Wellness Letter: Behavioral Health News

Mood and Hormones: What's the Connection?
By Dr. Stephanie Buehler

Puzzled about menopause and mood changes? You’re not the only one—even experts are stumped about the exact mechanism of how a woman’s changing hormones affect the brain and mood. Clearly, there is clinical evidence in that many women report increases in depression and anxiety as they enter this phase of life. According to recent findings by the Harvard Study of Moods and Cycles, even women who have no history of mood disturbance may find themselves faced with feelings of sadness or excessive worry. What causes these mood disturbances, and what can women do to manage them?

The hormonal changes that a woman’s body experiences during perimenopause (the period leading up to menopause, or the cessation of menses) cause hot flashes and/or night sweats for some women. Campbell and Whitehead’s 1977 study of more than 500 pre-, peri- and postmenopausal women suggested that women who experience severe hot flashes and night sweats are among those who are at greater risk for depression. This lead to the speculation of a so-called domino effect, wherein the night sweats caused sleep disturbance, and the sleep disturbance, in turn, caused depression.

The mechanism by which changes in estrogen affect the brain are extremely complex, but researchers are hunting to find out how estrogen interacts with nuclear receptors in the nervous system. It does appear that estrogen has an antidepressant effect, so doesn’t it stand to reason that a lack of estrogen contributes to depression? But it isn’t necessarily so. Studies using estrogen as part of therapy for depressed postmenopausal women have had mixed results. Other studies suggest that women who have a history of mood instability, anxiety, and insomnia may want to discontinue hormone replacement therapy with caution. A recent overview of research in this area suggests that using estrogen with an SSRI (e.g. Prozac or Zoloft) may be helpful in relieving depressive symptoms.

Testosterone is another hormone that has a direct effect on a woman’s mood and behavior. Testosterone decreases gradually and naturally as women age. Depression and anxiety, as well as decreased libido, have been described clinically by women who are low in testosterone. Women who have had oophorectomy (hysterectomy with ovaries removed) especially show a positive response when given testosterone plus estrogen, reporting greater psychological well-being and a significant improvement in mood and anxiety.

Do the experts agree on whether hormone replacement therapy alone can improve mood, anxiety, and insomnia? The scientific evidence is somewhat inconclusive. It appears that women who have mood and other psychological disturbances best benefit when they use antidepressants, mood stabilizers, and psychotherapy, either in conjunction with HRT or as independent treatment.

If you are experiencing mild disturbances (symptoms that are annoying but that do not affect your ability to function in your home and work roles), here are some tips to help you navigate your way through perimenopause:

• Develop good health habits. Getting adequate sleep, eating a healthy diet, exercising regularly, and meditating or doing other forms of relaxation can help you stay in a better frame of mind.
  
  
• Stay connected. Isolating yourself when you are feeling bad is not healthy. Let your friends, partner, physician, or clergy member know what you are experiencing and let them know what you need from them to feel better.
  
  
• Don’t “self-medicate.” Using caffeine, sugar, alcohol or other substances may provide a temporary fix or numb or mask symptoms of depression and anxiety, but they won’t help in the long run. Seek advice from your physician regarding HRT, antidepressants, and vitamin and mineral supplementation.
  
  
• Consider psychotherapy. If you are feeling so low, worried, or disconnected that it is affecting your quality of life and your relationships, it may be time to see a psychologist or other psychotherapist. A short course of psychotherapy (6 weeks to 6 months) may be very helpful in giving you support and helping you cope with the physical and psychological changes of menopause.

For more information, visit the following websites:

The Massachusetts General Hospital Center for Women’s Mental Health has a good overview article on menopause and mood.

The North American Menopause Society has an online booklet about menopause that includes information about menopause and mood.

—May 2005