Depression, Neurotransmitters, and Hormones

Reader’s Question

It is a fact that hormone changes can cause depression in women, given that they are chemicals and as such can cause chemical imbalances in the brain. I have observed that this can be true of the hormone changes associated with childbirth as well as the hormone changes associated with the onset of puberty. The resulting depression is usually treated with antidepressants.

My question is, though, given that the depression is caused from a hormone imbalance, then shouldn’t the most appropriate/optimal treatment be a correction of the imbalance instead of the administering of antidepressants? I have read of cases where this approach has in fact worked. It, however, does not seem to be a popular approach.

Thank you for your reply.

Our Consulting Clinical Psychologist’s Reply

Great question! Hormones and Neurotransmitters are two different substances in the body. Hormones circulate through the bloodstream, prompting action in a variety of cells and organs. Neurotransmitters, however, are very specific in their action and act to increase or decrease chemical signals between specific nerve cells. There is a complex interaction between these two substances, and the research clearly demonstrates strong links in specific mental health issues.

Research has found a link between depression and the stress hormone “cortisol” for example, with excessive levels of cortisol found in a majority of severely depressed patients. As you mentioned, one study of 176 patients with Cushing’s Syndrome (excessive cortisol) — reported in Clinical Endocrinology — found that 73% of depressed patients improved when receiving treatment to lower cortisol levels. This link is well-known, and as you observed, psychiatric symptoms can increase and decrease with events known to involve changes in hormone levels such as the onset of puberty, childbirth, menses, and menopause.

So why do we use antidepressants? The use of any type of hormone treatment is an “entire body” treatment as hormones circulate throughout the body, creating significant physical changes, most of which are unrelated to mood or other psychiatric issues. Changing hormone levels on a long-term basis is very tricky business as you can actually produce hormone disorders with the treatment.

A more efficient approach is to target specific neurotransmitters for treatment. The hope is to avoid creating an “entire body” problem by focusing on changes in a specific neurotransmitter associated with the mental health problem. We have antidepressants such as Celexa that are very Serotonin-specific and have very little influence on other neurotransmitters. Using a neurotransmitter emphasis, we avoid significant changes to the body hormone levels and thus have minimal side effects. However, it’s not a perfect approach at our current level of technology and many psychotropic medications create changes in hormone levels — producing some of the side effects we see in current medications.

In current theory, depression is related to lower levels of the neurotransmitter Serotonin (and others). Depression is not considered to be caused by hormones, although decreasing and increasing hormone levels can influence depression symptoms. Thus, depression and other psychiatric issues are considered related to a neurotransmitter imbalance rather than a hormone imbalance.