Hormone Treatments for Mood Disorders

HORMONE TREATMENTS FOR MOOD DISORDERS
Strictly speaking, hormones (especially thyroid and estrogen) are not mood stabilizers, but, in my experience, need to be addressed first in all mood disorders.
THYROID
The thyroid hormone T4 (Synthroid) helps to stabilize mood, but needs to be in the upper 1/4th of the normal range. Another thyroid hormone, T3 (Cytomel), acts more like an antidepressant. Thyrolar and Armour thyroid provide T4 + T3.
TESTOSTERONE
In men with depression and low testosterone – supplemental replacement hormone has anti-depressant effects. Unfortunately, oral testosterone is not effective in men. Injections are a hassle. Patches and gels are expensive and frequently not covered by insurance.
DHEA
A recent study found that supplemental DHEA, which is an inexpensive over-the-counter, may help depression. It is a normal hormone that slowly declines in both men and women. It turns into partly estrogen, partly testosterone.
ESTROGEN & PROGESTRONE
I have treated many women over the years that were perimenopausal or menopausal in whom I was not able to control their depression or mood swings without supplemental estrogen. There is confusion and controversy regarding the use of hormone replacement therapy (HRT) in menopausal women. Each study seems to contradict the one before.
The confusion is due to multiple factors – usually not addressed in the studies. The simplest factor is dosage – lower doses are probably effective and don’t have significant risk issues. Menopausal women who still have their uterus have to take progesterone if they take estrogen. Progesterone takes away from the estrogen benefits in the brain (mood, memory, verbal, fluency). It also makes a difference what kind of progesterone is taken – synthetics (Provera and others) or natural (prometrium and others). More important is how progesterone is provided. Intra-uterine or intra-vaginal probably does not interfere with brain benefits of estrogen.
Another factor is what type of estrogen and how it’s taken. Conjugated estrogens (Premarin and Cenestin), containing many of the different types of estrogen, can probably be taken by mouth without causing possible reductions of many hormones.
Taking Estradiol (the most active form of estrogen) by mouth (Estrace, Estradiol, most birth control pills) causes the liver to make more binding proteins for thyroid, testosterone and the Estradiol itself. This reduces the effect of each of these unless the woman compensates by making a lot more of this hormone. Each woman is different, but I have seen many patients where the oral Estradiol causes low effective hormone levels.
Then there are the studies that scare women away from HRT. These studies usually focus on a small subgroup of women and aren’t relevant to the average woman.