Meltdown

Since I wrote this essay on menopause and depression, I have received dozens of emails from women, and one from a man worried about his wife. They have, mostly, been women in distress who are finding the menopause debilitating, frightening and difficult. Some of them expect me to have a solution, but I have nothing for them but sympathy and advice, which I try to provide, always. Others ask how I am, and whether anything has changed since I wrote the essay.

Yes. Plenty has changed. I thought it about time for an update.

Yesterday, my partner -- he is known as FRB -- and I were in Cumbria. We are both planning to run the 60-mile Fellsman race in April, so we thought it was a good opportunity to stop off in north Yorkshire and run some of the route. This is a very normal activity for me and FRB: on Mondays, people always ask me "where did you run this weekend?" and they expect the answer to be something epic or somewhere beautiful. And it usually is. So there was nothing untoward or unusual about our plan. I had run High Cup Nick fell race the day before and thoroughly enjoyed it -- here is my race report -- then that night we had gone out with friends to celebrate a birthday in Staveley. I had decided to drink alcohol. This, these days, is extremely unusual. I go weeks without touching alcohol, but now and then I want a drink. I stopped because I am scared it messes with my moods, and anything that adds to my risk of depression and can be avoided, should be avoided. For years now I have taken melatonin to help me sleep, but now I wonder whether that has a mood effect and I avoid that too. I really have no idea what does what any more, and that is infuriating because it reduces my ability to have control. So I am furious with myself that I chose to drink, and to give in to something that I can easily control and that I am certain does my mental state no good.

In addition: last year I was prescribed sertraline, an anti-depressant and SSRI (selective serotonin reuptake inhibitor). I asked for it because I still wasn't stable, I was still getting at least one bad dysfunctional day a week, and because I had lost the energy to write or summon up any enthusiasm for work. This is not advisable when you are a freelance writer. Luckily the way book advances work meant that I could survive financially for a while. I wasn't entirely idle, but I wasn't productive enough to devise a new book proposal, no matter how much I wanted to. I had asked for the anti-depressant after trying microdosing. Stupidly I had believed the hype, but I didn't like how brittle it made me feel, and instead of having endless hours of flowing creativity, as all the Reddit raves suggest, I found I could do lots of chores but was too unsettled to write. I tried it for a month and stopped. My house was very tidy though.

I left the box of sertraline untouched for months. I was worried about taking it, because I have taken SSRIs before and I knew that they deadened libido, for a start, and I didn't want to add to the muffling effect of the menopause. I read this very good journal article by Dr Mandy Leonhardt and although she only explored whether SSRIs work with HRT in one paragraph, it was enough to make me think they might. (It's not Mandy's fault: there isn't enough research on anti-depressants and HRT because there isn't enough research on menopause.) Still, the box remained unopened. I started to see a therapist instead, and I told her I wanted more control. I wanted to understand what was out of my control and what was in it, and I wanted more serenity, stability, resilience. All the things that the menopause removes. She didn't pronounce an opinion on the anti-depressants, but two weeks before Christmas, I began to take them. I don't remember what triggered this decision, and anyway I made a decision only to take 25mg, which was probably sub-therapeutic anyway. After a couple of weeks I increased that to 50mg.

I got the usual nausea, and got used to taking my dose with some thick pink liquid. After a couple of weeks, I began to feel better. It wasn't dramatic, but suddenly I managed to find some enthusiasm and optimism. I wrote a book proposal on my whiteboard, sort of, and though it is ill-formed and messy, it is a statement of intent and I'm pleased with it. My therapist said with some wonder, you have more energy, I can feel it. And I realised, I hadn't realised how much energy I was using fighting my erratic mental health.

For a few days I felt like me again. Really me. Me from ten years ago, before my first menopause, before my peri-menopause, before I became this person who is more anxious, less optimistic, less enthusiastic, less sociable. I know that I still achieve a lot. I run spectacular fell races and enjoy them. I write some things here and there. I perform at festivals and conferences, and no-one would guess. And I enjoy doing that. In a way, it is an escape, even though there have been times I have performed, and chatted, and enjoyed it, and got back to my room exhausted and low. Sometimes, I even go out and socialise, though less and less. But it took me two years to write this Strava longread, when it should have taken two weeks. And I had lost the ability to want to do things. Instead there was mostly dread, in various degrees.

So I loved the buoyancy of those days when it seemed like sertraline was working. It was as if huge heavy doors had opened onto light. Then I had to start taking progesterone, as I must for ten days every month. Suddenly I was sleepy and dopey, and my energy dropped. It didn't drop to the bottom, but it diminished. I began to think of sertraline and progesterone fighting each other, and me being left with a strange uneasy neutrality. It was better than the worst times but not as good as the best times.

