Mental Illness By Way of Hormones

DeeDee newThat I have a mood disorder goes unquestioned; the true nature and biological aspects of cause are up in the air. Besides the usual childhood traumas and genetic influences, it looks like hormones are in part to blame. Don’t start any hating about stigmatizing women’s normal, natural cycle, because I’m not talking about a normal experience.

I’m talking about a set of oversensitive physiological responses to and/or chronic imbalances of basic hormones like adrenaline, cortisol, estrogen, progesterone, and testosterone. The kind of sensitivity to adrenaline, for example, that means I can’t have medications containing epinephrine (aka adrenaline, often found in injectable local anesthetics, to reduce bleeding) because it immediately sends me into shock. It took awhile to figure that out, during which time I became thoroughly conditioned to have panic attacks at the dentist’s and oral surgeon’s offices as a matter of course. My body’s over-reaction to epinephrine presents as a classic panic attack, complete with cold sweats, elevated heart rate, and vasovagal syncope – all completely involuntary responses – and a sure sense of apocalypse.

Evidence suggests that some of my hormones are out of whack, but lab tests don’t find much that really falls outside of a normal range, aside from my cortisol levels (which are much too high. Sigh.) Way to be invalidating, modern medicine! The problem is, the testing isn’t done in a way that actually could identify a hormonal pattern underlying the cyclic aspects of bipolar-type symptoms that I experience, independent of whether there’s any empirical foundation to my suspicions in terms of abnormalities of hormone levels, rates of change, or sensitivity.

Somehow a “hormone imbalance” sounds different and less stigmatized than a “neurotransmitter imbalance”, especially because simply referring to “hormones” implies the cyclical sex hormones, which are both familiar to all and clearly not under my control. I found myself wondering, if I have a mood disorder (yes, yes, I do) that is at least in part caused by hormones, is that really mental illness?

Well, duh. Yes, it is. The manifestation of extreme mood symptoms was what earned my PMDD diagnosis, regardless of the suspected hormonal basis and accompanying physical complaints (like aching ovarian pain and limp-inducing grinding joints).

Every month, there’s a depressive dip, on the short side but usually just as sharp, ranging from a little blue to suicidal ideation. Surrounding that nugget of negativity is a longer period of general dysphoria, irritability, hyper-reactivity, and reduced cognitive capacity. It’s brutal, but because I know approximately how long each phase of my cycle lasts, I also know when an episode is more than “just” hormones – the depression simply lasts too long. Long enough to just barely count as major depression, when at least a couple of times a year, four to seven days of dysfunction turns into two to four weeks, and things get pretty dark and scary.

I also know how soon to expect improvement, however temporary. I’m starting to adjust the way I work to better accommodate the more predictable and generally brief losses of cognitive and emotional functioning. But I also know how soon to expect things to decline again, which currently makes me very hesitant to take on new projects or make commitments that span more than a few weeks’ time. I can predict that I’ll be out of action for a couple of days at certain times, but I can’t predict how much longer the malingering lows may linger.

Still, having identified hormonal imbalances as a chief suspect in the great mystery of my mental dysfunction, there is much more hope for effective treatment to stabilize the mood rollercoaster. Where antidepressants have failed to contain my melancholy tendencies, a little progesterone might make all the difference. There’s also that much more room for disappointment, of course, but I can’t help but hope for better outcomes.

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15 thoughts on “Mental Illness By Way of Hormones

  1. Totally relate with you , took steroids for acute episodes of asthma , since the of 4 or 5 and by the time the attacks stopped in late teens , i started having short temper , weight gain , pms etc.,(hormonal imbalances due to steroids ) but took me many years to figure out what the real problem was ……….meditation , yoga help but when i stop my practice for an extended period i start feeling the mood swings and the worse thing is guilt for taking it out on family , so i just immerse myself in fav books , music etc…. maintaining a journal – marking the “bad days ” also helped .But still struggling with it

    • I agree, mindfulness and yoga have been very helpful for me. But it can be difficult to maintain those practices, even when we know how important it is. Creating routines that help maintain wellness practices makes a big difference, but sticking with it through the ups and downs is still a challenge.

      • You are right , sticking with them is very difficult , I have started again after a break , and read blogs / quotes @ tumblr , wordpress etc. for motivation.the concept of minimalism , ( zenhabits.net ) and other sites works for me , as it helps to de-clutter the mind

  2. Although “hormone imbalance” is definitely less stigmatized, I would say that it would be quickly dismissed. It automatically assumes that there is some kind of quick fix to it, or that it will just pass on it’s own. For instance, when a man (particularly the husband) asks, “Are you having a period?”, I go off the deep end. Even if it is true, there’s no need to chalk it all up to hormones and ignore everything that is coming out of my mouth. It’s almost as if the thinking, “Well every other woman in the world goes through it too, why can’t you handle it?” comes into play.

    With BP, when symptoms surface, a certain urgency immediately attaches. I recall my husband sitting in the car yesterday, yelling at me, “You need to take your medicine!” (That infuriates me too, but I can’t say he’s entirely wrong). When I informed him that I was out of medication and would be until I can make it to my Pdoc in five days, his voice took a softer tone. Because there was no “quick fix” available, and no real foreseeable end in sight, he was finally willing to work with me.

    • Yeah, at least my husband knows better than to blame everything on hormones, even if that’s the main culprit. And the thing is, not every other woman goes through it to quite the same painful, dysphoric degree. Discomfort and dysfunction are worlds apart.

      There’s also no quick fix for endocrine imbalances (which most neurotransmitters fall under) even if people think otherwise. Most treatment approaches try to override your natural systems, and some bodies don’t respond well to that sort of insult. There’s more individual variation than is advertised, too, and much like other areas of health care, the accepted one-size-fits-all best practices are woefully outdated. We may as well still be in the 20th century in terms of the way endocrine problems are treated, and as for the way patients are treated… Bah.

