Like, I didn’t even know it was possible to feel that low. I kept thinking about suicide. And I think, I’ll be honest, the only thing that stopped me was my kids, because I thought I can’t. How can I do that to my children? But even like, the… I remember just sitting and looking at photographs of them to try and get my brain like… I honestly can’t describe this in any other way other than it felt like someone had unplugged my brain because I didn’t have any responses to anything. Like when I watched the television, even, it was just like I couldn’t process what I’m seeing. And I was like, There’s nothing wrong with my eyes, I can see what’s going on, but it doesn’t make any sense to me. Nothing made any sense. And there was this one morning where I felt slightly different and I said to the nurse, My brain feels different. It’s really weird. And he was like that, That’s amazing. You know, the medications are finally kicking in. And it was only a couple of hours and then it just, I just went back. So I wonder now what, I don’t really know but I’d obviously had some sort of change. So basically they discharged me and I wasn’t any better. I was only discharged because they discharge you if you can’t afford to self-fund, your insurance will only cover you for a month. So they discharged me and I was in the same position I was when I went in, only on a lot more medication. So, yeah, after I got home, my psychiatrist increased my drugs again. So I was on something that’s completely off licence in the UK and on a very, very high dose. And I did become functional. So I think I must, I definitely must have improved to a certain degree in that I was, you know, I wasn’t in bed anymore. I was looking after the kids and stuff, but I felt so flat. I felt like I was never going to know what the emotion happy was like. I just thought, I’m never going to feel happy. I don’t know what it feels like. I can’t remember. I couldn’t remember what it felt like to want to do anything, to have any motivation in your day or to enjoy any activities. I was just going through the ropes, just looking after the kids. And I was really emotional, couldn’t stop crying, which I hadn’t been. You know, when I was very, very low, I couldn’t even cry because I was that low. But then at this point, I was just endlessly crying. And a lot of the time I didn’t know what I was crying about. And I just kept saying to my husband, I don’t feel like me, I don’t feel like me. I’m just, who am I? It’s just not me? I’m quite a confident person. I’m quite, I’ve got quite strong opinions, and I lost all of that. I was just literally clinging on to him and it was really like, slow, really that the penny kind of dropped. So I’d been unwell, it was coming up to a year, and there was a couple of things. I had a couple friends that said to me, so one of them said to me, You need to watch the Davina documentary. Actually, I was in hospital and I watched that. I sat and watched that from the hospital bed. And even then I thought, Oh, I don’t think this is me. But that’s interesting because I didn’t obviously know a lot of the information that was in it, and it was a very slow, kind of, the penny dropping. I think another friend told me about you, and tagged me in your posts. And then, I found your podcast and I listened to, I think it might have been the first episode when you were with Rebecca Lewis and you were talking about mental health aspects of perimenopause. And you said, or either you or Rebecca said, The thing is, you’ve got oestrogen receptors in your brain and it can affect your neurotransmitters, your serotonin and your dopamine. And I was just like, Oh my God, what, maybe this could be part of the picture for me. I’m 45. I never thought for a minute it could be the whole thing, but I just thought, what if it’s contributing? I decided to go and see a nurse privately. I emailed my psychiatrist to ask him what he thought because I thought, Oh, you know, I’m on all this medication. I’m on six medications already. I’m quite scared about possibly taking HRT as well because what if it makes me worse, you know, something that can affect your mood. So I thought, well, I need him to be on board with this and to kind of oversee everything. And he just wasn’t interested at all. He told me that menopause has a nonspecific effect on mental health and yeah, he clearly didn’t want to be involved. And so I thought, okay, what do I do? I don’t want to just go and see a GP that may not have lots of education and knowledge. I want to see a sort of an expert. And I was really lucky I found a nurse in my area that does, she runs a clinic by herself. And she was amazing. Absolutely amazing. She had a three or four month waiting list, but I emailed her and told her my story and she emailed me straight back, like within an hour, and she said, I’ll fit you in. And she saw me within about a week. And she was amazing. And she said to me, You struggled with postnatal depression. There is a kind of a link. It’s really going to be worth giving you a try. With HRT, you know, you’ve got nothing to kind of lose and see how you go. And she started me on a 50 mcg oestrogen patch. And I can honestly say it made a difference within a week. I’m not, you know, I wasn’t kind of like springing out of bed thinking, you know, I feel great, I’m amazing, I’m back to my old self. It was slow, but within a week I felt like the blood was flowing in my brain and I felt like I had energy. And I didn’t even know that I hadn’t had energy before that, you know, I hadn’t… If you’d have said to me, Do you feel unwell physically? I would have just said, No, I’m alright. But when I suddenly thought, My God, I’ve got energy, I feel. And I just started to feel like something was making a real difference. And it was slow and I struggled with the progesterone. So I found that when I went on the progesterone weeks, I would gain be tearful again. And she was amazing again, like, it was actually at Christmas time and I think I emailed her in a panic, on the 26th or 27th, thinking she won’t reply, but when she gets back in the office in January, she’ll contact me then. She emailed me back within the hour, saying, try it vaginally, the Utrogestan. So yeah, I sort of slowly overcame those sort of hurdles and I would say to make a massive difference it took three months. And to feel 100% my old self, it was six months. But now I’ve been on HRT for almost 18 months and I’m off almost all the psychiatric drugs.

