Tag Archive for Depression

18 Mar 2012
mood disorders

Hormones and mood– the first steps to feel better

Mood disorders are among the most common complaints I see in my anti-aging practice. The most common symptoms are anxiety and depression. However common associated symptoms are fatigue, insomnia, difficulty concentrating and memory problems.

One of the challenges I always face in treating a new patient is tackling numerous symptoms in just one hour. Sometimes the history alone can take half that time.

For that reason I advise my patients when I first meet them that the first visit will focus largely on hormone balancing. If mood problems are among their chief complaints I advise them that hormone balancing may result in dramatic improvements in their mood symptoms. I let my patients know which hormones are associated with nervousness and anxiety and which ones associated with sadness and depression so they can anticipate what they might experience with the initial course of treatment.

The following is a simple guide for patients to help them understand common associations between hormones and mood.

Nervousness and anxiety:

In women these symptoms are typically associated with low progesterone levels and/or excess estrogen (specifically estradiol). The best marker is the progesterone to estradiol ratio (Pg/E2). Optimal ratios are between 100-500 to one. I target 300:1as my goal.

Men, especially those who are obese, may have elevated estradiol as well because of excess conversion of testosterone to estradiol. This can contribute to anxiety(and further weight gain).

Low testosterone in both men and women can contribute greatly to anxiety. Many patients with low testosterone feel buffeted by stressors in their lives. They tend to be “reactive” rather than “proactive.”. Testosterone deficiency, when corrected, helps them feel more “in control” of their lives and better able to handle what challenges life throws at them.

Thyroid deficiency can cause not only anxiety but also panic attacks, trouble concentrating, decreased memory and slow speech. Thyroid excess can also cause anxiety and a racing heart and insomnia. Hence the reason for tight monitoring of thyroid levels to keep them in the mid to high normal range but not outside the range.

Overactive adrenals caused by chronic stressors generally will not cause anxiety per se, but they can cause irritability, cravings, confusion, fatigue, and insomnia. Adrenal fatigue can cause general emotional imbalances, fatigue, trouble concentrating, and insomnia.

DHEA deficiency can be associated with e inability to handle stress, trouble concentrating and insomnia.

Depression

Estrogen excess can be associated with depression. The annoying additional symptoms of weight gain, water retention, mood swings irritability, insomnia, swollen and/or tender breasts and headaches commonly associated with excess estrogen all serve to aggravate depression.

Progesterone deficiency (see earlier discussion of a low P/E2 ratio) can also cause depression as well as irritability.

Testosterone deficiency can also be associated with mild depression in men and women. However it can also do this if it is too high (as what might occur with too vigorous replacement, although this is a far less common cause of depression than too low.

Thyroid deficiency is a common cause of depression. Associated symptoms of constipation, headaches, water retention, memory and concentration problems, insomnia, fatigue, and reduced libido all tend to aggravate these symptoms of depression.

Cortisol deficiency, as what occurs in adrenal fatigue, generally won’t cause depression symptoms specifically but can certainly cause emotional disturbances, aggravated by associated blood sugar swings.

Finally, symptoms of deficiency of DHEA, one of the master adrenal hormones, can include depression, along with trouble concentrating and insomnia.

While deficiency of vitamin D, a hormone not a vitamin, is not typically associated with depression, I have seen patients who reported better mood when their levels were normalized.

So an initial anti-aging plan usually starts with hormonal balancing: first adrenals, then the sex hormones, and finally thyroid. I advise my patients to start with this approach for tackling their mood related symptoms, adjust dosages based on labs and clinical response and see how they do.

Many patients can stop at this point. They feel more on an even keel, able to cope with their daily stressors, and feel more optimistic about their current life and their future than before normalizing their hormones.

Hormones are not a panacea for mood problems. If symptoms persist we next pay attention to optimizing neurotransmitter levels. We have one option of a scientific approach, which can include direct measurement of urinary neurotransmitter levels, testing for cofactors deficiency, identifying markers of toxicity in the GI tract (including dietary stressors, intestinal and liver status), followed by corrective treatments. Or we can choose the other option of empirical (try it and see what happens) intervention with herbals, amino acids, cofactors like NAC to enhance nerve transmission, and other natural therapies to target symptoms by promoting boosting or calming of neurotransmitters based on our clinical experience. This is what is done by psychiatrists. In our specialty we look for corrective natural approaches first, or if the patient is already on psychotropic drugs, seek to eventually replace them if possible and the patient is willing. We never stop psychotropic drugs that are working until we feel the time is right, and then only with gentle tapering and the cooperation of the patients’ doctor(s).

