Do hormones really affect women' mood?

In the past fifteen years the field of endocrinology has produced vast amounts of evidence showing that the loss of estrogen that occurs normally during menstrual cycle changes puts women at greater risk for mood, anxiety, and craving disorders. Considering the prevalence of these illnesses among women, we’re fortunate to be gaining a better understanding of them.

Women are more than twice as likely to become depressed. Research shows that they’re also more likely to suffer from anxiety. More develop phobias. It’s the same ratio for agoraphobia: nearly 8% of women become agoraphobic, compared to only 3% of men. More succumb to post traumatic stress syndrome. Seventy percent of those with social phobia are women. What could be happening here?

The cyclic nature of estrogen secretion may account for women’s special vulnerability to mood and anxiety disorders, Dr. Mary Seeman reported, in the Journal of the American Psychiatric Association, in an analysis of dozens of studies on how female hormones affect psychopathology in both men and women.

The theory of “recurrent estrogen withdrawal” proposes that a low estrogen state drives the onset, or worsening, of mood symptoms in women who are predisposed--by virtue of already low serotonin levels--to mood and anxiety disorders. In 1996, researchers at the University of Edinburgh published a report discussing the molecular level at which these changes occur. Struck by estrogen’s “profound effects on mood, mental state and memory” they described the hormone as “nature’s psychoprotectant.” Sufficient levels of estrogen must be present in the brain, that is, if psychic stability is to be maintained. Estrogen’s importance to cognitive processing and memory is not a slight matter. It’s been discovered that actually buffers the brain’s neurons against degeneration.

By the end of the nineties mounting evidence had begun to show a unique and persistent hormone connection to almost all mental illness in women. For example, binging and purging behaviors in bulimics worsened during the premenstruum, when estrogen levels go down. So did panic attacks in women with panic disorder. Impulse disorders, too, seemed to get worse during that week or ten days before the period begins--kleptomaniacs went on more stealing escapades, trichotillomaniacs pulled more hair, skin cutters cut more skin.. All of these illnesses are related to serotonin dysfunction, and, as we’ve seen, serotonin and estrogen are inextricably linked.

In the nineties a Canadian psychologist, Barbara Sherwin, was conducting very interesting studies on how estrogen loss affects cognition and memory. I went to Toronto to spend a day with Dr. Sherwin in her office at McGill University. I needed a mini-course in estrogen and she was willing to give it to me.

From early fetal life, hormone receptors are present in the hypothalamus of the brain. It is here that they begin organizing brain circuitry, setting the stage for puberty, regulating subsequent adult sexual behavior, and controlling the frequency and intensity of emotional disorders. Research in neuroendocrinology has much to tell us about the pre-menopausal malaise that used to be thought the result of women’s sadness over the loss of reproductive function. Now it’s known that the mood and cognitive changes experienced are physical in origin.

Low estrogen affects mood. What I hadn’t known, until speaking with Dr. Sherwin, is that in order to produce serotonin the brain needs estrogen. I didn’t even known that estrogen existed in the brain. “There are estrogen receptors in various organs throughout the body, the brain included,” she explained. “That’s why estrogen loss produces so many different bodily symptoms--loss of skin elasticity, bone shrinkage, mood and cognitive decline”.

When estrogen levels rise, on the other hand, as they do in the first week of menses, their overall effect is to increase the amount of serotonin available in the spaces between the brain’s nerve cells. That improves mood. Within the brain, estrogen may in fact act as a natural antidepressant and mood stabilizer.

Dr. Sherwin introduced me to the work of researchers who were doing important basic science, including Bruce McEwen at Rockefeller Institute, in New York, and Joseph LeDoux, at New York University, who were discovering the molecular changes supporting the view that estrogen had profound effects on the mind and its capacities.

It wasn’t long after my visit with Dr. Sherwin that I learned of an important review of ten years’ worth of studies entitled, Estrogen, Serotonin, and Mood Disturbance: Where is the Therapeutic Bridge? Two researchers in the Perinatal and Reproductive Psychiatry Program at Harvard Medical School had essentially been motivated by the same question that I had: What is the hormone connection to women’s mental health? Joffe and Cohen looked at a hundred-and-twenty five studies on the relationship between women’s reproductive cycle hormone changes and their mental status. In study after study they found that women with histories of depression are apparently more vulnerable to recurrent episodes during periods of “significant reproductive endocrine change”.

