Political controversies often use the suffix “gate“ to embellish their significance. In pop psychology, the equivalent is the made-up “syndrome”, which involves a combination of symptoms and circumstances to explain behaviours and reactions.
The latest is “rushing women’s syndrome”, which former swimmer Lisa Curry used to explain her hormonal shifts leading to her divorce.
But while this syndrome is not a medical diagnosis, Curry is right to point out a link between hormones and mental health. Mental illnesses are due to a combination of biological, psychological and social factors. And women are twice as likely as men to experience mental illnesses such as depression and anxiety disorders.
Women have biological hormone shifts on a cyclical basis and these hormonal shifts have been linked with mood changes. Many girls experience various mood swings and other changes in mental health around puberty, which is time of major hormonal change.
Some women who take certain types of the combined oral contraceptive experience depressive symptoms with irritability, loss of enjoyment and even suicidal thoughts. The “pill” is a great liberator of women in terms of reproductive control but the negative mental health side effects of certain types have not been well researched.
Other key hormonal mental illnesses are post-natal depression and psychosis. Soon after giving birth, there is a sudden rapid drop in the high levels of pregnancy hormones and this shift is thought to be a potent trigger for post-natal disorders.
Women experience a major hormonal shift during the transition to menopause, during which time they are 14 times more likely than usual to experience depression. This is known as perimenopausal depression. It affects women differently than other types of depression, causing anger, irritability, poor concentration, memory difficulties, low self esteem, poor sleep and weight gain.
Perimenopausal depression is not well recognised and is often poorly treated with standard antidepressant therapies. Women with this type of depression generally respond better to hormone treatments. But the link between depression and hormones is not often made.
Another poorly understood condition is premenstrual dysphoric disorder (PMDD), which is a severe form of cyclical depression with its origin in hormone shifts between phases of the menstrual cycle.
It’s also important to note that trauma and violence can lead to chronically elevated levels of the stress hormone cortisol, causing significant mental ill health at any time in a woman’s life. High cortisol levels have huge impacts on many brain regions resulting in rage, suicidal thoughts, obesity, infertility and learning problems.
So, what’s going on?
The reproductive hormones estrogen, progesterone and testosterone all have key interactions with many brain chemicals and circuits. They are potent and have been shown in animal studies to acutely impact on the key emotional regulation centres as well as modulating behaviours.
Estrogen is a neuroprotective agent and has direct impacts on dopamine and serotonin, the key brain chemicals associated with the development of depression and psychosis. The fluctuation in hormones appears to be a potent trigger for mental ill health.
Our clinical studies involved giving estradiol (a potent form of estrogen) to consenting women with schizophrenia and found they had a significant improvement in their symptoms of hallucinations and delusions.
Similarly, perimenopausal depression can be assisted with hormone treatment commonly used to treat menopausal symptoms such as hot flushes.
Towards greater understanding
There is a great deal of individual variation in the vulnerability to the effects of hormone shifts on mood and behaviour. This has led some experts to discount the connection between the mind and hormones.
But people rarely experience even the most obvious physical illnesses in exactly the same way – so why should we expect uniformity in the mental health impact of hormones? Besides, hormones are one of many factors that can trigger or perpetuate mental ill health.
Discussing the hormonal impacts of mental health does not demean women, as some argue. For those affected, understanding more about the relationship between hormones and mental health allows validation, empowerment and the opportunity to get effective treatments.
– Jayashri Kulkarni