- Depression and Irritability
- Hormonal Causes of Depression and Irritability
- Irritability and Hormones
- Oestrogen and Progesterone
- What is it?
- How does it work?
- Is it effective?
- Are there any disadvantages?
- Where do you get it?
- Women need to know about the link between the pill and depression
Depression and Irritability
Depression can be a serious and debilitating disorder. It is distinguishable from ordinary sadness which typically stems from an event — such as an illness, disability, death, trouble in a close relationship, loss of a job, etc. and which is usually self-limited. You should seek medical attention if you experience symptoms of depression, some of which may be lack of joy, fatigue, and extreme irritability, that don’t seem to have a reasonable cause and persist for a prolonged period of time.
Symptoms of Depression
Clinical depression may manifest with a number of symptoms, including:
- Prolonged sadness
- Loss of interest or pleasure in things once enjoyed (e.g. decreased libido)
- Changes in sleep patterns or appetite (unplanned weight loss or gain)
- Diminished self-esteem or self-confidence
- Lack of energy or fatigue
Hormonal Causes of Depression and Irritability
Hormonal imbalances may cause depression and irritability since there is already data implicating them in difficulty managing stress, reduced feelings of happiness or hope, and interference with normal sleeping and eating patterns.
Thyroid Dysfunction: Hypothyroidism (diminished level of thyroid hormones) is a known hormonal cause of depression in men and women. Low levels of thyroid hormones cause a reduction in serotonin, an essential neurotransmitter that positively influences mood and behavior.. Learn more about hyperthyroidism here.
Estrogen Deficiency: Estrogen deficiency in women during perimenopause or menopause is often associated with depression. A common sign of diminishing estrogen production is feeling overly sensitive to remarks by others or becoming tearful or crying for no apparent reason. Lowered levels of estrogen may also cause feelings of sadness and hopelessness.
The way estrogen improves mood, increases a sense of well-being, and promotes sleep is by enhancing serotonin levels. Estrogen also promotes increased amounts of the calming neurotransmitter gamma-aminobutyric acid (GABA). GABA is an anti-anxiety, anti-pain hormone that elevates endorphins, thereby producing pleasurable feelings. Estrogen also increases norepinephrine activity in the brain, which is responsible for improving mood, cognition, alertness and energy. You should be aware, however, that in some people elevated levels of norepinephrine cause anxiety, panic attacks and an agitated depression. Learn more about estrogen therapy here.
Progesterone: Progesterone is thought to promote good moods by boosting serotonin and GABA, which both work to decrease irritability, calm anxiety and dispel panic. Progesterone facilitates restful, refreshing REM sleep and less waking from deep sleep. Low levels of progesterone decrease serotonin, which can result in poor sleep and depression. Also, diminished amounts of progesterone prevent the balancing of the stimulating effects of estrogen and can lead to anxiety.. Learn more about progesterone therapy here.
Cortisol: Both elevated and low levels of cortisol have been associated with depression. Stress causes increased levels of cortisol to be released into the bloodstream, while the resolution of the stress typically causes cortisol levels to return to normal. When stress is an everyday occurrence, however, or when it persistently occurs at unpredictable intervals, cortisol levels can remain abnormally elevated.
High levels of cortisol may result in agitation and elevated blood sugar. When cortisol levels remain abnormally high, they may cause the level of serotonin in the brain to decrease, resulting in anxiety, insomnia, poor mood and depression. On the other hand, after excessive or prolonged stress, cortisol can also “burn out” and levels can fall dramatically. Surprisingly, low cortisol levels can also cause anxiety, irritability, inability to handle stress, fatigue and a feeling of being overwhelmed.
DHEA and Growth Hormone: Decreased levels of these hormones have been associated with depression in men and women. Produced in the body naturally, their production decreases with age and this decrease can affect mood and even mental functioning. In severely depressed patients, DHEA and human growth hormones (hGH) supplements can be helpful in improving mood and mental functioning. DHEA is classified as a neurosteroid, or neural hormone. In some recorded cases, it has been especially beneficial in improving mental function in patients with advanced HIV disease.
Testosterone: Frequently, depression in men is a result of the declining levels of testosterone that occur with aging. Low levels of testosterone lead to irritability, grumpiness, anxiety, mood swings, and loss of enthusiasm. Testosterone supplements elevate mood and in some cases relieve depression in men. The hormone works to improve mood by elevating levels of dopamine, (a “reward” neurotransmitter), serotonin, and noradrenaline in the brain. Testosterone enhances aerobic metabolism which increases overall energy, leading to increased vigor and enthusiasm. Women, too, normally have testosterone in their bodies and must be tested to keep their level of this hormone in the normal range. A sudden drop in testosterone can affect a woman’s libido, energy levels, and mood.
