Hormones are substances produced and released by glands in the body, e.g. thyroid hormone (thyroxin) from the thyroid gland in the neck. Such substances generally have their own specific physical effects, but because they enter the blood stream, they also go to the brain, and there they frequently have other effects. A number of these brain-active hormones are believed to influence mood and be involved in causing depression and other altered mood states.
Other hormones thought to be involved in mood regulation include thyroxin (from the thyroid), growth hormone (from the pituitary-a gland that is attached to the base of the brain), male and female sex hormones (such as testosterone and estrogen), and melatonin, from the pineal gland in the brain.. back to top
When is hormonal therapy used?
Hormone therapy is usually used in diseases in which a person is not producing enough of a particular hormone to maintain healthy body function.
At times, a person may not be able to produce any of a certain hormone at all. The endocrine system has been recognized for many years as being important in the development of mental illness. Freud and Kraepelin, both famous figures in the history of current understanding and treatment of mental illness, noted the probable importance of the endocrine system and its role in the causation of mental illness. Before them, Hippocrates (460-377BC) had written about his views that a woman was dominated emotionally by her uterus and her menstrual cycle, and that pathology of the uterus might be the cause of some forms of mental illness.
This idea has been altered by the modern day understanding of science and anatomy, but researchers today continue to be aware that the endocrine system does play a part in the production of altered mood states and with further studies there is hope that there will emerge new ways to treat both depression and other disorders.
Post-natal depression
Studies in women suffering from post-natal depression have found that very high doses of estrogen seem to be just as effective as an anti-depressant as orthodox anti-depressant drugs. However, such high doses of estrogen may have dangerous side effects if used on a routine basis and are, therefore, not considered practical as a treatment for depressive illness. However, this is a rapidly developing area of research which is likely to add greatly to the knowledge base in the near future.
Premenstrual Dysphoric Disorder (PDD)
This is a disorder which is characterized by recurrent physical and emotional symptoms that occur in the last week of the menstrual cycle and remit within a day or two of the onset of menstruation.
The diagnosis is difficult to make because of the normal variation of symptoms experienced during this time and the poor reliability of retrospective reports. The diagnosis is normally made after prospective ratings of mood and related symptoms produce positive results over at least two consecutive menstrual cycles.
About 5% of all women meet the criteria for having this disorder, which must be of an intensity and severity sufficient to cause defined levels of impairment in normal functioning. If such symptoms became worse on starting the oral contraceptive pill, a change in the type of pill may be useful.
Hormonal strategies have been used as a treatment for these pre-menstrual syndromes because of the view that the symptoms are caused by endocrine changes. Progesterone levels in the blood drop in the second half of the menstrual cycle (called the luteal phase) and this hormone been proposed as the main culprit. However, rigorous studies based on treatment outcomes have not supported the use of progesterone replacements as an effective treatment.
Hormonal treatments are not considered to be first line treatments for the Premenstrual Dysphoric Syndrome (PDD). Selective serotonin reuptake inhibitor type antidepressants (SSRIs) can be useful for PDD and are usually taken throughout the cycle although some studies report that the use of fluoxetine solely for days 12-14 of the cycle may also be helpful.
Oral contraceptive pill (OCP) and mood changes A link has been made between the OCP and disturbances of mood. Many of these original studies, however, were carried out with high dose estrogen pills which are no longer in use. In women with a past history of either premenstrual mood changes or of major depression, there has been reports of a recurrence of depression after commencing on the OCP. At the same time there are also reports of women whose mood has been improved by using the OCP.
It is good practice to pay particular attention to a history of any previous mood disturbance before starting on this form of contraception.
Men
Depression in the older man It is normal in men that, once they reach a certain age, levels of testosterone decrease. However for about 20% of men over 60 years of age this drop in testosterone is much greater than expected. The psychiatric consequences of this process are not well understood. Nevertheless research has been undertaken to investigate levels of testosterone in men who develop major depressive illness, and also to study the role of treatment with androgens (male type hormones).
It has been found that in men with low testosterone levels, who also suffer from a depressive illness, treatment with testosterone may have some benefit.
Depression in women treated for breast cancer
The management of breast cancer uses hormonal manipulation as a key part of various treatment strategies. The impact on a woman of the diagnosis and treatment of breast cancer is known to increase the risk of that woman developing depressive illness, sometimes severely.
There has also been concern about the consequences of inhibition of physiological estrogen resulting from the adverse influence of chemotherapy on the ovaries of pre-menopausal women, and also from the anti-estrogen effects of the medication, Tamoxifen (an anti-cancer medication used in post-menopausal women) and its impact on mood.
In certain prospective studies Tamoxifen has been shown to increase the risk of significant depression in such cancer patients. The depressive symptoms emerged in temporal relationship to the use of Tamoxifen and appeared to remit 2-4 weeks after the treatment with the drug was ceased.
The use of estrogen to manage such deficiency states is highly controversial as it may promote the growth of cancer cells. However, it does augment serotonin and nor-epinephrine activity in postmenopausal women and by doing so may decrease their vulnerability to the development of depression during treatment. Since depressive illness can also kill, and is thought by some to worsen the prognosis of cancer, the matter is not one that can be readily resolved.