It is critical to have knowledge of one’s hormone status if mood problems are present. This requires salivary or capillary blood testing for the adrenals and sex hormones and venous blood (regular blood draw)for the thyroid. Your fellowship trained ant-aging specialist is equipped to start you on the pathway to correction of hormone imbalances. This could be you solution to mood problems and the response can be rapid If the response is suboptimal then the neurotransmitters themselves can be nudged into normal balance with a creative,individualized plan. This process can be more lengthy, involving dietary changes, detoxification and correction of nutrient deficiencies. It requires close monitoring and good communication between doctor and patient.

The many successes I have had in my career with helping patients feel better with hormones and adjunctive treatements continue to enhance my enthusiasm for this approach to managing anxiety and depression. If these problems plague you I encourage you to seek our a doctor with the proper training and experience to help you feel your best.

Dr. Stephen Center | One comment | Tags: , , , , , , , , , , ,
21 Nov 2011
hormone replacement

Progesterone–who needs it? (who doesn’t need it?)

Progesterone is a critical ovarian produced steroid hormone that plays specific roles throughout a woman’s life. For women who are premenopausal, progesterone production begins around mid-cycle, rises to a peak @ day 21 of the typical cycle, and then plummets in the absence of pregnancy, triggering a period @ 2-5 days later. Low progesterone during this “luteal” or “moon phase” of one’s cycle is referred to commonly as PMS. During this PMS time of the month low progesterone and normal or high estrogen levels create the typical pattern of “estrogen dominance,” with weight gain, water retention, breast tenderness, mood swings and general crabbiness. For these women, when testing confirms low luteal progesterone, anti-aging physicians prescribe bioidentical progesterone. This includes either (or both) topical progesterone or oral progesterone. With proper dosing and timing adjustments PMS symptoms will usually decrease or disappear altogether.

Most gynecologists and family doctors only think about the uterine protective effects of progesterone, so that when women have hysterectomies they don’t recommend it. That is a very bad decision, as post hysterectomy patients generally gain a lot of weight and experience major mood problems when they are given nothing or unopposed estrogen. What they need, as virtually all postmenopausal women need, is progesterone (and usually estrogen as well in the form of Biest). .

What are the roles of Progesterone in one’s body?

Progesterone::

Balances the effects of estrogen
Has a calming effect and enhances mood
Has beneficial cardiovascular effects
Balances blood sugar and thyroid function
Helps rebuild bone 9up to 10% increase in bone density on clinical studies).

Among the many symptoms of low progesterone are::

Anxiety
Depression
Irritability
Mood swings insomnia
Pain and inflammation
Osteoporosis
Decreased HDL
Painful menstruation

I have seen many women gradually reduce and later discontinue (under medical supervision) their anti-anxiety and anti-depressive drugs as well as sleeping pills after they achieved the optimal progesterone levels and proper progesterone to estradiol ratio (the goal is @ 300 to 1 on salivary or blood spot testing). Men with mood problems and those with high estradiol levels can be greatly helped by progesterone if levels are low.

Hormone receptor positive breast cancer is the major contraindication to progesterone. All patients seeking bioidentical hormone replacement therapy need regular cancer screening before and for the duration of treatment. There have been no studies showing an increased risk of cancer with bioidentical progesterone. Ther have been studies (Women’s Health Initiative) showing that the bio-similar (not bio-identical) progestins in Prempro increase risks for many conditions including cancer. That is why progestins should be avoided. True progesterone is healthy and natural for our bodies.

Women who are having periods usually use progesterone from days 14 to 25 of their cycle. Sometimes it is started earlier, like day 10, if mood problems warrant it. Too much progesterone thins out the lining of the uterus and can throw off the normal menstrual cycle and cause spotting at random times. Too much progesterone can also increase appetite and sugar cravings. That is why your doctor needs to be experienced In managing your use of hormones via followup labs and consultations.

Women who have stopped menstruating can use progesterone 5-7 days a week.

