Hormones and depression - estrogen and PMDD/postnatal depression, implications for other types of depression
So if "antidepressants" aren't nearly as effective as we'd like, what should we do? Environmental changes and empathetic care by fellow humans are well and good, and should work for many of us, but they aren't nearly as available as they should be. Is there no sustainable medical intervention, which can reliably help us while not making us worse in long term, which is supported by sound theoretical basis and sound research?
I think that there just might be such an intervention which might be effective for many of us. Maybe even for majority. You guessed it, it's hormonal replacement therapies for depression.
I'll publish series of posts regarding some findings about hormones and depression. Some of this is preliminary, but on the whole it looks very compelling to me.
When going through adversity in life, only some people become depressed, others are more resilient. Is it possible to boost this resiliency? I'll start the conclusion right away: We know that hormones regulate our brain, and alter reactions to stress response. By manipulating hormonal levels, it should be possible to alter our stress response, increase resiliency, and thus fix many types of depression.
Of course hormones are being regulated by the brain in turn, but I'll leave discussion about that for another time. If we are talking about medical interventions for depression, and any kind of chemical imbalance, if there is a holy grail - this is as close as it gets according to my understanding.
For now, let's talk about types of depression which seem respond extremely to hormonal treatments, PMDD and postnatal depression. Here is something very important:
Postnatal depression is not more common after a long labour, difficult labour, caesarean section, separation from the baby after birth, nor is it determined by education or socio-economic group. The only environmental factor which seems to be important is the perceived amount of support given by the partner. There is no doubt that the first 6 or more months after delivery can be an exhausting time, full of anxiety and insecurity in mothers with the new responsibility of the baby. Even allowing for that, there does seem to be a clear hormonal aspect to this condition.
This provides some support for the idea that hormones modify our reaction to external events. Hormonal treatment in such cases is very effective.
We studied the effect of high dose transdermal oestrogens in this condition in an attempt to close the circle of studies treating this triad of hormone responsive depressions - premenstrual depression climacteric depression and postnatal depression. This was a double blind placebo controlled trial of 60 women with major depression which began within 3 months of childbirth and persisted for up to 18 months postnatally.(24) They had all been resistant to antidepressants and the diagnosis of postnatal depression was made by two psychiatrists who are expert in the field. We excluded breast feeding women from the study. They were given either placebo patches or transdermal oestradiol patches 200 mcgs daily for 3 months without any added progestogen. After 3 months, cyclical Duphaston 10 mgs daily was added for 12 days each month. The women were assessed monthly be a self-rating of depressive symptoms on the Edinburgh postnatal depression score, "EPDS" and by clinical psychiatric interview. Both groups were severely depressed with a mean EPDS score of 21.8 before treatment. During the first month of therapy the women who received oestrogen improved rapidly and to a greater extent than controls. None of the other factors, age, psychiatric, obstetric or gynaecological history, severity and duration of current episode of depression and concurrent antidepressant medication influenced the response to treatment.
The study showed that the mean EPDS score was less with the active group at one month and then maintained for eight months and that the percentage with EPDS scores over 14, (diagnostic of postnatal depression) was reduced by 50% at one month and 90% at 5 months. This was much better than the placebo response.
This is from an article about this by John Studd, https://en.wikipedia.org/wiki/John_Studd_(gynaecologist), who is involved in research about hormonal treatment for a long time now. Here is a full article: http://www.studd.co.uk/dep_women.php.
Next I'm going to publish series of studies from Finland which look as compelling, and then provide some information we have on effects of estrogen on the brain, and some guesses on why it can be so effective and why it might be important in other types of depression as well. I also think that testosterone replacement therapy, which some males anecdotally find extremely effective for their depression, might work because it increases estrogen levels along with testosterone levels.
In general, lots of things are going on with hormones and depression, and there isn't as much research into this as indicated by lots of preliminary studies for many conditions (depression, psychosis, even schizophrenia and bipolar disorder). This should be in large part simply because hormones are bioidentical, and thus not patentable. It's not as profitable to research this as it is to research drugs. Apart from that, there is tunnel vision of many of psychiatric researchers, which "default" to the brain-altering drugs. On the other hand, endocrinologists aren't feeling comfortable dealing with "mental illness". This arbitrary separation of endocrinology and psychiatry makes great disservice to all of us.
Is it a magic bullet and is it as easy for many depressed people as boosting some hormonal levels? I don't know. There probably are other things going on, like natural cyclical changes in hormonal levels. For many people it's not probably as simple as bump some particular hormone. For many others though it just might be. I believe that already existing research tells that hormonal interventions for depression for depression and other disorders like bipolar, OCD, and even schizophrenia, can achieve good results in many people, and will publish some of it here. Stay tuned.
Comments
Post a Comment