Hormonal Mood Disorders

Despite all the uncertainty about diagnosis of mental health disorders, there is sufficient evidence to indicate that a significant subset of people diagnosed with mental health disorders, in fact, have hormone imbalances. The connections between hormones and the brain is undeniable. Hormones impact brain chemistry and circuitry, and hence influence emotions, mood & behavior.

For many adolescents, the first exposure to the mood-changing impact of hormones is puberty. Adolescents can experience significant upheaval due to constant emotional ups and downs, irritability, depression, anxiety, brain fog, and moodiness. In adolescent girls, hormonal disorders are often overlooked because we tend to focus on the time they begin menstruating.  We forget that long before a girl undergoes menarche, a variety of other changes occur that commence with hormone fluctuations.

PMS affects up to 85% of women. Irritability, tension, and dysphoria are the most consistently described symptoms. Women whose affective symptoms are especially severe may meet criteria for PMDD, which occurs in 2-10% of women. PMS and PMDD are often incorrectly diagnosed as bipolar disorder or other mood disorders that have many similar symptoms. The confusion is tragic because these therapies are often ineffective and more damaging, with serious long-term side effects in the form of obesity, metabolic syndrome, diabetes, sexual dysfunction & movement disorders.

PCOS patients are another group of adolescents who create a set-up for misdiagnosis.  These patients have significant hormone fluctuations without a menstrual cycle. They have florid mood swings, affective dysregulation, depression, impulsivity, suicidal gestures…the whole gamut.

Pregnancy and postpartum are other key times when mind and hormones intersect. Some women have their first experience with significant moodiness, emotional ups and downs, and frank depression during or after pregnancy. Postnatal depression and psychosis are key mental illnesses that have a major hormonal component to their onset and course. This is thought to be triggered by the sudden, rapid drop in the high levels of pregnancy hormones shortly after birth.

The next commonly recognized — but not well-understood — time, is broadly referred to as ‘menopause’. Most symptoms associated with menopause — erratic periods, hot flashes, mood swings, sleep disturbances, mental fog and decreasing mental focus, weight redistribution, decreasing motivation, diminished exercise endurance, muscle & joint aches, diminished exercise recovery, headaches, and changes in sex drive— take place during perimenopause — the time before menopause — when testosterone, estrogen and progesterone can go up and down erratically. These fluctuations can actually start as early as late thirties.  During this time, women are 14 times more likely to experience depression. It affects women differently than other types of depression, causing anger, irritability, poor concentration, memory difficulties, low self-esteem, poor sleep and weight gain. Perimenopausal depression isn’t well recognized and is often poorly treated with standard antidepressants. Women with this type of depression respond better to hormone treatments.

Low testosterone in men can result in a multitude of mood concerns.  Testosterone is also converted to estradiol in men. Too much or too little estrogen can lead to depression and other mood issues. Fluctuating estrogen levels, also cause mood swings, which further complicate the picture.  A discernable PMS pattern of behavior is often recognized with these fluctuations. Men with hormone imbalance often benefit by testosterone replacement, which causes their moodiness, irritability, insomnia and other symptoms to resolve.

In addition to our male & female hormones, there are other hormonal imbalances that can have profound effects on mood.

Thyroid issues are an often overlooked, hormonally-triggered cause of symptoms. Some men and women have even been mistakenly misdiagnosed as having panic disorder or anorexia, before properly diagnosed with an overactive thyroid. An underactive thyroid — hypothyroidism — can cause depression, moodiness, fatigue, and anxiety. Interestingly, one symptom of undiagnosed hypothyroidism is depression that does not respond to antidepressant therapy. Thyroid problems are also more likely to show up during periods of hormonal flux, which makes it even more important to have a full thyroid evaluation done if you experience depression or anxiety during these times of life.

Adrenal issues can cause a variety of symptoms that seem to be mental health-related, including depression, anxiety, and insomnia. In patients that have experienced trauma or violence, chronically elevated levels of cortisol can result, causing significant mental illness. High cortisol levels can result in rage, suicidal thoughts, obesity & infertility. A chronic excess of stress hormones can make you feel jittery, anxious, unable to sleep, and irritable. A chronic deficiency of stress hormones can make you feel sluggish, tired (even after sleep), moody, depressed, and have difficulty concentrating. Daily fluctuations and imbalances can cause a mix of these symptoms.

Hormone replacement is also often part of the transition process for transgender patients. This is, yet, another area where hormones and mood intersect. Many transgender patients experience dysphoria, or psychological distress due to the discrepancy between the sex they were assigned at birth and their gender identity. There is a high prevalence of depression, anxiety & suicidal thoughts.

Hormones help align physical characteristics with gender identity. Many individuals report hormone therapy is extremely beneficial because it enables them to maintain a physical appearance that more closely matches their gender identity, thus increasing their comfort with their physical appearance and decreasing dysphoria & distress. The effects on physical characteristics from HRT can usually be seen in one to three years, but a person receiving hormones will continue taking them for the rest of their life in order to maintain the effects. Research shows that HRT significantly reduces depression, anxiety, and sensitivity, along with feelings of hostility. Additionally, HRT often has the effect of increasing self-esteem and feelings of attractiveness. During gender transition, people who receive hormones typically experience a second puberty, during which secondary sex characteristics change to align with gender identity.

Trans-women receive estrogen in addition to antiandrogens to block testosterone. Trans-men take testosterone, which stops the menstrual cycle, lowers voice, and facilitates facial hair growth, though there may be other effects as well. Non-binary individuals (those whose gender is not specifically male or female) take hormones to produce characteristics that align with their identity or eliminate characteristics causing distress/dysphoria.

It is essential to remember that it is not possible to choose which characteristics result from HRT, and hormone therapy will affect people in different ways. Because of this, the initiation of hormone replacement can also increase feelings of dysphoria and distress.  Many transgender patients don’t quite know what to expect.  Often the changes in hormones they experience from replacement do not yield results that they anticipated or have side effects that were not considered.  For the reason, it is essential to counsel these patients thoroughly before initiating a regimen.

Before you go down the road of antidepressants and/or anti-anxiety medications, make sure you take a complete medical history, assess symptoms, do a thorough clinical exam, and run comprehensive blood testing to evaluate and diagnose any hormone balances. Unlike most medications and supplements that support and balance hormones, antidepressants and anti-anxiety medications often have significant side effects, and frequently don’t even resolve your symptoms if the underlying cause is a hormonal issue. At Tree of Life Medical, we will help determine if your mood disorder is related to fluctuations in hormones, and, if so, we will get you treated with the right combination of therapy.  Diagnosis of hormone-responsive depression should be made through a patient’s personal and family history and not necessarily through the measurement of hormonal levels.  We will carefully consider your symptoms and history to help determine if you have a hormonal component to your mood concerns.  We will also perform thorough physical examination and laboratory analysis to gather additional information, as necessary.