Back to Sunday. I had realised the night before that I'd forgotten to pack my sertraline. I began to panic. FRB said, why don't you pretend that you've taken it? I think the placebo effect is real and I'd be very happy to have one. And I don't know what the half-life of sertraline is, but I definitely feel a lift about an hour after I've taken it. So unless the placebo effect appeared I worried I was facing a day of alcohol depression and no medication. No crutch. Even so, I got up, we had breakfast, I was chatty and sociable. We set off, and my mood dropped. I got quieter. My partner is very sensitive to this and knew something wasn't right, but I said I would still run, that I wanted to, that we could do 14 miles. I didn't want to. I wanted to drive home and run upstairs to my bed and switch off everything and sleep. But I don't give up.

We set off up the first big hill and I knew it was going to be more difficult than usual. I knew this by turning to look at the scenery, which my brain rationally knew was beautiful, but I felt nothing for it. I didn't care because I couldn't care. None of it meant anything. It was just there. I turned back to the climb and kept going, but my usual endurance, which I am good at and which gets me round most things, was missing. I noticed my freezing cold feet getting wetter and colder in bogs, I noticed my cold hands. My legs felt leaden. I can't remember ever feeling so unwilling to run. Usually even if I'm unenthusiastic, that will always pass, and I will find the delight somewhere, in the scenery, in the exercise.

On Sunday I hated it. We reached the top and the weather got worse. Sunny on the valley floor, winter on the top. It was windy but even the wind wasn't blowing away my blackness. FRB asked if I was enjoying it. I would normally have said yes even if it wasn't true, but I had no resilience today. No, I said, I'm not enjoying it. I was shocked I'd admitted it. I don't think I've ever said that before. Usually wildness and landscape lift me like nothing else. They exhilarate me. They fix me. But not today. I tried, I really did. I kept going though my legs were heavy and so was my mood. But I got up the hill. I smiled for the camera. I looked normal. You wouldn't know otherwise.

Image by FRB

Then the hail started. FRB looked over to the west and said, the weather is coming in, and I expected rain. But this was fierce, driving hail. Biting, pock-marking, ferocious hail, gusted in and with no end to it. I already had cold feet and hands, and this was too much. We had done barely any of our planned run, but I said, I want to get off this hill. I want to stop.

That is not me. I don't stop. On 30 mile races when I feel awful, I don't stop. On high climbs in awful weather, I don't stop. I never give up. The two things I am best at in fell running are running downhill and mental strength. I keep going, and especially in hard conditions. I thrive on them, and I find them invigorating.

Invigorating: to give vigour, to give life.

It's only five minutes to the next summit, FRB said, and this will blow through. Try to find something positive. But I couldn't. We were crouching behind a wall for shelter and the hail was still fierce, and I couldn't find the strength to go on. I wanted it all to stop.

Because he is kind and thoughtful, he knew I couldn't continue. He knew I was in a state. We set off downhill to a track, and by the time we reached it, the hail had stopped and the sun had come out and I felt foolish. I felt like I had had a meltdown, and I had the shame of a child after a tantrum. But I knew he would understand how uncharacteristic it was. And even with the sunshine and the weather, my feet felt like ice, and I found the three miles back to the car a trudge.

I blame myself for how I felt, because of the wine. Even though my therapist tells me I should be kinder to myself. I was shocked at how woeful I felt, and how not taking an anti-depressant had had such a powerful effect. I took it this morning (Monday), and today I feel mostly fine. Perhaps I should be concerned that it can have such a strong effect on me. But I will take any crutch going.

Mostly fine. I've stopped thinking I'm ever going to get more than a mostly. And that I suppose will be enough.

I am very lucky that FRB was so patient and thoughtful. That he recognised my blackness and allowed for it and forgave it. I wish he hadn't had to. It has been years, and I still have to rely on the kindness of friends and family and colleagues to forgive me on days where I want to cry not write, when I don't pick up the phone or open post. I have hoped again and again that those days are gone but they aren't.

So this is my update: I am a work in progress. I can never predict how a day will turn. I am a different woman at 50 to 45-year-old me, and I miss that 40-year-old, with her assumption that things were mostly fine, and her confidence in her abilities. I take, I think, the most appropriate kind of HRT. I pay to see a therapist. I run a lot, I'm very fit, I eat well. And I still feel unstable and that my moods are unpredictable. I hope that once I'm done with progesterone this month, I will get some vim back thanks to the sertraline. I will get two good weeks before the progesterone has to start again. And I think that is the best I can hope for.