To meet the psychiatric criteria for the diagnosis of depression patients need to have 5 of the following symptoms for at least a 2 week period: Depressed mood most of the day, insomnia, fatigue, diminished ability to concentrate, diminished interest in activities that normally make them happy, agitation, feelings of worthlessness, significant weight loss without dieting, thoughts of death. Interestingly I see many of these symptoms in men and women with hormone imbalance as a result of menopause, perimenopause and andropause. When we treat them with hormone optimization many of these exact symptoms vanish. Obviously there are thousands of cases where depression is related to imbalances of neurotransmitters in the brain and are treated very effectively with traditional anti-depressants. However, I believe there is a high proportion of depressed patients who are symptomatic because of hormone imbalance. I will explain an alternative explanation for what is depression.
1. What are the main hormones that effect mood?
In both men and women the number one hormone that I see effects mood is thyroid. One of the main symptoms of sub-optimal thyroid is depression. However this is often missed by most doctors because the only look at the TSH (thyroid stimulating hormone) level and fail to look at free levels of T4 and T3 (active thyroid hormone). In younger patients the normal range for free T3 is 2.5 – 5.2 and as we age that range drops to 2.0 – 4.0. Many times patients who are euthyroid (meaning levels in the normal range) will respond extraordinarily well to thyroid replacement (T4 and T3). I have personally seen patient with free T3 in the 3.0 and less range who are very depressed, fatigued and have lost interest in daily activities experience near total relief of all their symptoms with supplemental thyroid. Many good psychiatrists also understand that in order for anti-depressant medications to get into the brain and work effectively, you need optimal levels of both T4 and T3. Here is a video from Good Morning America discussing thyroid and mood: https://www.youtube.com/watch?v=dKxPVrnswtU
2. What other hormones affect mood?
In men without question suboptimal levels of testosterone can cause depression, fatigue, lack of concentration and agitation. I have seen countless men in my office with testosterone levels ranging anywhere from 150-650 (normal range 348-1197) with many of these symptoms who respond amazingly well when you put them on testosterone. When I speak with these men, much of their depression if tied to decrease sexual performance with their spouse or significant other. Within weeks of injecting or using a testosterone cream their sexual function improves and their mood is fantastic. It has been my experience that because doctors have so little time to see patients they often fail to dig into a mans sexual history and miss the boat completely. Or if they do their response is simply “well your just getting old so get used to it.”
In women I have seen estradiol, progesterone and DHEA work wonders for improving mood. Some women are depressed because they suffer from insomnia and simply are not well rested. When you give them progesterone they start sleeping amazingly well and viola their mood improves. There is no question about the positive effect that DHEA and estradiol have on the brain. Ask 10 women going through menopause who have been treated with bio-identical hormones what the effect of estradiol, progesterone and DHEA had on their mood. It really is undeniable and there is nothing more rewarding than giving a women her life back with this simple treatment.
3. What about diet and depression and mood?
If you are reading this right now and suffering from depression I want to challenge you to make one dietary change over the next 90 days: completely remove all refined and processed sugar from your diet. The effect that sugar has on the brain is undeniable and the link is as simple as high insulin bottoms out serotonin levels in the brain which ultimately affects mood. When you cut out foods with refined sugar you also cut out the majority of other poisons that accompany sugar in processed and junk food. And even though the FDA says each individual ingredient is safe, they can not tell you that if they put five or more of those ingredients in the same food if combined they are safe. Here is a link to why antidepressants don’t work for many patients in life extension: http://blog.lifeextension.com/search?q=depression&submit=Go
Lastly, in almost every study that looks at exercise and its effect on mood, the conclusions are that exercise reduces depression more effectively than any medication. So in addition to cutting out sugar, get moving! Obviously patients will depression will often say “if I only had more energy I would get out of the house and exercise”. My response to that is go back and read #1 and #2 above.
To summarize, this blog is to give patients and clinicians a different thought process to evaluating and treating depression. Many times depression is really suboptimal thyroid, testosterone, estradiol and progesterone and until you treat these hormone imbalances patients will never feel better no matter how many anti-depressants they take. Lastly, do not underestimate the power of diet and exercise on mood. I can attest to the fact that if I go more than 2 consecutive days without exercising my mood changes dramatically (I get super irritable).
If you would like to speak to me about your symptoms please feel free to visit my website at www.DoctorBreen.com and give my office a call. I will look at all your hormone levels and figure out your nutritional status and give you a roadmap to recovery.