The Connection Between Hormones and Depression
Q: My wife is 37 years old and has started
to slip into depression. She cries and gets anxious, also hides away from her friends and
cannot see her way out of it. My worry is: She is being treated for anxiety and I fear she
is still slipping. We are both desperate for an answer to her problem. Her period has been
irregular recently and I wondered if this could be hormonal and whether HRT would help.
A: As painful as this
must be for both of you now, your wife has at least two important things in her favor. She
has sought help, and she has the support of a significant loved one you.
the most common serious psychiatric problem, affects nearly 20 million Americans every
year. The majority never seek help, which is a shame because 80 percent to 90 percent of
people with depressive illness get better with treatment, whether that's medication,
psychotherapy or a combination.
One in four women is likely to experience severe
depression, according to the American Psychological Association, and it's about twice as
common in women as men. While experts debate just why that is, they suspect it's caused by
a combination of biological, psychological and social factors that play out differently in
men's and women's lives.
mention what sort of treatment your wife is receiving, nor how long she's been treated and
by whom. But it sounds like time for a re-evaluation and perhaps a second opinion. A
complete and careful history by a mental health professional is critical for proper
diagnosis and treatment. "It's very multifactorial, what goes into creating
depression," says Dr. Marlene Casiano, a psychiatrist in private practice near
Chicago. "You have to really look at a lot of different things."
As your question suggests, it's important to rule out
potential underlying physical causes. Thyroid imbalance, crash diets, certain cold and
allergy drugs, high blood-pressure medications, herbal remedies and, yes, hormones are
among the things that can contribute to mood swings and depression. But it's important not
to jump to conclusions about causes and effects.
Theres still a stigma attached to having a diagnosis of
depression, Dr. Casiano says, and people have a tendency to want to attribute it to
things like hormonal changes.
But even if a contributing medical condition is
discovered and treated, "You still do have to treat the depression itself," she
At 37, your wife is younger than average for
perimenopause, but it's possible. Her irregular periods could be the result of
perimenopause, or of the depression. "When people are depressed they're real stressed
and that could throw off their periods, too," Dr. Casiano says. Your wife could ask
her mom at what age she reached perimenopause, and blood tests of her hormone levels could
help clarify the picture. If she's perimenopausal, hormone therapy might help some but,
"That probably would not be enough if she has the full criteria for depression,"
Dr. Casiano says.
us back to the importance of proper diagnosis and treatment. Depression and anxiety often
coexist, but anxiety has more outward, physical symptoms such as heart-pounding panic
attacks and insomnia. A family doctor may see just that part of it and not ask further
questions designed to reveal depression. The problem is that sleeping pills, tranquilizers
and other anti-anxiety drugs can make depression worse.
patients, if they want to start out with a family doctor because they have a lot of faith,
that's fine," Dr. Casiano says. "But if they don't see improvement within a
month, they really, really should see a specialist."
Any doctor can prescribe antidepressants and other
psycho-active drugs. As long as they truly understand the psychopharmacology of what
they're prescribing, that's fine. "Modern drugs are getting more complex in terms of
drug interactions and which types are most appropriate for which individuals," Dr.
Casiano says. "If you don't do well on one drug, there are plenty of others out there
that we could try you on."
to remember that many antidepressants don't take effect for a few weeks. Sometimes the
depressed person doesn't notice, and loved ones may see slight improvements first. No one
should go off these drugs without discussing it with their doctor. The usual advice is to
wait several months after feeling better before tapering off. Slow tapering is important
to avoid side effects and return of depressive symptoms.
may be shy about discussing their life with a stranger or simply don't want to pursue
therapy into personal issues, and settle for a prescription. But generally, most people do
better with combination therapy, Dr. Casiano says. During "talk" therapy, people
can learn to change or at least recognize triggering situations and destructive thought
patterns that contribute to depression. With psychotherapy, recovery is often quicker and
relapses fewer or at least caught earlier on. That's important, because as with
other types of illness, the earlier you catch and treat depression, quite often, the
quicker the recovery.
Its such a waste of human
potential, Dr. Casiano says, Sometimes people feel this is how life is going
to be and its not really true once theyve seen better.
She works with women suffering postpartum
depression who often look back and regret delaying treatment because their mental state
made them miss the first precious, fleeting months of their babies' lives. And there's
some evidence that the babies of depressed mothers don't do as well, and even experience
The point is not to load yet more guilt on already
overburdened new moms or anyone else. The point is to encourage people to get help as soon
as possible to minimize any negative consequences in their lives and relationships.
Living with a
depressed person can be difficult as you tiptoe on eggshells wondering what to say or do,
desperately hoping not to make things worse. Gently ask your wife how she feels. Find out
what you can do around the house to lighten her load until she feels better. Cultivate
your listening skills, and resist the urge to jump into active problem-solving. Recovery
takes time and pressuring the person doesn't help. Meanwhile make sure your needs, and the
needs of other family members, are getting met. Remember that with proper treatment people
can and do get better.