How do hormones affect depression?

How are our hormones linked to depression? Do women experience depression the same way as men do? Join this second episode of HRT Is Good For You as we speak to Professor John Studd about hormones and depression, and how even some women diagnosed with Bipolar Disorder may actually need a second opinion from a gynaecologist after all. 

This podcast is powered by the London PMS and Menopause Clinic and hosted by Chloe Russell. 

London PMS and Menopause Clinic 

Address: 46 Wimpole Street, Marylebone, London, W1G 8SD

Phone: 020 7486 0497 

Website: https://www.londonpmsandmenopause.co.uk

Thanks to Ben Talbot-Imber for production support and conversation editing.

Transcript

spk_1:   0:07
Hello and welcome to the HRT Is Good For You podcast. Episode two. This podcast is made for women and men of all ages, with particular emphasis on women entering the menopause. My name's Chloe and I will be hosting the series, made for and powered by the London PMS and Menopause Clinic. On today's episode, I'll be chatting to Professor John Studd about depression and hormones. In the last episode, I spoke to Professor Start, about 11 reasons to be happy about taking HRT and one of the reasons we touched on was how it could be beneficial for people with depression. Today we'll find out in more detail how hormones and depression coexists with each other and how HRT can help with this. I hope you enjoy the show.  

spk_1:   0:55
So, professor, during this time of the pandemic, a lot of people are getting low moods and depression is quite a big thing. At the moment of this, I thought would be really important for us to discuss this and find out the importance on how hormones can help people with this.

spk_0:   1:13
Yeah, good point. Apart from the isolation we have in the moment in the situation, specifically talking about the menopause. That's very important because it causes all sorts of symptoms like flushes, sweats, obedient headaches, insomnia and depression. And the depression, of course, becomes worse and in times of stress. But the covid aside, let's just say that depression is very common in women. It's more common in women than men. When you look at descriptions of antidepressants, suicide attempts or a mission to hospital depression is twice as common in women than men.

spk_1:   2:04
Why's that?

spk_0:   2:05
Well the difference is that women have these hormonal fluctuations, like premenstrual depression. I mean, certainly men do not have hands depression. Women's follows their hormonal changes specifically, as I mentioned premenstrual depression but also post natal depression and also menopausal depression. When there's a decline of estrogens and therefore the depression is more common, it's very important to recognise the depression in women is different to depression in men because men don't have these hormonal cycles,

spk_1:   2:54
And those three stages of depression, that's reproductive depression. Is that right?

spk_0:   2:59
That's right. That's what we called reproductive depression. That's a combination of the pre menstrual, post natal menopausal depression and then occurs, or their car in the same woman throughout the ages until they get to the menopause. When in a funny thought away several years off the menopause the Depression declined to little bits because there's no homeowner flux anymore. It is low, but it is worth at the time we call the the Menopause in transition what people call the peri menopause. And that is when in the two or three years before the period store, that's the worst time off. Menopausal depression.

spk_1:   3:54
Is reproductive depression easy to diagnose in your patients?

spk_0:   3:58
Yes, if you ask the right questions and you listen importantly to realise you can't die. This is my blood test.

spk_1:   4:08
When a women is pregnant does is it works similar to menopause, where the Depression is suppressed.

spk_0:   4:15
That's right, these women who may be incapacitated with three bed to depression when they become pregnant, the depression goes. They are at their best when they're pregnant. But then, of course, when the home and there was fall off three months off the delivery, the Depression starts again as post natal depression.

spk_1:   4:40
What are the risks of using antidepressants and the benefits of using Hate Shorty to treat depression

spk_0:   4:46
with the risks of antidepressants. A very well known I mean, what they often don't work this more. Suicides is more terrible. Problems like strokes and a ll sort of things. All sorts of problems cover that too. Depressants. But essentially, they're the wrong treatment for her nodal problems. Hormonal problems require hormonal treatment.

spk_1:   5:12
What percentage of your patients take antidepressants when they when they come for their first consultation? And do you find that in time they don't need to take the antidepressant?

