I have a patient who worked as a day trader. You've got to have the metaphorical equivalent of certain male parts to do this kind of work--remaining focused, aggressive, and ruthless in a high stakes, high stress undertaking. She came to me because her world as day trader had fallen apart with the onset of menopause. When the market crashed in early October, 2008, she reported that she'd sat frozen in front of her computer, knowing that she needed to react and regroup yet unable to do anything but watch the debacle.
"You have to understand." she said with uncharacteristic (for her) tears in her eyes, "This was not me."
She proceeded to tell me about other pre-menopausal activities that had been her, namely extreme sports and risky jobs the likes of which I never once considered as options for my cautious self. Yet despite these major changes brought on by diminishing levels of estrogen, her gynecologist declined her request to consider estrogen therapy; she was not, after all, experiencing hot flashes.
One of the best kept secrets about the myriad of changes brought on by menopause is the profound effects that the loss of estrogen has on the brain. There is no doubt that some women do just fine in cognitive and emotional ways through menopause and beyond, but many do not. When my patients report that they are "doing just fine" post-periods, I always ask "How's your mood" and "How's your memory?". Not unusual, then, for me to uncover evidence that, in fact, they are not doing just fine at all.
If you are interested in hearing more about making the complex decisions involved on the road to our 600 month birthdays and beyond, please consider joining me for a menopause workshop on June 5th from 10:30 to noon at my Denver office. Please call 303-393-0300 to register; the non-refundable $20 fee is due at the time you sign-up. You do not need to be my patient to attend. If this topic is of interest to you but June 5th is a no-go, leave your name and number with my staff, and we will contact you with dates later in the summer when I will present the same material.
Showing posts with label Estrogen and mood. Show all posts
Showing posts with label Estrogen and mood. Show all posts
Sunday, May 23, 2010
Monday, March 3, 2008
Estrogen and mood
Antidepressants are still first-line treatments for major depressive
disorder across the female life cycle, but when they fail, novel
approaches that integrate the use of estrogen are now being
investigated, including the use of estrogen by itself or in combination
with antidepressants.
--Dr. Stephen Stahl, UC San Diego
Investigators such as Dr. Stahl have an increasing appreciation of the many actions of estrogen on the brain. The same types of cellular receptors for estrogen that abound in reproductive tissues are also found throughout the brain, notably in many areas involved in mood and memory functions. Does your mind mind a lack of estrogen?
Dr. Stahl notes that phases of a woman's life associated with large hormonal fluctuations --think postpartum and perimenopausal-- are times in which a woman is at highest risk for the onset of major depression. Women with a history of a depressive episode following any estrogen shift are even more vulnerable to a recurrence following other 'reproductive events' later in life. In other words, if you think premenstrual was difficult, look out for perimenopause.
Stahl calls this phenomenon 'kindling,' and theorizes that each mood crash associated with estrogen withdrawal may actually damage the brain. He dubs this process excitotoxicity in which the neurons are literally excited to death, and these episodes increase the future risk of treatment-resistant depression under similar hormonal circumstances.
A study supporting the use of estrogen in the treatment of depression was conducted at Massachusetts General Hospital. Fifty perimenopausal women --defined here as the transitional state from cycling hormones to no hormones at all marked by irregular periods and elevated FSH levels-- were diagnosed with varying degrees of depression. Half were randomized by investigators to receive estradiol (known to some as 'bio-identical' estrogen) via a skin patch such as Vivelle Dot or Estraderm. The control subjects got sticky, hormone-free blanks.
Two-thirds of the estradiol treatment group were depression free after three months of patchwork compared to only one-fifth of those without hormones.
disorder across the female life cycle, but when they fail, novel
approaches that integrate the use of estrogen are now being
investigated, including the use of estrogen by itself or in combination
with antidepressants.
--Dr. Stephen Stahl, UC San Diego
Investigators such as Dr. Stahl have an increasing appreciation of the many actions of estrogen on the brain. The same types of cellular receptors for estrogen that abound in reproductive tissues are also found throughout the brain, notably in many areas involved in mood and memory functions. Does your mind mind a lack of estrogen?
Dr. Stahl notes that phases of a woman's life associated with large hormonal fluctuations --think postpartum and perimenopausal-- are times in which a woman is at highest risk for the onset of major depression. Women with a history of a depressive episode following any estrogen shift are even more vulnerable to a recurrence following other 'reproductive events' later in life. In other words, if you think premenstrual was difficult, look out for perimenopause.
Stahl calls this phenomenon 'kindling,' and theorizes that each mood crash associated with estrogen withdrawal may actually damage the brain. He dubs this process excitotoxicity in which the neurons are literally excited to death, and these episodes increase the future risk of treatment-resistant depression under similar hormonal circumstances.
A study supporting the use of estrogen in the treatment of depression was conducted at Massachusetts General Hospital. Fifty perimenopausal women --defined here as the transitional state from cycling hormones to no hormones at all marked by irregular periods and elevated FSH levels-- were diagnosed with varying degrees of depression. Half were randomized by investigators to receive estradiol (known to some as 'bio-identical' estrogen) via a skin patch such as Vivelle Dot or Estraderm. The control subjects got sticky, hormone-free blanks.
Two-thirds of the estradiol treatment group were depression free after three months of patchwork compared to only one-fifth of those without hormones.
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