Dr Louise Newson: [00:17:56] Which is quite something, isn’t it? And yeah, it’s a very powerful story and obviously I’ve let you talk a long time because it’s really important to get the context of everything. And we see a lot of women similar to you in my clinic and the first time I heard a similar story, in fact, it was a lady I’d only had my clinic, I was working on my own and she came up from Essex and her parents had driven her up because she couldn’t drive. She was housebound. She had had, similar to you, really horrendous experience and she was on lots of antipsychotic medication, antidepressants, really feeling dreadful. And she had a history of postnatal depression as well. And she was 54. So it was almost easier than it was with you because she had no periods, she had a few hot flushes, she had some muscle and joint pains and she had some vaginal dryness. So I remember looking at her and saying, Well, I have no idea, I’ve never seen anyone who’s had this amount of psychiatric illness due to their hormones. But what I do know is that you’re menopausal, and I do know that there are benefits for your bones and your heart for taking HRT, and it might help some of your flushes and so forth. So I said, I’m happy to give you some HRT to try. And she came back, three months later and she actually came in and she was wearing this flowery jumpsuit. And I looked at her and I looked at the name and I thought, This must be a different person, I’ve called the wrong patient in. And I said, Oh, how did you get here today? She said, Oh, I just drove up from Essex. I said, Oh, but what? I was so confused because I’ve never seen such transformation so quickly, I think in anything else I’ve done in medicine. And she said, like you, she said, within a week I started to sleep. I started to feel different. My brain started to come back. And after three months she wasn’t completely better, but she was significantly better and had started to reduce some of her medication. And it was after her, I thought, I’m going to read more evidence, read more information about the power of hormones in our brains. And we have oestrogen and testosterone and progesterone receptors in our brains, all over our brains. And there’s a reason that they’re there because these hormones can help with the way we think, the way we function. All our other neurotransmitters work as well. And it’s very frustrating that people don’t know that and don’t understand. And there’s this real divide in medicine that the psychiatrists often don’t know much about the menopause because they’ve not been taught about and they don’t think about these hormones in our brains. And gynaecologists often don’t see people who are psychiatrically unwell because they don’t go to gynaecological clinics. In general practice obviously we see both. And in my menopause clinic I often see women who are more extreme with their symptoms, especially psychological symptoms. But there is this whole reproductive depression, we call it. But women who have had postnatal depression often have PMS [premenstrual syndrome] or PMDD can find that their perimenopause is worse. And we are doing some research at the moment. We’re funding a PhD student, looking at how we can pick up women early and work out, what is it that features that suggests that it’s more related to hormones rather than a psychiatric condition? Because the sooner we can consider hormones and manage women with hormones. The concern for me is that a lot of women are being given unnecessary medication like indeed you had and it’s a significant chunk of not just your life, but for your children and your partner and your friends around you, for something that might have been mitigated otherwise. And we know that in the perimenopause, often symptoms are worse. And it’s probably the changing hormone levels because you were still producing hormones, of course, because you were having your periods. And one of the things that we’re looking at, is it more that it’s the testosterone that dropped or is it more that the oestrogen has dropped or is it the changing hormone levels? And there’s so many things we don’t know but what we do know, is that HRT is safe, but there are different doses as well. So some women do respond to lower doses. But there is some evidence that when women have psychiatric or psychological symptoms, they do need higher doses to get in through the blood brain barrier into the brain. So obviously the HRT goes into the bloodstream, but it’s got to go from the bloodstream into the brain to work on the brain symptoms. And some people do need higher doses to get into the brain to function. So it’s really important, as you know, that the dose is changed according to an individual’s symptoms, and it is very individualised. But sometimes not having the right dose can only enable people to be partially rather than fully better.

Anna Geldard: [00:22:41] Yeah, I have to say it wasn’t until I was on 100, that I really felt like, gosh, I really feel myself coming back. I really do feel like I needed that. And I have ended up on a higher dose. But the nurse, I’m still with the original nurse, and she said to me, If your GP does query this, based on some things that have been said about higher dosing, even though I’m not your prescriber, I would be prepared to come and talk to your GP about what I’ve seen you go through, because I firmly believe that if you look at risk versus benefit, the risk to you and your mental health is higher than leaving you on a higher dose. And I certainly feel like that myself, like I’ve been included in the conversation at all points and I would definitely rather, maybe I have to keep an eye on whether there would be any kinds of… they’ve said to me, you know, watch out for any irregular bleeding or anything. But the thought of ever, ever feeling the way I felt, even for an hour, it would just be, it’s terrifying and really terrifying because I just didn’t know it’s possible to feel that horrendous. Like, no, like I say, I honestly think had it not been for the fact that I’m a mum of three, the only thing in my brain was just like, I can’t. How can I do that to them? How can I leave them without a mum?

