Menopause & Mood: The Role of Estrogen in midlife depression and beyond.
"Estrogen's Role in Mood Regulation through Serotonin and Noradrenaline"
Estrogen is a hormone that plays a crucial role in mood regulation, primarily through its interactions with serotonin and noradrenaline, neurotransmitters associated with mood. Estradiol, a form of estrogen, can increase serotonin synthesis and availability, contributing to a more positive mood. The hormone also increases noradrenaline synthesis, which might have neuroprotective effects.
"Link Between Fluctuating Estrogen Levels and Perimenopausal Depression"
A significant fluctuation in estrogen levels has been associated with the development of perimenopausal depression. For example, wider fluctuations in estrogen levels have been found to increase the risk of depressive symptoms. Likewise, estrogen withdrawal can result in depression in some women.
"Understanding the GABAergic Deficit Hypothesis for Depression and Estrogen's Role"
Another interesting aspect is the GABAergic deficit hypothesis for depression, suggesting that deficiencies in GABAergic neural inhibition (in which estrogen and allopregnanolone play a role) could contribute to depressive symptoms across a woman's reproductive life cycle.
"Efficacy of Estrogen-Based Therapy for Major Depressive Disorder During Perimenopause"
Estrogen-based therapy, specifically transdermal estradiol, has been shown to effectively treat major depressive disorder (MDD) during perimenopause. Two randomized controlled trials showed significant antidepressant effects, leading to the inclusion of estrogen therapy as a second-line treatment in the 2016 Clinical Guidelines of the Canadian Network for Mood and Anxiety Treatments (CANMAT). The therapy was most effective during the menopause transition. However, the use of estrogen therapy for depression in late postmenopausal women did not show positive results.
"Potential of Estrogen Therapy as a Preventive Approach to Midlife Depression"
Estrogen has also been studied for its potential to prevent depressive symptoms in midlife women. A trial using transdermal estradiol plus intermittent oral micronized progesterone reduced the risk of developing depressive symptoms compared to placebo.
"Importance of Considering Estrogen Therapy in Treatment of Midlife Depression"
The review suggests considering estrogen therapy, particularly transdermal estradiol, as part of the treatment for midlife depression. This might be particularly useful for women in the menopause transition who present with depressive symptoms and concomitant vasomotor symptoms. Soares, CN. 2023. Psychiatric Clinics of North America. Menopause and Mood. The role of estrogen in midlife depression and beyond.
This represents yet another example of improvement by stabilizing waning hormone levels rather than manipulation of our systems with antidepressant medications which are known to have addiction side effects like sexual dysfunction, weight gain, and anxiety. While we know the additional benefits seen with oral E2 with respect to lipid improvement we applaud the use of bioidentical hormone replacement in this review.
Jason & Rita.