Correlation does not prove causality. The fact that someone becomes morbidly depressed exactly on the day ovulation begins and remains that way until the day she starts bleeding doesn’t prove that premenstrual drops in estrogen cause mood changes, but it damn well raised suspicions. Once information from new brain imaging techniques was added to the mix, the case for a hormone connection to women’s mental vulnerabilities became as close to an open and shut case as are you’re likely to get. Neuro-imaging has improved our understanding considerably, indicating lightening flashes of activity in different parts of the brain during what used to be called, dimly, “that time of the month.”

It is the dance between two kinds of hormones, ovarian hormones and brain hormones, that ultimately determines how symptomatic any given woman will become during her menstrual cycle, and at other reproductive risk points as well. If, for example, a woman is genetically coded to have low, or borderline levels of brain serotonin, the estrogen drop that occurs premenstrually may be all it takes to send her serotonin spiraling below the level of optimum functioning, putting her in a mental state that, for all its upsetting symptoms, mysteriously vanishes as soon as her period starts and her estrogen levels go back up.

Why does this happen? Because serotonin needs estrogen for its metabolization in the brain. The two hormones are a dynamic duo, functioning arm in arm. As estrogen levels drop, so does serotonin. When estrogen rises (as it does, for example, once menstruation begins) serotonin levels come right back up with it, and calm is restored. The ebb and flow of womens’ menstrual moods is orchestrated not by the moon but by secretions in her brain and ovaries. What we now know is that the sometimes negative outcome of these secretion changes is not inevitable. Just as science has learned to modify insulin changes and thyroid changes, it can now modify ovarian changes. If you don’t want to blame your mood on your ovaries, blame it on the brain. Blame it on whatever pleases you, just don’t resign yourself to the view that women were born to suffer.

To me it’s fascinating that the individual pieces of this important puzzle were not available to us twenty years ago. And the dynamite effect of putting those pieces together has occurred only in the last decade. Building on previous knowledge and assembling the picture step by step, endocrinologists at places like the Neuropsychiatric Institute in California, and the Reproductive Mood Disorder Program at the University of Texas Medical Center have come to understand that women are not only vulnerable during the premenstruum, they are vulnerable at all the reproductive risk points. Moreover, a woman who suffers at one of these risk points is vulnerable to becoming symptomatic at others. If she has genetically low serotonin in her brain, estrogen drops are going to affect her, simple as that.

Things have taken a more enlightened turn since then, thank God, but we are only now coming to understand what actually happens to women’s mental well-being at times of hormonal stress. Women scientists in particular, including psychiatrists and reproductive endocrinologists like Barbara Sherwin, are making a unique and important contribution to the massive surge of research that is currently shaping a whole new paradigm for understanding the role of hormonally created change in female well-being and mental status.

Commonly referred to as an individual’s emotional or psychological well-being, mental health is a term that has no one official definition according to the World Health Organization. Most experts believe that mental health is measured by an individual’s ability to remain capable and competent, handling normal levels of stress, maintaining happy and healthy relationships and his/her ability to lead an independent life. Another sign of mental health is being able to quickly recover from difficult situations, which may include both physical and emotional.

While individuals who have been diagnosed with a mental illness often require a greater need for mental health promotion, even those who have not been diagnosed still need a certain amount of the same. The truth is that everyone has mental health needs, including those who have no illness. Mental health promotion may be given in the way of encouragement, love, support, understanding, etc.

If an individual believes that he/she is suffering from a mental health illness, a psychiatrist should be consulted for a professional evaluation. In some cases, a regular discussion with a professional may be enough for individuals to overcome their issues and return to a positive mental health status. For others, medication may be required or even hospitalization in extreme cases. With the proper treatment, many individuals who suffer from some type of mental health illness can often live a happy and healthy lifestyle. The first part of overcoming any type of illness is to recognize the problem early, whether that recognition comes directly from the sufferer or from those closest to him/her.

