Hormones & Psychiatric Disorders

• Depression can be linked to hormones and psychological disorders.
• Pamela W. Smith, M.D., MPH, MS, owns the copyright for 2024.
• AKH Inc., Advancing Knowledge in Healthcare is jointly accredited to provide continuing education for healthcare teams.
• Participants can claim credit for this CE activity until December 17, 2024.
• A review of the prevalence of depression in society needs assessment
• Psychiatric disorders in women have a link to estrogen
• Progesterone plays a role in anxiety and depression in women
• Testosterone's role in psychiatric disorders in both men and women warrants examination
• Examine the part DHEA and cortisol play in mental health
• Review the functions thyroid hormone has on anxiety and depression
• Effects of melatonin on mental health is something to understand

Disclosure Statement

• AKH Inc. has a policy in place to ensure integrity and objectivity in its continuing education activities.
• Authors must disclose any significant relationships with ineligible companies whose products or devices may be mentioned in activities.
• Identified conflicts of interest are mitigated by AKH prior to accreditation of the activity.
• AKH planners and reviewers reported no relevant financial relationships to disclose.

Depression (MDD)

• Major depressive disorder (MDD) was ranked as the third leading cause of disease burden globally in 2008 by the WHO, and second by 2020.
• MDD is projected to be the leading cause of disease burden by 2030.
• Obesity and depression have an increasing worldwide prevalence
• Obesity and depression are among the most challenging health problems that women face today
• Obesity and depression are associated, and that association is stronger in women than in men
• Females are more than twice as likely as males that are afflicted by mood disorders
• Premature mortality can be a result of higher rates of both depression and obesity by diminishing quality of life and increasing risk of morbidity
• Depression may have possible contributing factors like Chronic low-grade inflammation, oxidative stress, metabolic and endocrinologic disturbances
• A primary contributor to major depressive episodes may be hormone fluctuation
• Vulnerability for depression in women increases significantly in puberty and declines after menopause.
• Postpartum and perimenopause phases, and the time immediately after a surgically induced menopause have link to depression in women with substantial changes in sex hormone levels, related to estradiol levels.
• In clinical populations, studies have found that there are links between sex hormones like estradiol and testosterone, and depression.
• Sustained low estradiol levels have also been observed in women who experience major depressive disorder.
• Sex differences in depression are documented worldwide.
• Women are susceptible to mood disturbances, depression, and anxiety during times of hormonal flux, such as menopause, puberty, perimenstrual, and postpartum periods.

Estrogen and Mood

• Estrogen directly regulates mood regulating neurotransmitters functions, including norepinephrine, dopamine, serotonin, and acetylcholine.
• Neurotrophic factors, known as the brain's cell fertilizers and a direct cause of depression, are influenced by estrogen.
• Depression has links to neurotransmitters such as norepinephrine, dopamine, serotonin, and acetylcholine
• Endorphin levels in the brain and bloodstream are elevated by estrogen
• Mood is regulated by the interrelationship between hormones such as progesterone, DHEA, testosterone and melatonin
• Women are at a higher risk for depressive disorders such as depression and anxiety, which is associated with fluctuations in estrogen levels during reproductive cycle events.
• Fluctuations in estrogen levels which are the same in the time during menopausal transition, a time characterized by drastic fluctuations in estrogen levels and increases in new onset and recurrent depression, have relation to increased risk of depression
• Regulating estrogen levels with hormone therapy may prevent mood disorders or help treat women diagnosed with mood disturbance
• Estrogen has neuromodulatory and neuroprotective effects that are directly relevant to mood
• Affective regulation has been linked to estradiol regulation of neurotransmitters and a high concentration of estrogen receptors in neural structures
• Disturbance in mood is correlated with estradiol deficit, fluctuating estradiol, and rapid estrogen withdrawal.
• Postpartum, perimenopause, and post-menopause depression is related to the return of stable and optimized estrogen levels
• Sex steroid deficient causes various neuroendocrine changes when going though perimenopause and menopause. At the hypothalamic level, eating disorders are a result of estrogen withdrawal, altered blood pressure control, and vasomotor symptoms. On the other hand, the tone modifications of serotoninergic, opioidergic, and noradrenergic contribute to mood, behavior, and nociception changes, at the limbic level.
• Positive effects in climacteric depression by HRT are shown through both direct effects on neural activity, and cognitive efficiency observed decrease in menopause modulated by the modulation of serotoninergic and adrenergic tones.
• Modifications in mood and cognitive performances are related to estrogen because the brain is a source of neurosteroids
• Natural hormone replacement is suggested as a therapy for mood changes that may occur during perimenopause/menopause
• Postpartum period, perimenopause, and post-menopause clinical restoration of stable estradiol levels helps recover from depression
• Animal studies showed antidepressant effects in animal studies for estrogen
• Use of estrogen has a better outcome than when using a placebo for reproductive mood disorder for postpartum depression and mild depressive disorders during perimenopause.
• The menopausal transition has depressive symptoms from 15-50% in women
• Gonadal hormone fluctuation links to depressive conditions
• Combination of antidepressant and hormone therapy may be considered when severe depressive conditions arise
• Sleep disturbance, and not hot flashes may better enhance mood in women during the menopausal transition by changes in levels of estradiol when preforming therapy that treat insomnia
• Prevention of clinically significant depressive symptom, shown to be more effective than placebo
• Short term estradiol use for depression can help perimenopausal and postmenopausal women, and the antidepressant benefit that is shown may be independent of physical symptom improvement.
• Estrogen augmentation of antidepressants in perimenopausal depression can be done using low doses, since those with MDD in partial remission have shown benefits.

