Hormonal Update Volume 3 Number 5

Depression - The Hormone Connection

More than 19 million Americans suffer from depression each year, almost ten percent of the general population. Women are at least twice as likely as men to experience a major bout with depression during their lifetime. Historically, jokes have been made attributing a woman’s blue moods to her hormones. And it is true, puberty, menstruation, pregnancy and delivery, perimenopause and menopause are all times in woman’s life when she is more vulnerable to depression. Are hormones the reason? The answer appears to be yes. New findings have revealed that hormonal imbalance, declining or fluctuating hormone levels, and chronically high levels of stress hormones can all cause depression.

Generally, when a woman seeks treatment for depression, her symptoms are empirically evaluated. She is then given a prescription for antidepressant medication, such as Paxil, Zoloft or Prozac. Most health care practitioners never even consider hormone level testing as a tool for diagnosing the cause of depression. And yet, if the underlying cause of the depression is hormonal then individualized hormone replacement therapy could provide effective, long-term relief. In this Hormonal Update we take a look at the relationship between hormones and depression. 

Defining Depression

Symptoms of Depression

Depression is a serious illness that can affect all aspects of a person’s life, including relationships, self-image, work, social life, diet, and sleep. It’s more than feeling a little blue now and then, or having a few gray days once in awhile. For those suffering from real depression it’s not a question of just “snapping out of it,” or pulling themselves together. They are generally unable to lift their own spirits without professional help.

Often people who are depressed don’t immediately recognize that they have a problem. Instead they simply feel helpless, hopeless, and unable to take positive actions in their own behalf. Sometimes depression can be triggered by a traumatic event or loss in a person’s life. At other times it can seem to descend without warning and engulf its victim in a dark cloud of despair. Untreated, depression can continue for weeks, months and even years.

The HPA Factor

In the brain the hypothalamus gland regulates the pituitary gland, which in turn controls the secretions of sex steroid hormones from the adrenal glands. This relationship is commonly referred to as the Hypothalamic-Pituitary-Adrenal axis, or HPA. It is a complex regulatory system that controls and manages our stress response.

Disruptions in the HPA can activate excessive production of the stress hormone cortisol. Elevated cortisol over a long period of time can deplete the adrenal glands and diminish DHEA production. DHEA is the hormone that helps buffer cortisol’s effects so we can recover from stressful situations. Low DHEA levels can compromise the immune system, which can in turn lead to illness and increased risk of depression.

Chronically high levels of cortisol have now been linked to a number of mood disorders including depression, melancholia, anxiety, insomnia and loss of libido, as well as to heart disease, osteoporosis, and Alzheimer’s disease. Once depression is relieved cortisol levels usually return to normal. However, sometimes it is difficult to know if your stress level is affecting you physiologically and psychologically. Stress is so commonplace in today’s society that many of us just accept it as way of life. Monitoring cortisol levels can be a helpful tool in the diagnosis and management of depression.

Reproductive Hormones and Depression

Estrogen is an excitatory hormone, which means it makes things happen. In the brain estrogen triggers increased blood flow and oxygen metabolism, as well as the activity of neurotransmitters - the chemical messengers that enable your brain to think, feel, remember, decide and take action. Serotonin, norepinephrine, and dopamine are the neurotransmitters of “disposition management.” They govern our feelings of satisfaction, contentment and confidence. Both estrogen and progesterone influence these neurotransmitters. For example, the neurotransmitter serotonin affects your mood. Estrogen increases production of serotonin. When estrogen is low, serotonin production slows down. Low serotonin levels can open the door to depression. Estrogen replacement can enhance the body’s natural production of serotonin.

Progesterone is a calming hormone that is believed to bind with gamma-aminobutyric acid or GABA receptors in the brain. GABA is an amino acid that acts as a neurotransmitter. It has a calming effect on the brain and can increase feelings of well-being. When progesterone levels decline mood swings, depression and anxiety can be the result. Progesterone also balances the effects of estrogen. When there is not enough progesterone in circulation the activities of estrogen can go unchecked. Too much estrogen in the body can also cause anxiety, agitation, and irritability. Contrarily, too much progesterone in the system can lead to feelings of lethargy and apathy, also symptoms of depression.

Imbalances in estrogen and progesterone, which disrupt the natural homeostasis of the body, increase stress and can also cause an increase in cortisol production. For example, a study of women with postpartum depression found that the increased secretion of cortisol during pregnancy caused a temporary suppression of adrenal function right after delivery. Increased cortisol can help the mother’s body cope with the stresses of pregnancy and delivery. However, adrenal exhaustion combined with the sudden decline of post delivery estrogen production is now thought to be a major contributing factor in postpartum depression. For some women this decline is normal and they take it in stride. For others it is much more dramatic. It is important to remember that while all women have the same basic hormones, their hormonal profiles are all unique. The fluctuation or decline of a hormone level can vary widely from woman to woman, as can her response to these changes. 

Even though most women are familiar with PMS, many do not know about its more serious sister premenstrual dysphoric disorder or PMDD. While it is not unusual for PMS to involve feelings of sadness or mild depression, PMDD brings with it much more serious feelings of hopelessness. The defining symptom of PMDD seems to be depression or mood swings so severe they interfere with a woman’s daily life. Occurring the week before the onset of menstruation and disappearing a few days after, the symptoms of PMDD far exceed those considered normal during PMS. Statistics show that women who have PMDD are at increased risk for depression after menopause.

Even the Androgens Play a Role

One study on the effects of testosterone on depression and women’s health yielded some very interesting results, especially regarding the relationship between estrogen and testosterone. Women with low estrogen and low testosterone seem to be at increased risk for osteoporosis, depression and obesity. High estrogen and low testosterone correlated with increased risk for obesity and decreased libido. High testosterone and low estrogen were associated with aggression, depression, increased libido and substance abuse. And, high estrogen and high testosterone increased risk for type II diabetes, breast cancer and cardiovascular disease.

DHEA, the hormone responsible for buffering some of the negative effects of cortisol, has shown promise as a mood elevator. As we get older DHEA levels decline naturally. In a study involving nearly seven hundred women it was found that the lower a woman’s DHEA level the more likely she is to experience depression. In another study sixty-seven percent of aging men and eighty-four percent of women reported remarkable increases in perceived physical and psychological well being when DHEA was restored to a more youthful level. The use of DHEA for depression, at least preliminarily, is yielding positive results for those who need DHEA replacement.

Hormone Replacement and Depression

If you are suffering from depression a saliva hormone level test can help determine if hormonal imbalances or fluctuations are the cause. If they are, an individualized hormone replacement therapy program can help lift your depression and rejuvenate your sense of well-being.

Estrogen, progesterone, DHEA or testosterone replacement have all been shown to be helpful in alleviating depression. However, before a replacement hormone program is begun it is always best to determine what hormones, if any, are needed. Hormone balance in both men and women can vary dramatically. Monitoring hormone levels after you have begun therapy can help insure that your hormone dosage continues to fulfill your precise hormonal needs. Understanding your own hormone levels is key to knowing what is right for you. Your health, happiness and sense of well-being can depend on it.