Hello Sam, welcome,
In some ways I have been in a similar position to yourself. Along with the hormonal upheaval I also have had recent serious family difficulties to work with.
You are going through an awful lot right now. Am sorry it is so hard for you right now.
When I was first struggling with perimenopause symptoms I wanted to try not to go onto hrt. For mood swings and mental health wise I decided to take sertraline ( and AD) and also took a course of CBT, like you it helped at the time. But as my peri symptoms for progressively worse I decided I really need to go onto hrt, I am on patches and mirena coil. At the same time I weaned myself off the AD.
Fast forward and my moods got a lot worse, mine are very much linked to my natural cycle. I did not want to go onto AD's as I saw this as a step backwards, and although I have family problems I saw the moods as only being hormonal related and if I took care of the hrt, my cause of mood of you like, then it would completely help my moods.
I was wrong. It just was not enough and I was getting worse. After some debate, and some advice on here, I spoke honestly with a g.p and went back on a low dose of AD, I went for Mirtazapine, as it seems not to affect sexual function like other ADs can.it helps me sleep, though I can be a bit drowsy in the day sometimes, something I am willing to put up with. I could not carry on as I was.
I now see this as another part of support for my mind and body. I am on a very low dose as I say, and if and when the time comes to cease, I will do so with my gps support. I am also on a waiting list for therapy to work with everything else that is piling up in my life right now.
It was a hard decision for me to go back onto an AD, but tbh, I just could not cope any more with everything going on in me and around me. It's early days but I feel I have made the right decision. I see it hopefully as a stepping stone, a much need temporary extra support. But like Flossie says it makes sense to take something that can help you feel better.
do be kind to yourself, there is so much going for you. Do try if you can to continue the exercise and mindfulness, some time just for you.