It is important to realize the difference between a positive mental health status and one that may be indicative of an illness. Every life has stressful situations, tears that must be shed and boundaries that must be overcome. However, the best way to measure mental health is by assessing an individual’s ability to handle these situations appropriately. There is no one universal symptom or sign of a mental health illness, but is best described as an individual’s inability to operate or deal with everyday situations in a healthy and productive manner.

The information in this article is to be used for informational purposes only. It should not be used in place of, or in conjunction with, professional medical advice. Anyone with questions regarding mental health must consult their physician for further information, a diagnosis and/or treatment regimen if one is deemed necessary.

In a time when resources are scarce and problems are many, professionals are choosing evidence-based practices to improve outcomes related to services. Evidence is emerging that school-based mental health services are an effective and cost efficient way to improve school performance and mental health and reduce behavioral problems. To assess the effectiveness of school based mental health (SBMH) services to provide these outcomes in students from Pre-K - 12th grades, Robert Schmidt, M.Ed. and Kathryn Seifert, Ph.D. collaborated on the evaluation of outcomes for a SBMH program for a mid-Atlantic rural school district.

The project began in 1999 after a Federal grant was awarded to the school district. The children’s scores on the Devereaux, BASC, CARE and several school measures such as absenteeism, disciplinary referrals, and suspensions were measured from the beginning of services and at the beginning and end of each school year. Youth were referred to the project from teachers, guidance counselors, parents, student self-referrals and other agencies such as the Departments of Social Services and Juvenile Services of which resulted in 1,247 SBMH referrals during a five-year period.

From 1999 to 2004, 36% of these students were referred because of symptoms of depression, 26% because of family problems, and 24% because of behavior problems. There were 84 referrals to the program in 1999, compared to 437 students in 2002 and 239 students in 2003. Peak referral times were consistently observed during the months of October and February. Youth in the transition years of sixth and ninth grades were referred to the program most often. More Caucasian females participated in the project than any other ethnic/gender group. In 2000, 2,132 mental health sessions were provided, in contrast to an amazing 15,763 sessions during the 2003/04 school year.

A group of one hundred thirty-two students who participated in the program showed significantly improved attitudes toward teachers and school, decreased mental health symptoms, and increased self-esteem after one year of services. From the 2001 to the 2002 school year, students participating in SBMH had significantly improved school attendance (from approximately 4600 to 4200 days absent). One hundred seventy-eight students had a significant (49%) decrease in disciplinary referrals and violence related disciplinary referrals from the 2001 to the 2002 school year. One hundred thirty-four participants had a significant decrease (54%) in suspensions from school. Parents of 103 students reported that their children were having significantly fewer problems after receiving services. Ninety-nine youth self-reported significantly improved commitment to school, interpersonal relationships and self-esteem, as well as fewer stress related problems. Two hundred fifty students reported significantly reduced school maladjustment and clinical maladjustment and improved attitudes toward parents and emotional well-being.

This project demonstrated that school based mental health services improved student well-being, behavior and school success, while showing a significant decrease in the initial presenting mental health symptoms, violence and other behavior problems at home and at school. Although these services and study enter into it’s sixth year and is on-going, other school-based mental health services must be provided, expanded, and studied. This project provides a framework for improved student health/success and decreased school violence while positively enhancing the community of which we live, work and play.

You feel like you've known each other all your lives even though you've only known each other a few months or years, maybe even just a couple of weeks. You look into each others eyes and see kismet or fate. All starry eyed and dreamy you start planning for happily ever after.

Ok maybe you aren't just being starry eyed. Maybe you have been living together for a while and truly believe it is time to make the union a legal and formal bond. That is absolutely wonderful! No matter what anyone says, there is something special about being married to each other and not just living together.

Now, in some countries the government will not require the couple to undergo any marriage seminars. In most religions and in countries that do not have divorce however marriage counseling is actually mandatory before couples can get married. After all in these countries or faiths, marriage truly is meant to be for life. That being the case, everyone wants to make sure that the pair goes in with their eyes wide open and not covered by rose colored glasses.