Compounded topical and oral progesterone is best obtained from experienced nationally recognized compounding pharmacies. Topical progesterone in a cream or gel is calming and often mood elevating when taken once daily, usually in the morning, applied to the forearms which are rubbed together. Oral sustained release progesterone capsules are taken an hour before bedtime if insomnia is an issue. Some women use both forms in the beginning and often later switch to just oral or cream.

So if you are interested in hormone and potentially slowing the aging process, be sure your doctor evaluates your progesterone levels using salivary of blood spot (capillary blood) samples. These are collected on @ day 21 of your cycle if you are menstruating or any day if you are not. If they are low please see your fellowship trained anti-aging, bioidentical hormone specialist who can prescribe the best progesterone dose, vehicle of delivery and schedule of use to meet your needs. Your clinical response and progesterone levels will then be monitored and the plan adjusted accordingly.

It is well worth the effort to balance estrogen EVEN IF YOU ARE NOT TAKING ESTROGEN. Creating a healthier progesterone to estrogen balance will promote a better shape, a better mood, a better sleep and a better you!

Stephen A. Center, MD
ABAARM Board Certified
Fellowship Trained Anti-Aging Medical Specialist

Dr. Stephen Center | 2 comments | Tags: , , , , , , , ,
09 Aug 2011
Depression

Treating depression as a correctable symptom rather than as a drug dependent disease

A recent CDC release reports that antidepressant drug use has skyrocketed in the last 10 years. Is depression some kind of epidemic? They also found that a sizable percentage of patients treated with these types of drugs did not actually have a diagnosis of depression. Quite often they were given the drug prescription for off-label use for symptoms of fatigue, job stress, insomnia and other conditions. Presumably the decision to use an antidepressant meant that the condition was not due to a treatable disease, so prescribing drugs to stimulate or suppress neurotransmitters in the brain would ideally provide patients with more relief of symptoms than adverse reactions.

Physicians who are thoroughly trained via board certification and specialized fellowship training in anti-aging and integrated medicine approach the symptoms of depression entirely differently. We take note and advocate learning better coping methods with job, financial, marital, parental and other stressors. We also review dietary factors and look for metabolic imbalances that can affect the major neurotransmitters associated with depression, such as serotonin, dopamine, and norepinephrine.

Among the many tools we use for reducing and eliminating depression symptoms, besides optimizing diet, detoxifying the intestines and liver, and using specific amino acids and herbs to help regulate imbalanced neurotransmitters, are bioidentical hormone replacement therapy (BHRT). Correctable hormonal causes of depression symptoms include inadequate adrenal regulation (often referred to as “adrenal fatigue”), progesterone deficiency in women, testosterone deficiency in both sexes, and estradiol deficiency. Depression may be associated with suboptimal thyroid status (often a failure to convert the less active thyroid hormone, T4, to the far more active thyroid hormone,T3).

The message of this blog is that all of these hormone deficiencies and metabolic imbalances can be improved with sensible treatment. If any one or a group of these conditions are improved, depression symptoms can abate, often completely and long term. Every month, in anti-aging and integrated medicine practices, patients are successful tapering off drugs they may be on for depression symptoms as their underlying deficiencies and imbalances are progressively corrected.
Results of these treatments can be seen in days to weeks.

Similar approaches are successful for treating fatigue, loss of stamina, insomnia and hundreds of other common complaints. The treatment plans are usually supported by clinical or experimental research augmented by the practitioner’s personal experience (there is no substitute for intuition).

So if an physician advises drug therapy for depression symptoms, think carefully, as there is no better advocate for your welfare than yourself. If the condition is severe and treatment is urgently needed, sometime antidepressants can be essential temporarily. Psychiatrists are best equipped to prescribe drugs in these situations. But if you are like most patients with less serious depression symptoms, you owe it to yourself to seek out medical care that addresses underlying reasons for your mood problems. Anti-aging and integrated medicine physicians have a vast toolbox to manage depression and other mood disorders. Our goal is to provide symptom relief, like drugs, but heal the body and brain at the same time, unlike drugs.

Be well!

Stephen A. Center, MD
BodyLogicMD of San Diego
Board certified and fellowship trained in Aging and Regenerative Medicine

Dr. Stephen Center | 2 comments | Tags: , , , ,
 

The information provided on this blog is for reference use only, and does not constitute the rendering of legal, financial or other professional advice or recommendations by the BodyLogicMD affiliated physician. This page is not for the use of diagnosing and/or treating medical issues.