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depression and hormones

Depression is one of the most prevalent mental illnesses worldwide. It is a complex disorder requiring a long term treatment plan. Depression does not have a direct etiology; a multitude of factors play a role in the symptoms. The basis of this mental illness is an imbalance in the mood-regulating chemicals in the brain; dopamine, serotonin, and norepinephrine.


The causes and risk factors of depression are:

  • Genetics: the genetic causes of depression are not straightforward. Inheritance of susceptible genes increases the risk of depression and other mental illnesses in a person.

  • Co-morbid medical illness: chronic medical conditions such as thyroid disease, inflammatory bowel disease, or cancer makes a person more susceptible to depression

  • Hormonal changes: women during the menopausal transition are more vulnerable to depression. Premenstrual Dysphoric Disorder (PMDD) and postpartum depression are variants of depression that occur in differing stages of a woman's reproductive life. Premenstrual Syndrome (PMS) increases the risk of depression.

  • Substance abuse: alcohol abuse makes the symptoms of depression and anxiety worse.

  • Medications: particular medications such as corticosteroids, beta-blockers, or seizure medications increase the risk of depression. These drugs affect the levels of serotonin and other mood-regulating substances in the brain.

  • Personal issues: major life event, conflict, abuse (physical, emotional, sexual), loss or death of a loved one


Depression consists of both emotional and physical symptoms. Every individual will experience a different set of symptoms, and with varying intensity. The myriad of ways depression can manifest in an individual makes it hard to recognize that something may be wrong. For some, the symptoms may be subtle, while for some people, they can be glaring. Symptoms:

● Lack of motivation

● Feelings of hopelessness, worthlessness, or guilt

● Restlessness, irritability, negative emotions

● Persistently sad mood, or feelings of emptiness

● Apathy

● Inability to concentrate, forgetfulness

● Loss of interest in activities that were once enjoyable

● Increase or decrease in appetite (resulting in weight gain or loss)

● Tiredness, fatigue, muscle aches

● Increase or a decrease in sleep

● Thoughts of suicide or suicidal attempts


Estrogen increases the production and action of serotonin. During the menopausal transition, the turbulent changes in the hormonal levels make a woman more susceptible to depression. Postmenopausal women are also more likely to experience depression and anxiety than premenopausal women.



The treatment for depression is tailored to every individual's needs and requirements. It includes antidepressants, psychotherapy, or both. One's lifestyle also plays a significant role in managing symptoms of major depression. Exercising regularly and following a balanced and healthy diet; reduce the risk and severity of depression. For women going through the menopausal transition, treatment with bioidentical hormones aid in the management of depression. Bioidentical hormones contain naturally derived estrogen that will mimic estrogenic effects. They will not only reduce mood symptoms, but they will also reduce menopausal symptoms making the transition smoother.


Depression is the number one mental illness worldwide, yet it is also widely unreported. A woman's reproductive journey of constant change in hormonal levels places her at a greater risk for this disease. It is a sly ailment, one that grows without any noticeable difference. Therefore, the key to early diagnosis and effective management is to be aware of the symptoms and risk factors.


REFERENCES


1) Bromberger JT, Epperson CN. Depression During and After the Perimenopause: Impact of Hormones, Genetics, and Environmental Determinants of Disease. Obstet Gynecol Clin North Am. 2018 Dec;45(4):663-678. doi: 10.1016/j.ogc.2018.07.007. Epub 2018 Oct 25. PMID: 30401549; PMCID: PMC6226029.


2) Sassarini DJ. Depression in midlife women. Maturitas. 2016 Dec;94:149-154. doi: 10.1016/j.maturitas.2016.09.004. Epub 2016 Sep 16. PMID: 27823736.


3) Barth, C., Villringer, A., & Sacher, J. (2015). Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Frontiers in neuroscience, 9, 37. https://doi.org/10.3389/fnins.2015.00037


4) Santoro N, Epperson CN, Mathews SB. Menopausal Symptoms and Their Management. Endocrinol Metab Clin North Am. 2015 Sep;44(3):497-515. doi: 10.1016/j.ecl.2015.05.001. PMID: 26316239; PMCID: PMC4890704.


5) Wariso BA, Guerrieri GM, Thompson K, Koziol DE, Haq N, Martinez PE, Rubinow DR, Schmidt PJ. Depression during the menopause transition: impact on quality of life, social adjustment, and disability. Arch Womens Ment Health. 2017 Apr;20(2):273-282. doi: 10.1007/s00737-016-0701-x. Epub 2016 Dec 21. PMID: 28000061; PMCID: PMC6309889.

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