Hormone Replacement Therapy and Depression
Updated: Dec 15, 2021
The term depression is part of our everyday vernacular at this point. We use the term freely to describe fleeting feelings related to everything from the weather to a temporary relationship conflict. Make no mistake, true depression is a serious condition that requires active treatment and support from a psychotherapist or psychiatrist.
It is important to differentiate between long-standing problems with depression and signs and symptoms of depression related to hormonal changes and daily stressors. Without a doubt, if you have suffered bouts of depression throughout your life, hormonal changes can exacerbate those symptoms. Likewise, If you have never had depression, hormonal changes can bring about intense depressive feelings and symptoms.
Symptoms of Depression
It is crucial to understand the symptoms of depression so that you can do something about it. Human nature tends to explain away our problems by rationalizing troubling signs and symptoms, especially if you are a woman. You are expected to suck it up and carry on managing a career, children, parents, and your relationship. There are several different types of depression, and we won’t get into those here, but the basics of major depression are the following. The criteria for major depression is having five or more of these symptoms most days of the week for two weeks or longer.
Loss of interest or pleasure in your activities
Weight loss or gain
Trouble getting to sleep or feeling sleepy during the day
Feelings restless and agitated, or else very sluggish and slowed down physically or mentally
Being tired and without energy
Feeling worthless or guilty
Trouble concentrating or making decisions
Thoughts of suicide
Perimenopause, Menopause, and Depression
If you are going through perimenopause or menopause and don’t have symptoms of depression, consider yourself lucky. It is impossible to know how many women experience depression because they don’t seek treatment and expect and accept that this is a “normal” part of perimenopause and menopause.
There is some evidence to suggest that depressive symptoms are more severe and common during perimenopause and subside post-menopause. According to Medscape, “Investigators from the Harvard Study of Moods and Cycles recruited premenopausal women aged 36–44 years with no history of major depression and followed up these women for 9 years to detect new onsets of major depression; they found that women who entered perimenopause were twice as likely to have clinically significant depressive symptoms as women who had not yet made the menopausal transition.”
The fact is, more study is needed to assess depression and the hormonal changes that accompany perimenopause and menopause. We know that the hormones estrogen, testosterone, and progesterone fluctuate during perimenopause and plummet during menopause. Estrogen is related to the production of serotonin, a mood-regulating neurotransmitter. Fluctuating estrogen and progesterone levels cause serotonin production disruption, leading to more mood swings.
Testosterone and estrogen are related to libido. When those hormones decline, so does your sex drive, leading to feelings of worthlessness and guilt. Low testosterone can also affect energy levels and motivation. Estrogen affects concentration and energy as well as sleep quality. The interplay and relationship among hormones are complicated and not well understood. As we learn more, one thing is certain, perimenopause and menopause bring about many changes- some having to do with hormones and others related to aging and shifting priorities.
How Hormone Replacement Therapy Can Help
Almost all of the symptoms of depression have the potential to be helped by hormone replacement. However, alleviating depression and anxiety takes a multi-pronged approach that combines hormone replacement with other healthy lifestyle choices that we will talk about later.
A study reported in Harvard Health Publishing states that: “Between October 2010 to February 2016 (the study) included 172 perimenopausal and early postmenopausal women ranging in age from 45 to 65 who experienced low-level symptoms of depression. Roughly half used a skin patch containing the hormone estradiol for 12 months and intermittent oral progesterone pills. The rest received a fake skin patch and placebo pills. The women were evaluated at the beginning of and throughout the trial for symptoms of depression using the Center for Epidemiologic Studies Depression Scale. Researchers found that only 17% of women in the hormone group developed clinically significant depression, compared with 32% of those in the placebo group.”
The bottom line, we need more studies, but if you feel low or experience any of the depressive symptoms we mentioned, take it seriously. Talk with us at Optimal Hormone Health about a complete evaluation of your hormone levels to discuss bioidentical hormone replacement.
Other Treatments for Depressive Symptoms
The multi-pronged approach we mentioned? It is time to discuss those and make it clear that only your effort to feel better will yield results. And that isn’t easy when you feel like crap! So as not to feel overwhelmed, tackle one or more of these at a time to help improve your mood and energy.
Counseling. There are few downsides to counseling, except the cost if you don’t have insurance to pay for it. The fact is, depression doesn’t usually occur in a vacuum, and there are other life stressors and coping mechanisms to talk about. A therapist can also talk to you about whether they think anti-depressant medications are worth considering.
Exercise. The mood-enhancing benefits of exercise are undisputed. You can start with walks each day and build from there, or just stick with walking!
Stress Management. Some stressors are difficult to cope with because they happen without warning. The loss of a friend, parent, or even spouse, a sudden accident or medical problem, loss of a job, or move are significant events that can cause depression and anxiety. Circumstances change, and managing your emotions can be a challenge. At times like this, taking care of yourself must come first and seek therapy to give you professional support.
Good Nutrition. Eat well to feel well. It is that simple but might take some significant adjustments. There is even a field called nutritional psychiatry, and diet has been associated with a decreased risk of depression. Specifically, a diet that emphasizes a high fruit intake, vegetables, whole grain, fish, olive oil, low-fat dairy, and antioxidants is recommended. A low intake of animal foods is associated with a decreased risk of depression.
Hormone Replacement Therapy and Depression
One of the challenges with treating women going through perimenopause and menopause who have symptoms of depression is they think there isn’t help. You don’t have to suffer, and with hormone replacement and other lifestyle changes and support, you can feel better.