Dr Louise Newson: [00:24:07] It’s very, very scary. And you know, I’m not saying and we’re not saying that everybody who’s perimenopausal or menopausal would experience anywhere near the thoughts that you have or the symptoms that you had. And I’m also not saying that every psychiatric illness is due to changing hormones, but there are a not insignificant number of women who have similar stories and are struggling with their mental health. And so one of the ways we as an organisation are trying to help is we’ve written an education module for psychiatrists with the Royal College of Psychiatrists about mental health and hormones. And we’re doing a lot more work to try and increase awareness. So you sharing your story today, obviously, hard to listen to and I’m really grateful for you sharing it, is hopefully going to allow people who are listening to just think slightly in a different way and it might not be the person that’s struggling themself. It might be their partner or a friend who might then be able to then speak out for this person and say, Look to the doctors, Please, can you consider hormones as well as everything else that you’re doing? Because we know that there are more benefits than risks generally for HRT and for some women, it might be transformational as it has been for you. So yeah, I’m very grateful, Anna for you coming onto the podcast today. Before we finish, I’d really like to just ask you three tips, actually. So three things that you think would have been the most amazing things to have known before all this happened. So not just for you to know, but your husband as well. So what are the three things that you think would be useful?

Anna Geldard: [00:25:49] Yeah, so I’d say my first tip would be just to do with education and awareness. Kind of an obvious thing. But I do think that there is a massive kind of black hole with hormones that so many of us don’t know enough about it and how, how they can be with menopause such a multitude of symptoms and how it can really affect your brain and your mental health. And so I just think, more open conversations, starting from at home with the kids quite young. It’s just another part of how your body works, you know, and kids learning it at school and just those kind of open conversations, filtering hopefully more through society so it becomes less of an unspoken thing and more of a just, you know, another, another thing about the body. And I particularly think that what seems to be really misunderstood that I definitely didn’t know, and would have really helped me, is that we can spot changes in symptoms much younger than what we think. And I think there’s still this real myth that you don’t really need to think about menopause until you’re in your late 40s or 50, and actually anything over 40 is really normal to have symptoms. And so many women have symptoms in their late 30s, but they don’t even realise it. And so that’s just, I just think that’s something that really needs to change. Absolutely. And just generally, I think it would really help if we all stop thinking of menstrual cycle purely in terms of fertility, because it’s so much more than that. And I just, I just hope that that will change and we’ll start understanding all the different effects on our body. And not that it has to be something negative. Not all women are going to suffer badly in menopause, but just say if you are aware of it more, you can spot issues earlier, using a tracking app. It’s a really good idea to track your cycles, at least from your 30s, against any symptoms so you can spot patterns early and you can spot when symptoms are occurring as according to where you are in your cycle. And then secondly, I would say make sure your resources are evidence based and good resources. There’s a lot of misinformation out there. There’s a lot of information on social media, so just make sure that whoever you’re listening to is appropriately qualified. There is really good places to get information. You can download the NICE guidelines for menopause. There’s the British Menopause Society, there’s the balance website. Obviously, yeah, just be careful what you’re reading. And thirdly, I would say advocate for yourself because the situation at the moment is still that not all doctors and healthcare professionals know as much as they should or would like to. And that’s not their own fault. That’s just because they haven’t had the training. So if you’re told something doesn’t feel right or you’re not getting the help that you feel you need or you don’t, you’re just not getting the right advice, try someone else. Try and ask your surgery, Who’s the best person to speak to for menopause issues? Who’s had the training? And just go back again. Because you know yourself, if, you know, if you’re feeling that your symptoms are hormone related and you’re being told you’re too young or whatever, make sure you try again and don’t just give up at that first hurdle. So that’s what I’d say.

Dr Louise Newson: [00:29:18] Thank you ever so much Anna for coming onto the podcast today and sharing your story.

Anna Geldard: [00:29:23] Thank you so much. I’m really grateful to have been given a platform to share my story because I just really hope anybody out there who is struggling in the way that I did and hears my story, that it might allow them to access the help that they need to get. And it’s not about scaremongering. It’s about empowering people and getting that awareness out there. That’s a little bit more to it than hot flushes for a small number of us.

Dr Louise Newson: [00:29:52] It’s been really brave of you and I really appreciate it. So thank you very much. You can find out more about Newson Health group by visiting www.newsonhealth.co.uk. And you can download the free balance up on the App Store or Google Play.

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