Perimenopausal Anhedonia and Anxiety

miriandra

As cancer fighters, we have a lot of reasons to experience anxiety and depression simply because of our situation. Chemo and radiation sap our energies, leaving us feeling drained and less-than. Aromatase inhibitors are well known to dampen our libido, which can also add to our frustrations and strain relationships. Well, guess what! It's not just our situations that are causing us to feel anxiety or malaise. AIs can affect our mental health a lot more than we previously thought.

New research released in 2025 is showing that ovarian hormones play a key role in dopamine regulation.[1] When estrogen levels fluctuate during perimenopause, it contributes to bouts of depression, anxiety, and anhedonia (the inability to feel joy fully or at all). When we are put into chemical menopause, it starves cancer cells - which is a very good thing. But it is now believed to also interrupt our ability to process dopamine. This makes it harder for us cope with the mental and emotional challenges a cancer diagnosis brings on its own, and exacerbates existing depression and anxiety.

The recommended treatment being investigated currently is estradiol administration. Obviously, that treatment may not be available to ER+ cases. But knowing more about the mental health risks of AIs can help women and their partners better prepare for those changes if they happen and make more fully informed decisions.

[1] https://www.biologicalpsychiatryjournal.com/article/S0006-3223(25)00608-0/abstract

[2] https://www.sciencedirect.com/science/article/abs/pii/S016503272500045X

miriandra

Yes, but it's difficult. I'm still building up the drive to find a new mental health provider. I had one, but my doctor seems to have stopped practicing, and the office stopped responding to my calls.

While I had been under my ghost doc's care, I tried a drug called Auvelity. It helped, but it caused my liver numbers to spike. I was able to come off it without much rebound, fortunately. After discussing my history with my onc, she suggested trying bupropion on its own (Welbutrin and generic) rather than Auvelity, which is a combination of bupropion and dextromethorphan. She suspected that the dextro may have caused the liver reaction. She said that Welbutrin is very frequently prescribed, and can be quite successful. We can hope!