Irritability and Hormones
Irritability is an inappropriate or exaggerated amount of anger or impatience exhibited in response to a fairly benign situation. Because it so clearly affects those around the person suffering from the condition, it is often complained about when observed in parents, spouses, and other intimates. Sometimes, irritability is one way a person expresses depression or anxiety. In some cases, the condition may be due to a hormone imbalance. Other factors that may be responsible for irritability are:
- Poor diet
- Drug or alcohol abuse
- Excessive caffeine
- Headache or other physical pain
- Interactions of certain medications or drugs
- Withdrawal from alcohol, drugs, cigarettes, caffeine, or sugar
If you are troubled by irritability or depression, or find yourself becoming frustrated or impatient much too easily, you should come to the Southern California Center for Anti-Aging. A consultation with Dr. Goldstone can be invaluable and may be the beginning of a positive life change. If Dr. Goldstone finds that your emotional problems are being caused by one or more hormone imbalances, you can trust her to follow through with bioidentical hormone replacement therapy (BHRT) that will rejuvenate you and remind you of how wonderful it is to feel energetic and alive. Contact Dr. Goldstone today to schedule a consultation!
Oestrogen and Progesterone
What is it?
Oestrogen (also called ‘estrogen’) and progesterone are hormones that are important for sexual and reproductive development in women. Oestrogen and progesterone help to regulate a woman’s menstrual cycle and play an important role in pregnancy. While they are often thought of as ‘female hormones’, oestrogen and progesterone are also found in men.
Oestrogen and progesterone are used in several medical treatments for conditions other than depression. When used as treatments, these hormones are usually taken as a tablet. They can also be given in a skin patch, as a cream or gel, injected or implanted just under the skin, and as a suppository. Oestrogen and progesterone can be given together or separately. They are generally only prescribed to women.
How does it work?
The amount of oestrogen and progesterone in a woman’s body varies over her lifetime. Women have lower levels of these hormones in their body at certain times:
- after childbirth;
- before, during and after menopause;
- at certain points in the menstrual cycle, contributing to conditions such as premenstrual syndrome and premenstrual dysphoric disorder.
Depression symptoms can also arise during these times. For example, post-partum depression is a type of depression that occurs after a woman has given birth, and premenstrual syndrome (PMS) can cause symptoms of depression. It is thought that raising the levels of oestrogen and progesterone during these times might improve mood.
Oestrogen supplements may also be able to increase the amount of the chemical messenger serotonin in the brain. Low levels of serotonin are linked to depression.
Is it effective?
There is mixed evidence as to whether oestrogen is effective at reducing depressing around menopause. More studies are needed to confirm the effectiveness of oestrogen in these situations.
Two studies found that oestrogen patches reduced depression symptoms in perimenopausal women (women who were about to go through menopause) who were diagnosed with depression. However, a review of 10 studies found that oestrogen was not clearly linked to a reduction in depression symptoms in women around the time of menopause. In some of these studies, the treatment combined both oestrogen and progesterone.
There is not much evidence to suggest that oestrogen can be used to treat depression in postmenopausal women (women who have finished going through menopause).
Two studies have looked at the effects of a progesterone skin cream for women who had menopausal symptoms, including depression. The progesterone cream was not more effective than a placebo (dummy) cream in reducing depression symptoms.
There is very little scientific evidence on oestrogen for the treatment of women experiencing postpartum depression (depression which occurs after having a baby). One study found that postpartum women treated with oestrogen had a greater reduction in depression symptoms compared to women treated with a placebo. However, many women who were treated with oestrogen still met the criteria for depression. More studies of better quality are needed to understand the effectiveness of oestrogen in treating depression after childbirth.
Synthetic progesterone is not recommended as a treatment for post-partum depression, and studies have found that it can actually increase the risk of depression during this time.
During the menstrual cycle
Depression can be a symptom of premenstrual syndrome (PMS), which affects some women during their menstrual cycle. Oral contraceptive pills which combine both oestrogen and progesterone have been studied as a treatment for PMS. A pill containing a certain type of progestin (drospirenone) and a low dose of oestrogen has been found to reduce symptoms of PMS better than a placebo (dummy) pill.
For general depression
There is currently no evidence to suggest that oestrogen or progesterone are helpful for people who have depression which is not linked to natural hormonal changes.
Are there any disadvantages?