      • Mr. Chickdee is a wise, wise man.

        You’re right. People get this idea that if an affected person takes their medicine, then they should be cured, right? It’s not an antibiotic. It doesn’t “cure”. It just treats. And as for outdated practices *eye roll*, they are archaic and almost inhumane.

  3. I am really glad to read your post today. My daughter is Borderline, but I have noticed that when she was pregnant–she has 2 kids plus 2 miscarriages–she was her most even. I have wondered if hormones play a role in this. Obviously they affect mood. For me too pregnancy was an island of calm. I’m not suggesting it as the cure, but as a sign of the powerful affects of hormone changes in the body.

  4. Part of my ongoing fight with depression stems from hormones out of whack. Not sure exactly which hormones cause the problem, but part of my problem is cyclical and diagnosed with PMDD. Then there’s the ongoing dysphoria, toss in some stress and my situational depression kicks in, I won’t even mention the joys of menopause. In my case of these are all treated by the same drugs, but after reading this, I’m not sure. However, I am a sincere proponent of pharmaceutical aids–they have saved my life. I understand your frustration in trying to get a handle on things. It sounds like your illness is very complicated. I send you thoughts of resolution and peace.

    • The standard approaches for treatment do in fact employ some of the same drugs for all of those purposes, if you are able to take them. However, SSRIs do not treat the cause of PMDD, only its symptoms. If it’s actually hormonal dysregulation, chances are that it can also be treated successfully, and then it’s possible that much of those inter-related problems could clear up. Unfortunately, you’d probably have to really work at it to get anyone to do appropriate testing to reveal the extent to which hormones are playing a role.

      I’d just like to actually treat the cause, wherever possible, instead of medicating symptoms away. My meds have definitely saved my life, too, but they’ve also put my life at risk, so I regard them all with some measure of suspicion.

      • I found I was on dangerous levels of Effexor for more than 5 years. My new shrink weaned me off (and thank goodness it went well), but I still suffer some damage. You must find a good doctor you trust, but that can be very hard. Also, as you know no one can advocate for you better than you. Since I’ve suffered with depression untreated for so long, there is no way I would go without meds, despite the side effects. Maybe with the exception of abilify–which I am on, but don’t want to be. I did try birth control pills for a while for my PMDD, it seemed to help. I’m just waiting to enter menopause–I think the end is near. (Missed my first period in 20 years! YAY!)

        I wish you all the best in treating just the depression. Changing your attitude helps greatly, but you really have to work at it. I thought I was doing pretty good up until my sudden suicide attempt. That’s what keeps me medicated.

  5. I feel you. I went back on the pill a year ago because the PMT was giving me two days a month at least where I just wanted to stay in bed and cry. It’s not a cure, but it has taken the edge off it.

    We find what works and live with it. Good luck in your journey.

    • I used to get just one or two days a month of falling apart, but then it got worse, and worse. A lot of times women do OK on the pill because it overrides the natural cycle and prevents ovulation and a bunch of hormonal effects that follow that. Unfortunately, that doesn’t work for everybody.

      Clinically, research has shown that PMDD is not improved by the pill or by progesterone supplementation, but I suspect there are critical methodological flaws in those studies. Just because your blood levels are “within a normal range” does not mean that they are adequate, appropriate, or being used by your body as expected. For example, the DHEA hormone can either be transformed into cortisol (under stress) or progesterone – so my high cortisol and normal DHEA levels could suggest that stress is hijacking my progesterone production. Go figure.

      I tried three different pills in the last year, all of which were rotten. The last one, Yaz, sent me to a cardiologist with heart palpitations, while actually making the dysphoria and anxiety even worse. My body is apparently so sensitive when it comes to hormones that it refuses to respond to the pill in the way that it’s supposed to, so suppressing my hormonal system clearly won’t work. I’m now working with a different treatment approach that’s cooperative, meaning that it works with my body instead of against it.

      • And the other thing with the “within a normal range” is that the “normal” is calculated from an average for a wide number of women, and, well, we’re not average.

        I’m glad you’ve got the treatment approach that’s working for you. I’ve just started this month’s break, and yesterday and some of today have actually been pretty miserable, but I don’t know if that’s the hormones, or because of the atmosphere around here (religious community, big Summer Chapter meeting coming up, a lot of senior sisters are stressed and snapping at each other or even butting heads). It could even be because of the hot weather we’re experiencing here in the UK that mean I’m not sleeping all that well. I’m due to go back to the doctor for a repeat prescription in the next 2-3 weeks, so I’ll ask about it then.

        • Another detail that’s not often discussed until necessary is that our bodies really do not react to synthetic hormones the same way as natural ones. The artificial progestins in most combination pills might not do much of anything (hence studies showing no efficacy) but the added estradiol does, combines with already adequate estradiol, and boom, you’re even further out of balance. I don’t know if those studies have been attempted with bioidentical progesterone instead of the manufactured molecules that try to fool your body into thinking it’s pregnant. My body is damn smart. It knows a toxin when it sees one.

          I’m not on to treatment yet – I actually start with (gasp!) monitoring to empirically establish a much more nuanced understanding of the root problem. As in, real biomarker data that can yield a real diagnosis, instead of an inappropriate and hurried PMDD diagnosis without proper prospective charting to validate it. Next stage is targeted testing based on my actual biology, rather than an “average” fiction that I obviously don’t fit. Then I can move on to actual treatment, with ongoing testing to properly monitor progress, instead of being subjected to a one-size-fits-all treatment algorithm. They report 95% success in treating severe PMDD, so here’s hoping.

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