Estrogen and Anxiety

• Directionality varies while Estrogens have a profound affect on anxiety expression in humans and rodents.
• Specific estrogen receptor ER subtypes cause discrepancy regarding the nature of estrogen's effects on anxiety.
• The relative impact on anxiety relies on the ER type:
  • ERα causes anxiogenic effects
  • ERβ causes anxiolytic effects
  • GPR30 can increase and decrease anxiety-like behavior
• Several neurobiological systems combined with estrogen receptors produces combined effects and influences emotional responses

Estrogen and Schizophrenia

• Estrogen is hypothesized to have a protective effect that has protective effects against Schizophrenia
• Compared to men, older women are more likely to develop late-onset schizophrenia after menopause.
• Women in the lower estrogen phase of their menstrual cycle show more psychological symptoms
• Adding estradiol to usual antipsychotic medication shows significant abatement of schizophrenia symptoms
• Addition of transdermal estradiol when adjunctive to schitzo treatment is an effective treatment.
• Adjunctive treatment using estradiol for those with combined depression and Schizophrenia works to improve depressive symptoms

Hormonal Balance

• Estradiol can be a patch for women of all ages for treatment of depression, anxiety, and schizophrenia, from results
• Consider natural hormone replacement therapy for hormones that are deficient
• Natural progesterone needs to be considered for the study for women because it affects how women regulate affects
• Estradiol is unnecessary for younger patients to help regulates mood if results are normal on saliva
• Before replacing estrogen in women already with results for normal levels before menopause, her other hormones are need to be balanced for a safer approach when replacing estrogen.

Progesterone and Anxiety

• It acts directly on the GABA receptors, so is an anti anxiety agent

Progesterone and Depression

• Depression is more often present when females are adolescence vs males
• increases in depression can be a result of depletion
• Prevalence of depression has link to perimenstruum, hormone level, and perimenopausal periods
• Depressive behaviors can help reduce with a decrease in progesterone levels
• Reproductive events and hormone are related to low levels of progesterone
• Hormones measurement for progesterone can be done through saliva testing

Testosterone and Mood

• And increase of four-fold in the increase in depression in the study with women with polycystic ovarian syndrome with body mass
• The rise and state from mood can be increase within the PCOS group by a variety.
• Women in the POCS groups can have depressive disorders

Testosterone and Mood

• Higher testosterone levels are a report for women suffering from postpartum baby blues
• Hypothalamic-pituarity-adrenal axes in the body can report on to where the testosterone come form.

Testosterone and Depression

• Higher fee testosterone can link to testosterone with a mediation affect that may lead to depression in the body to where those imbalances are present. Hormonal balance and those functions are present when depression becomes present and active. testosterone can affect mood if people in the bodies is not balance correctly
• Longitudinal with testosterone depression symptions
• Depression levels increase as well as those symptoms in what's seen between the transitions and how these functional states present for a certain aspect
• Evidence with normalize the testosorterone using standard medication treatments.
• Androgens come affect to the body can cause mood and how mood changes or what's not being shown when you see other.
• Those hormonal changes that are set can improve cognitive skills by a balance way across the board.

dhea Mood

• animal, 5-ht levels, effect to the 5ht , serotonin, 5-ht
• Mood for that effect there are levels that also show a relation in levels
• A certain level that may the mood and show effects for them

DHEA and Depression

• Dea had can contribute better effects, as how the depression rates, and the hormones by a combination
• Dea and how it functions to were how people can provide to get help from the mood is by many trials across the effects
• The medication to show better ways with what test can be shown

DHEA and Anxiety

• With androgens during a transition the high increase during a puberty effect a more high levels across by different aspects

DHEA and Schizophrenia

• In double - blind trails using DHEA to treat schizophrenia with higher dosage or a placebo showed the changes and effect across for that treatment to where different forms can present thems elves.
• DHEA helped to minimize anxiety by certain standards in medical conditions for Schizophrenia
• People that are seen with DHEA can provide there own version to better them selves with schritophrenia to where those can provide more details.

HORMONAL BALANCE

• Estrogens is most likely needed to help provide what those levels can increase within that section
• More balenced approached would be to consider natural hormones.

Cortisol and Mood

• Cortisol has a strong affect to the body.
• Cortisol increase or decrease and have effects to that section

Pregnenolone and Mood

• Pregneolone and it's parts, and hormones can show to what needs to be tested as why more people take these medical choices to balance with the body.

THYROID AND MOOD

• Thyroid hormone can increase or help get things resolved, by taking better routes, to what imbalance come to those actions

HYPOTHYROIDISM AND DEPRESSION

• There are relation ships for this problem
• There had can lead to some aspect
• 40% of medical issues can stem, as 20% show with hypothyrodism
• Chinese patients with depression can show those issues for more then what is originally shown with them already.

AUTOIMMUNE THYROID DISEASE AND MOOD

• Increase rate in psychiatric side effects. What the thrydiro hormones cause when the affect come in .