spk_0:   5:23
Well, about 50 or 70% have had anti depressants before coming. They make up the symptoms of hot flushes, sweats or libido problems. I'm excluding those. But there was to come for depression. At least 1/2 of them have had a trial of antidepressants that haven't worked. And then, of course, the characters have a trick that if their treatment doesn't work, they then call it antidepressant resistant depression. All they call it borderline personality disorder or worse. Still, they pulled it bipolar disorder, and that's a terrible misdiagnosis in a woman that has simply hormonal problems.

spk_1:   6:17
Does that happen quite a lot, that

spk_0:   6:19
Yes, yes, it's really quite common, and I've written this up years ago with examples of how you distinguish Holman Responsive PMS to Homer, not responsive bipolar disorder. And then, of course, these women who have PMS then we started it was by a pullover have antidepressants antipsychotics. They have, even these days electroconvulsive therapy and is a ll the wrong treatment if it's the wrong diagnosis. And if the correct diagnosis is meant to depression, it's even a treat with the surgeons you give Eastern's through the skin transdermal e on. That suppresses the cycles that produced the psychical symptoms

spk_1:   7:17
Andy surgeons are safe to be using.

spk_0:   7:20
Oh, yes, Eastern's are very, very, very safe. And not only did they help the Depression, but they will help the flushes of sweats, insomnia. They help the skin. They prevent osteoporosis, which the major factor in that one in three women of the age of 70 will develop in Austria. Product fracture of the spine or the hip. Now that can nearly all be preventive bye. Estrogen's given around the time of the menopause for a long period of time, not three months, but 10 years Is that 10

spk_1:   8:01
years prior to the menopause or 10 years? Well afterwards,

spk_0:   8:06
afterwards and if you if you start a few years beforehand. So much the better.

spk_1:   8:14
That's interesting. Ah, nde do use testosterone in this treatment for depression.

spk_0:   8:20
Yes, we do quite a lot. The evidence for that is less good than evidence for Easter. June's test sourcing, of course, helps energy and libido, but particularly, but it also helps the mood as well. And I looked at my figures a few years ago on 93% of my patients having issues for depression also have testosterone. That's more than I thought it would be. But it's night 3% of thes depressed women. I also give testosterone as well as oestrogen. So in my practise, it's very common,

spk_1:   9:02
huh? On DH with taking testosterone but getting a better mood and higher libido that were actually at Teo. Much better satisfied lifestyle as well.

spk_0:   9:15
Well, they're happier. Everybody's happier. Yeah,

spk_1:   9:18
talking about treatments. Often, people go to the doctor's on DH. The doctors tell them that in order for them to have a natural way off being treated with depression treatment away from depression, they should go out for long walks and be more involved with nature. Do you think this is a satisfactory treatment?

spk_0:   9:40
Well, it's a standard 30 lifestyle, both certainly on it may help take the edge off certain problems, but essentially, if they have recurrent depression with the periods recurrent post natal depression, having long walks and gave the chip is not really going to help. What they need is the logical, rational, effective treatment, which is estrogen's.

spk_1:   10:10
Have you published much on the subject of depression?

spk_0:   10:13
Who published a lot about about 500 papers on The Better Pause and Home and Care appeal about about 2030 pages of the papers on Depression.

spk_1:   10:25
Wow. And

spk_0:   10:26
that's an interesting question because these made published in good journals From The Lung Lancet door words, I've sent free papers to the British Journal of Psychiatry over the last five years on, they've been returned without even being reviewed. Now I know how to write papers. I know how to write good papers. They've been publishing good journals, but not in the British Journal of Psychiatry, who did not want to know the message. Even the title is rejected, and these papers have not even going to review. That's a terrible thing.

spk_1:   11:12
Why do you think that is?

spk_0:   11:14
Well, it's a question of territory I think, really, we all live in a little bubble, I suppose, with your orthopaedic surgeons or psychiatrists, all kind of colleges, we will have a little bubble our turf on DH. I think the psychiatrists are not really interested in having an alternative mode of therapy, which I think is different or too difficult for them. Now. That's very old because there's nothing difficult in treating a woman with hormones. GPS do it. I mean, the patient themselves learn in five minutes how to do it. And sir, countries what they recognise the cyclist city at the natural history of reproductive depression can very easily prescribe. S June 23 measures the question through the skin, perhaps testosterone on DH. Certainly progesterone as well, if the patient has a uterus. So it's very, very easy. And I do not understand why psychiatrists are blind to these possibilities.