Marriage is no joke. It can be fun, exciting, sweet, passionate and absolutely wonderful. It can also be a lot of work. Keep in mind that you are adjusting your life to another person's; someone who you love but is still different from you in a number of ways. Marriage can be a rude awakening for some. It isn't only about the gown and the ceremony and saying, "I do".

Face it folks, we don't always, in fact more often than not, we don't listen to our parents. They may or may not be good examples of how marriages work. They may or may not be together so you may not have a real picture of what is involved, just the glamorized ideal that movies and books show to the general public.

There are organizations like Worldwide Marriage Encounter (WME) that try to give couples a real look at being married. They have special courses such as the evenings for the engaged where a couple meets regularly with an affianced pair in the WME or "encountered" couples home. The WME couple will discuss various things that the affianced pair may or may not have thought about yet. For example, what is the significance of money in the relationship? Is money supposed to be pooled and shared or should it be only the male's income that is spent since he is the breadwinner or head of the family?

How about work? Should the wife continue to work if the husband is earning well enough to support them both? Would they prefer that she stay home and become mother and wife full time? Why?

These questions may seem trivial to some but in the long run, these can be major issues that can lead to separation or divorce. It is best to discuss these matters before any vows are made not after. It can save you a lot of heartache. Why not find out what are the available marriage counseling groups in your area? What have you got to lose? They may even help to make your good relationship great.

Mental health is simply the state of successful performance of all our mental functions. This is difficult to describe but when one is mentally healthy one is able to perform there day to day activities successfully and is able to manage healthy inter personal relationship, be able to cope with change and handle diversity. While in our normal day to day life we do not observe what mental health is all about it, we only get curious about it once we notice something is wrong or the absence of good mental health and even then most of the times we choose to ignore it.

Good mental health is something that has been ignored by most of us, while we do notice a slight headache we ignore to recognize sudden mood swings, low tolerance levels, being gloomy and blue all the time as a sign that something may be wrong with our mental health. More people worldwide suffer from mental illness than is ever understood, in the United States alone every year around 6% of the population goes through some form or the other of depression and depression is just one of the many mental disorders that exist. Most of the times our failure to recognize this stems from being unaware or being ashamed of admitting that “something is wrong with my mind”.

Is Mental Health separable from physical health?

While popularly it is thought that mental and physical health are separate in most cases one’s mental illness is caused by some physiological changes in the body and indeed many cases of depression in women are caused in and around the time of menopause or in men when they are going through nights when they don’t get enough sleeps because of work pressures. The body goes through stress and is fatigued by it and because of that the mind also reacts to it and develops some sort of disorder. The other way round is more obvious and when the mental health of people deteriorates the body takes its toll and that is more visible. What this essentially means is taking care of ourselves physically is also an important aspect of maintaining our mental health.

Public Attitude about Mental Health and Illness

Even in developed societies like the United States where there are a large number of information sources and any one can just go to the internet and take self diagnostic tests to see whether they are suffering from any form of mental disorder a large number of cases go unreported. This is because of the public opinion that mental health is a given and there is some degree of stigma associated with the fact that a person’s mental health is suffering from one reason or the other.

People suffering from one type of disorder therefore will go through a long phase of denial where in they will refuse to acknowledge that something seems to be out of ordinary. This will translate into the patients developing multiple disorders which will become more difficult to cure or even diagnose. It will also result in the disorder getting deeper entrenched and will make it that much more difficult to cure it as well.

Use the Internet

Awareness is the key to fight mental illness, awareness about the fact that more people than you can imagine suffer from it in some point or the other in their lives and awareness about the fact that once diagnosed it can be easily treated through a combination of talk therapy and medication. Internet is a good source of information and you should learn to leverage it to your best use. The first step is to understand what changes in behavior are you experiencing which is possible to do for most people in the early stages. The next step after making a list of symptoms is to take a few self diagnostic tests which you can do anonymously and see where it takes you. There are a host of mental disorders and chances are that after taking a few of these tests you would be led to specifically one or the other. Then you can do more in depth study about it and even if you think it not necessary visit a doctor at least once to double check whether you are suffering from that particular disorder, something else or it was just a false alarm.