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Hormonal Imbalances and Depression

Endocrine Disorders can affect your mental health

With Patricia Celan MD and Cory Rice DO 

When something is out of balance with your hormones, it has an affect on the whole system, which means you're going to feel it manifest in both your body and mind.

 

Living with an endocrine disorder — such as hypothyroidism, Addison's disease, or acromegaly (a dysfunction of the pituitary gland) — means dealing with physical issues as well as possible cognitive and mental health issues.

You might have noticed that your hypothyroidism comes with the frustrating side effect of a depressed mood, or that your adrenal disorder triggers anxiety, agitation, or an inability to focus. It’s unfortunately not uncommon, but being aware of how it all fits together and what you can do to manage it is key.

How your hormones can impact your mental health

More research is needed around how hormones and mental health are connected, but experts say there is definitely an interaction between hormones and well-being. Here’s what we know: Your endocrine system works in tandem with your nervous system — known as the hypothalamic-pituitary system — to maintain a sense of homeostasis, or physiological equilibrium. This equilibrium is what the body wants, but when it’s not achieved, a lot can go wrong.

When something is out of balance with your hormones it has an effect on the whole system, which means you’re going to feel it manifest both in your body and your mind.

Ready for a deeper dive? According to Dr. Cory Rice, internist and certified BioTE practitioner, “The major endocrine glands in humans are the thyroid gland and the adrenal glands. If this chemical messaging system or the hormone feedback loops are negatively compromised in any way, this can have profound effects on someone’s health, particularly as it relates to their mental health.”

For example, he says, the thyroid gland is the “master gland” of our endocrine system. It’s responsible for producing the hormones T3 and T4, and it’s T3 that has a major role in one’s mental health. “Many of the T3 receptors in our body are concentrated in our brain. So if we have a thyroid gland that is underperforming (not making enough T4 and/or T3), there is not enough thyroid hormone getting to the brain. This can, and oftentimes will, lead to increased rates of depression or anxiety or other mental health issues.”

For example, patients with hyperthyroidism and hypothyroidism can experience erratic and unpredictable mental states. Commonly reported are anxiety, brain fog, mania, lethargy, depressive mood, and confusion.

Dr. Rice also explains that the adrenal glands help to regulate our internal stress response.“If someone has physical, mental, or any other personal stress in their life, their adrenal glands may not function appropriately,” he says. “Stress is very common for a lot of people. Some stress is good for us, but if certain types of stress persist for too long, this can have dramatic, detrimental effects on someone’s health.”

One of the hormones responsible for how we experience and manage stress? Cortisol. “If a person has consistent, uncontrolled stress, it will compromise their ability to produce and use their cortisol,” Dr. Rice says. “If this happens, they will oftentimes get very fatigued and gain weight — among other problems. This can also lead to mood disorders such as depression, apathy, and anxiety.”

Dr. Patricia Celan says, “Excessive cortisol can actually reduce activity of the hypothalamus, resulting in imbalances of chemical messengers affecting sleep, eating, sex, cognition, and more; all of which can mimic or contribute to a disorder such as depression.” This can be seen in disorders like Cushing’s disease.

Inflammation can also play a role in mental health

Another possible culprit? Inflammation, according to Dr. Kelly Bay, DC, CNS, CDN. Dr. Bay says that autoimmune reactions against the thyroid and abnormal thyroid hormones could increase inflammation throughout the body, which could then lead to cognitive and emotional health issues as well.

We know this, she says, because “markers of increased inflammation, particularly brain inflammation, are common among those diagnosed with major depressive disorder, anxiety, and other mental health conditions.” For this reason, some doctors prescribe anti-inflammatory treatments for patients with depression.

Make sure to speak with your doctor about all of your physical and mental health symptoms

Because the mind and body are so linked, it’s important to work with your healthcare provider to take a holistic, systemic approach to assessing both your physical and mental health symptoms.

If you have or suspect you have an endocrine issue and are experiencing mental health symptoms, such as sudden feelings of anxiety or depression, or cognitive issues, such as trouble with focus or memory, Dr. Rice stresses the importance of working with a medical professional to test your hormone levels and adrenal responses before being prescribed antidepressants or antianxiety meds. This will help them determine the appropriate treatment. What may seem like depression might actually be successfully treated by thyroid medication before antidepressants, for example.