Hormone therapies can cause side effects. For example, common side effects of the oral contraceptive pill include nausea, breast pain and bleeding between periods. Hormone therapy may not be suitable for women who are pregnant or breastfeeding, or who are trying to get pregnant. Any hormone therapies should be taken under the supervision of a health care professional.
Where do you get it?
Most hormone therapies are prescribed by a doctor.
There is some evidence to suggest that oestrogen and progesterone may be helpful for depression symptoms which are linked to hormonal changes in women. However, these treatments are not well researched and are not recommended as a first choice of treatment. More studies of better quality are needed.
There is currently no evidence to suggest that oestrogen or progesterone are helpful for people who have depression which is not linked to natural hormonal changes.
Different types of contraceptive pills contain varying doses of oestrogen and progesterone. Credit: .com
The introduction of the contraceptive pill in the 1960s was a major milestone for female empowerment. It allowed women to separate sex from procreation, and to increase their participation in work outside the home.
Now, more than 100 million women worldwide use the oral contraceptive pill to prevent pregnancy or control their menstruation.
But the pill and other hormone contraceptives are not without side effects. We usually focus on the physical health effects of the pill, yet the most common reason women stop or change the pill is mental health side effects.
Depression is one of the most prevalent and debilitating mental disorders in Australia, and affects twice as many women as men. It is estimated that one in four women will experience depression in her lifetime.
One in four Australian women between the ages of 18 and 49 use the pill, at any one time. But few are aware of the link between the pill and depression.
Types of contraceptive pill
There are many oral contraceptives available in Australia, with different types and doses of the hormones oestrogen and progesterone.
The most commonly prescribed is a combination pill, which contains an oestrogen to prevent ovulation, and a progesterone to reduce the chance of a fertilised egg implanting into the wall of the uterus.
Most combined oral contraceptives have a similar dose and type of oestrogen, but the progesterone types and doses vary widely.
There are also several progesterone-only contraceptives that do not contain oestrogen. These are known as the “mini-pill”, or injected contraceptive (“depot provera”), or the skin implanted “straw” (Implanon or Norplant).
Hormones and mental health
A recent review has shown that sex hormones have significant impact on brain areas related to emotional and cognitive functioning. Progesterones have been shown to induce depression, particularly in vulnerable women.
Synthetic progesterone (more than natural progesterone) has significant effects on the brain chemicals serotonin and monoamine oxidase, resulting in depression, irritability and anxiety.
There is a great deal of variation in the effects of hormone shifts on mood and behaviour. Some women are very sensitive to small shifts in oestrogen and progesterone; others aren’t.
What does the research say?
Our research has involved measuring the clinical impact of various types of oral contraceptive pill on mood and anxiety. Overall, we found woman taking the oral contraceptive pill were more likely to be depressed than non-pill users.
Women taking the pills with low amounts of oestrogen had more depression than those taking higher oestrogen dose pills.
Certain types of progesterone were more “depressive” than other progesterones, but the progesterone-only contraceptives were the most depressive of all the contraceptives.
A 2016 Danish study of more than one million women supports our clinical findings. The researchers found that, compared to non-users, women aged 15-34 who took the combined oral contraceptive pill were 1.23 times more likely to be diagnosed with depression and prescribed antidepressant medication.
Adolescents aged 15-19 who used combined oral contraceptives had an even higher rate of depression than older women. They were 1.8 times more likely to be diagnosed with depression than the non-pill using peers, and this increased to 2.2 times among adolescents using progesterone-only contraceptives.
The study concluded that depression is a significant potential side effect of hormonal contraceptive use, especially in adolescents.
It’s not all bad news
Emerging research by our group and others suggests the combined contraceptive pill may improve “verbal memory” or memory for words and language. This is thought to be driven by oestrogen, which has been shown to positively influence memory-related brain regions.
Research also suggests that pills containing progesterones that are structurally more like testosterone improve visual-spatial skills (traditionally, a male-dominant skill) and pill types containing other progesterones may worsen visual-spatial skills.
Finding the right contraception
There are many types of hormone contraceptives and their use needs to be tailored carefully for the individual, especially among adolescents. Women and their doctors need to be aware that hormone contraceptives can contribute to mental health problems, and women should return to their GP if they experience mental health side effects.
The development of new hormone contraceptives that don’t impact adversely on brain chemistry is well overdue. Women must have the right to control their fertility without compromising their enjoyment of life.
Freer sex and family planning—a short history of the contraceptive pill Provided by The Conversation
This article was originally published on The Conversation. Read the original article.
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