spk_1:   12:28
No, it's quite fascinating. Really?

spk_0:   12:31
Yeah, sure said

spk_1:   12:33
Yes, Saad. What advice would you give Women who can't get the treatment in the form of hormone therapy?

spk_0:   12:41
Well, I'd say good on my website, gettable with women. It's all written down there on DH bent off the sections on depression. I give them to the GP. Give them to the psychiatry's so they can learn something. They have a god to come to a gynaecologist. But as long as they have the information that I hope is persuasive and convincing so that they can take them to the Jeep, your psychiatrist and say, would you please try this therapy? It's quite safe. It's well known for other things its eastern through the skin by patches or gels. And it's so simple, and please let me have it

spk_1:   13:28
and trying to think of, Ah, role play in my head right now. If I'm patient and I've got depression, what would be the steps in and after we've had a consultation? Is it something that you can do over the phone? Because this's really important at this time of life, which

spk_0:   13:46
they bought these days? And certainly, I mean, certainly women can have a telephone consultation with the doctor because there's no examination required. Ideally, you would, if appropriate, but you can do it over the telephone for telly telly consultations to get the history with the correct questions, listen to the answers, and if the gynaecologists and convince that it really is a depression treatable with Eastern's. They don't give him a prescription together, chemise, and they can start it. And then when all this covert thing has gone, then go back to your gynaecologist and then he can sort out things like blood tests, perhaps press example, ation, etcetera. But at the moment, it is certainly a hands off. Tell the community communication ty treatments, and that's quite straightforward. That's really good to

spk_1:   14:46
know. Is the prescription always the same To begin with as it is? You know, when you go to the doctors and they prescribe a pill

spk_0:   14:56
years, I made just about just about. Of course, there are many different varieties of Eastern's, but essentially we use transdermal is safer than by mouth on the transfer. Mel's, as I said, Are the patch or gaols really implants? Or they work well that that needs obviously a public consultation. So just the gaols on DH, perhaps with the addition of testosterone gel once again and possibly progesterone tablets for seven or 10 days a month, the prescription is fairly straightforward. Um, Andi, it's easily prescribed in the telephone, and a LL chemist will have it.

spk_1:   15:44
That's great. Good to know. On DH. I've got a question from the listeners, If that's okay for you, Sure. So is there a link between hormonal contraceptives like the Kool and the Implant on depression? There's always media attention whenever a study is released, but there's not that much nuance in the reporting, since it's quite an emotive subject. Is there a point at which we can give Lay? People were definite answer, and how far away are we from that point?

spk_0:   16:14
That's a very good question, because many recent studies show that the incident depression is twice as common and women on the combined pill. It's even worse in women with progesterone only pill. And also it were still you women having Tipo suggested to

spk_1:   16:38
What's a depot progesterone?

spk_0:   16:40
Or these injections or injections every three months of Riviera?

spk_1:   16:44
So that's worse.

spk_0:   16:46
It's not a bad contraceptive, but it's not good for depression. And it's not a good contraceptive. It women to have depression.

spk_1:   16:56
Yeah, that's not good. Ato, Is there a big increase in and depression among? People were taking the pill opposed to not taking the pill

spk_0:   17:07
well, Yes, yes.

spk_1:   17:09
Well, Professor, that was very nice. Summery. I appreciate that

spk_0:   17:14
Those my pleasure. Hope it helps.

spk_1:   17:16
Yes. Thank you, Professor.

spk_0:   17:18
Okay. Bye Bye, love.

spk_1:   17:22
Hello and welcome back. How did you find this episode? Was anything surprising? Thank you for the great question asked by Claudia Stalker at the end about contraceptives and depression. Quite a controversial topic, but cleared up nicely by Professor John. Start there. If you'd like to ask. Professor Question, you can find us on Facebook and Twitter, where you search for hate. Aarti is good for your podcast. Remember to share our episodes of friends and relatives that could benefit from hearing these episodes. Thank you for listening again, and we'll see you next time.