by Nicole Berardoni M.D., Tory McJunkin M.D., and Paul Lynch M.D.
Estrogen is an excitatory hormone produced by ovaries and adipose (fat) cells. Estrogen causes an increase in blood flow and oxygen metabolism. It also can increase several neurotransmitters or brain hormones. Norepinephrine, serotonin, and dopamine are the neurotransmitters responsible for many of the emotions you experience. Estrogen improves your mood by increasing serotonin levels. Low serotonin levels are thought to cause depression, and antidepressants like Prozac increase serotonin. Norepinephrine has a stimulating effect by increasing alertness and having a role in the production of long-term memory. Ideal levels of norepinephrine can produce a calm state in stressful situation; however, too much norepinephrine can produce anxiety. It is important to have a balanced level of neurotransmitters to maintain homeostasis or normal body functioning.
Progesterone acts as a relaxing hormone produced by the ovaries, instead of a stimulant. It works with a different neurotransmitter in the brain, but can cause a calming effect. Progesterone allows for feelings of wellbeing. Just like estrogen, when progesterone levels are offset depression and anxiety may ensue.
Hyperthyroidism (increased thyroid hormone) and hypothyroidism (decreased thyroid hormone) are very common diseases. Patients who suffer from hyperthyroidism are often extremely anxious, have an increased metabolism, feel hot, lose weight, have a rapid heart rate, and may have panic attacks caused by increased levels of thyroid hormone. On the contrary, patients with hypothyroidism often suffer from weight gain, slow thinking, cold sensation, and depression. If you suffer from thyroid hormone deficiencies or excess, you may benefit from regulation of these hormones.
Cortisol is a hormone produced by your adrenal glands that is necessary for survival. It is responsible for energy metabolism and is critical in the management of stress. Increased levels of cortisol are seen in stress; however, when pathologic it is called Cushing’s syndrome. Cortisol levels can be affected by many conditions, such as physical or emotional stress, strenuous activity, trauma, and infection. Chronically high levels of cortisol can produce face and trunk weight gain, excessive sweating, hypertension, easy bruising, thinning of the skin, stretch marks, hump-back fat deposits, insomnia, mood disorders including depression and anxiety. “Chronic elevation of Cortisol may also lead to Dopaminergic, Noradrenergic and Thyroid dysfunction.” (Duval 2006 ). When cortisol levels are too low, a person is said to have Addison’s disease. The most common symptoms experienced are fatigue, muscle pain, muscle weakness, joint pain, weight loss, hypotension, vomiting, diarrhea, and mood changes.
Depression is a mental illness that can be severe and affects many people of all different ages. Depression is thought to result from a chemical imbalance of serotonin within the brain. Serotonin is the chemical in the brain that controls a person’s mood and is usually decreased in patients suffering from depression. Therefore, many of the therapies for depression (Prozac, Zoloft, Celexa) raise serotonin levels.
Major depressive disorder has been associated with changes in the hypothalamus-pituitary-thyroid (HPT) axis and with hypercortisolism in a large controlled clinical study. When compared with matched control subjects, outpatients with major depression had slightly higher serum TSH (thyroid stimulating hormone), while urinary cortisol levels were similar. Also observed was lower serum cortisol in atypical depression than in non-atypical depression (Brouwer 2005). A large body of evidence suggests a potential role for the norepinephrine function as a possible biological factor in the control of suicidal behavior (Pitchot 2003). Some clinical research has shown that estrogen, progesterone, and testosterone replacement may be helpful in people with deficiencies. A thorough work-up must be done to determine what hormone replacement you may benefit from. A customized hormone replacement therapy program may help alleviate your depressive symptoms.
During menopause, the levels of estrogen, progesterone, and testosterone all decrease in a woman’s body. The drop in these hormones can cause many symptoms including hot flashes, weight gain, vaginal dryness, mood fluctuations, and sleep disturbance. Hormone replacement therapy, also known as HRT, reduces many of these symptoms in women. The HRT typically consists of estrogen and progesterone. Estrogen replacement has been helpful in reducing hot flashes, night sweats, vaginal dryness, and urinary tract problems. Low-dose estrogen along with low-dose progesterone may especially benefit women who experience disturbed sleep (Gambacciani 2005).
HRT is also recommended by many physicians to decrease the risk of post menopausal women from developing osteoporosis and heart disease. While clinical trials have continued to demonstrate HRT’s effectiveness in preventing osteoporosis, women must weigh the risk of the therapy with the benefits. The trials also showed that HRT actually increased rather than decreased risk of heart disease and many women are not given HRT routinely. Progesterone is included in HRT because it reduces the risk of uterine cancer (higher when taking estrogen only). Women can also add testosterone to their regimen, as this helps with vaginal dryness. Many other symptoms and conditions including chronic pain, may be improved by a customized hormone therapy regimen.
*At this time, Arizona Pain Specialists does not manage bioidentical hormone replacement therapy
- Thyroid and adrenal axis in major depression: a controlled study in outpatients. Brouwer JP, Appelhof BC, Hoogendijk WJ, Huyser J, Endert E, Zuketto C, Schene AH, Tijssen JG, Van Dyck R, Wiersinga WM, Fliers E. Eur J Endocrinol. 2005 Feb;152(2):185-91 PMID: 15745924
- Cortisol hypersecretion in unipolar major depression with melancholic and psychotic features: dopaminergic, noradrenergic and thyroid correlates. Duval F, Mokrani MC, Monreal-Ortiz JA, Fattah S, Champeval C, Schulz P, Macher JP. Psychoneuroendocrinology. 2006 Aug;31(7):876-88. Epub 2006 Jun 12.
- Catecholamine and HPA axis dysfunction in depression: relationship with suicidal behavior. Pitchot W, Reggers J, Pinto E, Hansenne M, Ansseau M. Neuropsychobiology. 2003;47(3):152-7.
- Effects of low-dose, continuous combined hormone replacement therapy on sleep in symptomatic postmenopausal women. Gambacciani M, Ciaponi M, Cappagli B, Monteleone P, Benussi C, Bevilacqua G, Vacca F, Genazzani AR. Maturitas. 2005 Feb 14;50(2):91-7