It’s also very possible that your mental health symptoms predated or existed alongside any sort of endocrine issues. It is a wise idea to connect your healthcare provider to your therapist or counselor. If you are thinking of speaking to a psychiatrist, it’s smart to let them know what sort of physical health conditions, such as an endocrine disorder, you have or are being tested for.

Adopt holistic, healthy lifestyle habits that can help support mental health

In addition to speaking with your healthcare providers about your physical and mental health — and any medications you’ll need to take or adjust — you’ll want to invest in healthy lifestyle habits that can help support your mental health.

For example, if you’re tired all the time and can’t work out or engage in the activities you love, your mood will take a hit, leading to depression, which leads to more fatigue. This cycle can be broken by embracing daily stress-management techniques that tell your nervous system to put the break on that all-consuming fight-or-flight mode.

Dr. Rice emphasizes a few key things that, over time, may contribute to better mental and cognitive health. These include good sleeping habits, smart lifestyle choices (avoiding alcohol as a stress-relief tool, for example, since alcohol can increase inflammation and is a depressant), and increasing exercise. “This can have a profound effect on mental health and, in many cases, can correct depression, anxiety, or other mental health issues,” he says.

Some ideas for stress-relief include:

  • Daily deep-breathing exercises, like breathing in for five seconds, holding your breath for five seconds, and breathing out for five seconds
  • Creating a pre-bedtime self-care ritual
  • Making sure to get some form of movement each day
  • Spending time in nature simply walking or meditating
  • Journaling (or simply listing) your worries and anxieties
  • Meditating with an app like Breath, Calm, or Headspace, or with free meditation videos accessible on YouTube 
  • Simply sitting still for a few minutes and focusing on your breath
  • Turning to art or dance for stress-relief
  • Embracing yoga or tai chi before bed or when you wake up
  • Integrating short stress-relief activities throughout your day

Dr. Nicole Arzt, MS, licensed therapist, also recommends joining a support group. “A support group shows you that you're not alone, and that others have experienced similar struggles and can provide insight,” she says. Facebook, for example, is home to several patient-run groups dedicated to providing a platform for people going through similar health problems. Additionally, seeking a therapist, if you don’t have one, is a good idea, she says.

Be sure to have your hormone levels regularly checked and take your medication as prescribed

If you already have a diagnosed endocrine disorder, you can help to prevent psychological issues by always taking medication as prescribed.

Dr. Celan says you’ll want to keep track of new and worsening changes in mood, sleep, enjoyment, energy, concentration, and appetite, as they may be a sign of the endocrine disorder changing and needing subsequent medication tweaking. You’ll want to be open and honest with your doctors about when symptoms began, the context in which they exist, and what those symptoms look like.

On the other hand, Dr. Celan says, “If you do not have an endocrine disorder diagnosed, when getting assessed for a new psychological problem, check if your doctor will also be looking at your hormone levels to assess for possible endocrine causes.”

Create a symptom diary or jot down some information to pass to your healthcare providers 

Some notes to make may include:

  • When any mental health issues began occurring
  • What those mental health issues are
  • Any external or life triggers, such as a new job, a loss of job, or a move
  • If the mental health issues occurred after diagnosis for an endocrine disorder
  • If you are taking any new medication and how long you’ve been taking it
  • Any sort of physical symptoms you might have, such as fatigue, skin issues, weight gain, or hair thinning
  • Any history of endocrine issues in your family

Reduce your inflammation levels

Dr. Kelly says that anti-inflammatory diets and nutritional therapies have also been effective when it comes to addressing inflammation that might lead to depressive or anxious mood issues.

“Studies have also shown that stress-induced inflammation can be addressed by stress reduction techniques such as breathing exercises and meditation,” she says. “These are all conservative, safe, and effective approaches to improve depression and anxiety in those with endocrine disorders.”

In the end, the mind and body are interconnected. Rather than thinking of them as separate, which they’re not, it’s smart to think of them as one machine with many moving parts. For this reason, be sure to advocate for yourself with your healthcare providers and ask for a systemic examination of your issues.

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American Thyroid Association Guideline: Treatment of Hospitalized Patients with Hypothyroidism and Use of Thyroid Hormone Analogs
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