By: Alyssa DeMatteo, LCSW, Mental Health Clinician
Each May we recognize Mental Health Awareness month to emphasize the importance of openly talking about mental health conditions. Simple logic dictates that if we are hurt anywhere, we must seek treatment to get better. This applies to both our mental and physical well-being. While we have made progress in ending the stigma around mental health, it still exists and as a result people hesitate to seek help or even talk about it with their loved ones.
Additionally, May 8th begins National Women’s Health week. This week-long observance serves as a reminder for all women to make their health a priority and to put time and thought into making choices that are right for them.
In view of these two very important observances, we’d like to shed some light on a topic relevant to both Mental Health Awareness and Women’s Health: The Estrogen-Depression Connection.
History
Throughout history, women’s moods have been recognized as distinct from those of men. As early as 1900 BC, there was record of a condition called hysteria — specific to women. With time, the definition of hysteria evolved, ranging from “wandering of the uterus” to associations with witchcraft, to a “demonstrated lack of control over emotions and behavior.” Hysteria was most commonly diagnosed in women between the ages of fourteen to twenty-five, and uncommonly after the age of forty-five. Taking a brief look back at these descriptions, we can clearly observe one thing: the developmental timeline of when mood changes in women occur and the surge of hormones that accompany each developmental phase. This begs the question: just how much does estrogen affect a person’s mood?
Did you know?
Historically, of the depressed women at inpatient psychiatric hospitals, 41% are admitted on the day before or the first day of menses?(1)
Estrogen & The Female Brain
Estrogen is a female sex hormone that is primarily produced by the ovaries, although smaller amounts are also produced by a structure in the brain called the adrenal cortex. While estrogen is present in both men and women, women have significantly higher quantities.(2)
There are also molecules in our brain called estrogen receptors that are densely packed into areas of the brain that greatly influence mood and behavior. One of the areas with the highest density of estrogen receptors in women is the limbic system, which is vastly responsible for emotional processing. Thus, the structures included in the limbic system (governing sleep, motivation, resilience, and mood — areas in which depressive symptoms can be expressed) are very easily impacted by changes in estrogen levels.
Serotonin & Estrogen
In the context of depression, serotonin has become quite the buzzword. Simply put, serotonin is a neurotransmitter responsible for regulating mood, digestion, sleep and more(3). It is produced predominantly in the brain, and many of the neurons in the brain that release serotonin contain the same estrogen receptors discussed earlier. Therefore, estrogen determines the availability, concentration, and use of serotonin.
We can think of the interaction between estrogen and serotonin similarly to the way sleep works in our bodies. When a person gets a sufficient amount of sleep, it can protect the body from illness. When a person gets less sleep, they are immediately more vulnerable to infections, illnesses, stress, and depression. Normal levels of estrogen help protect the brain from depression by regulating serotonin activity. When estrogen is disrupted or fluctuates too greatly, it leaves the brain at higher risk for depression — much like what happens during puberty, pregnancy, after giving birth, at certain points in the menstrual cycle, during menopause, and other developmental stages specific to women.
Take Home Message
There are clear periods in a woman’s life where she is more vulnerable to an increased risk for depression, usually around developmental milestones, which are closely linked to reproductive stages when estrogen levels are fluctuating(2). It is often difficult for women to accept that there can be a biological basis for depression, because of societal pressures to view depression as something that can be controlled by acting or thinking in a new way. While there is some truth to the fact that thoughts can influence feelings and lead to certain behaviors, there is no denying that there are also strong biological and hormonal factors that function outside of our immediate control.
One of the reasons why this lack of direct responsibility for one’s emotions is such an uncomfortable notion may be because of the societal pressures placed on women. From a young age girls are taught to behave differently than boys, to act with more responsibility and less carelessness. From school achievement, participation in extracurricular activities, careers, child bearing, to child rearing — women really do assume a lot of responsibility. And on top of this, emotional instability is one of the characteristics that is often weaponized against them.
Depression and estrogen-related issues need to be de-stigmatized to the point that it feels okay to ask for help. In the spirit of Mental Health Awareness and Women’s Health Week, let this information serve as a reminder that it is strong, brave, and courageous to reach out for help when you need it. It is critical to consult with your health care providers about these symptoms to gain access to the resources you need. We must give credit to biology and the inner workings of the human brain and body that are beyond our control.
References:
- Arpels, J.C. 1996. The female brain hypoestrongenic continuum from the premenstrual syndrome to menopause. Journal of Reproductive Medicine.
- Miller, K.J. & Rogers, S.A. 2007. The hidden link between hormones and women’s depression. The Estrogen-Depression Connection.
- Salters-Pedneault, K. 2021. What is seratonin? https://www.verywellmind.com/what-is-seratonin-425327
This blog is intended to be informational in nature. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment.
If you have any questions or concerns, please talk to your Care Team or other healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog or in any linked materials.
