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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by Zo on June 24, 2001, at 16:29:13
. . .Just pulled out of a major depression. . . Unbeknownst to me (who didn't get her lab work done) my estrogen level had slipped to half the normal level over the past 6 months. I gradually slid down and down, despite same mix of Effexor & Dexedrine in a.m.; Neurontin, Zyprexa and Valium at bed that had been working so well Am now pulled out of it, after 2 weeks of raising estradiol dose (with a little help chipping at codeine.) But be warned!
Major study just published on Medscape advising docs to use estrogen FIRST for Depression in *any* woman who might be even perimenopausal. Never would have believed it, til it happened to me. . .but it's that profound.
Zo
Posted by Maisy on June 24, 2001, at 19:52:08
In reply to To All Women Over 45: Estrogen = Major AD!, posted by Zo on June 24, 2001, at 16:29:13
Funny you should bring this up. Prior to my major depressive episode I was breastfeeding my child and called the doc to check my estrogen level because I thought I had atrophic vaginitis (caused by low estrogen) but couldn't have it done because the kids were sick. I was 39 then and thought I was perimenapausal. Soon afterwards I crashed and burned. I always suspected that there was a connection. Sure wish docs paid more attention sometimes. Thanks for the info. I think I'll look that article up.
Posted by Sulpicia on June 24, 2001, at 23:26:25
In reply to Re: To All Women Over 45: Estrogen = Major AD!, posted by Maisy on June 24, 2001, at 19:52:08
>Zo --
I'm delighted this worked for you, and so quickly.
I read the abstract last week and was sooo happy to see gender-specific research! FWIW, perimenopause can start as early as the mid-30s so if this works it might be even more widely applicable.
One caveat tho: exogenous estrogen causes or exacerbates depression in certain women. women who've had bad reactions to oral contraceptives and women with bipolar disorders should seek expert advice before considering estrogen.
The current research demonstrates that exogenous estrogens, thru complex chemical reactions with vit.B6 [inter alia] lowers tryptophan levels -- and this being a precursor to serotonin, can result in lower serotonin levels, causing depression in susceptible women. At least that is the most recent published explanation.
And no side effects?
S.
Posted by Jackster on June 25, 2001, at 2:21:49
In reply to To All Women Over 45:Estrogen = Major AD!/caveat, posted by Sulpicia on June 24, 2001, at 23:26:25
I wonder if there is any hormonal link with my problem - although I am only 29. I have agoraphobia - and notice that it is worse (even on meds) every month just before my period, and the onset of it coincided with the start of puberty.
Does anyone know any more about this subject?
Thanks
Jackie
Posted by Roo on June 25, 2001, at 13:40:52
In reply to Women under 45?, posted by Jackster on June 25, 2001, at 2:21:49
I got my hormones tested b/c I was concerned about
my moods and low sex drive. Turns out I have
low testosterone. I wonder if testosterone supplementation
would help with mood as well. They didn't want to
do this with me b/c I'm only 32 and there weren't
enough valid studies done on premenopausal women
taking testosterone. I've heard that women who
take estratest get a big boost in their libido and
feel great.
Posted by Willow on June 25, 2001, at 16:19:39
In reply to Re: Women under 45?What about testosterone?, posted by Roo on June 25, 2001, at 13:40:52
My testosterone level goes high on it's own. And yeah it might contribute to higher libido, but I can't contest for a better mood.
Willow
Posted by shelliR on June 25, 2001, at 20:06:22
In reply to To All Women Over 45: Estrogen = Major AD!, posted by Zo on June 24, 2001, at 16:29:13
>
> Major study just published on Medscape advising docs to use estrogen FIRST for Depression in *any* woman who might be even perimenopausal. Never would have believed it, til it happened to me. . .but it's that profound.
>
> ZoZo-Thanks for mentioning the article. Is this study under May/June 2001? I can't find it. I've been really confused about the estrogen thing. I'm sure I'm perimenopausal because of my age, but so far have no symptoms. Tried birth control pills--low estrogen and progesterone for premenstrual symptoms and became more depressed, I think--well, definitely not less depressed. Progesterone helps me for the physical symptoms of PMS but not the depression. I think changes in hormones has made nardil--which always worked for me--no longer effective as an anti-depressant. So I don't get why the birth control pills containing estrogen made me worse (good warning Sulpicia).
Any more clues to how I can find the article on Medscape? Any clues to why estrogen may make some people more depressed even in their late forties?
shelli
Posted by Chris A. on June 26, 2001, at 0:06:10
In reply to Re: To All Women Over 45: Estrogen = Major AD! » Zo, posted by shelliR on June 25, 2001, at 20:06:22
Shelli,
I believe this is an abstract from the same study. I remember reading it on Medscape, but couldn't find it there either.http://neuro-mancer.mgh.harvard.edu/ubb/Forum108/HTML/002357.html
Estrogen may have helped my depression - not sure. At the momment I'm not on it.
Hope you get to feeling better.
Chris A.
Posted by shelliR on June 26, 2001, at 9:22:09
In reply to Re: To All Women Over 45: Estrogen = Major AD! » shelliR, posted by Chris A. on June 26, 2001, at 0:06:10
.
Posted by shelliR on June 26, 2001, at 15:35:31
In reply to To All Women Over 45: Estrogen = Major AD!, posted by Zo on June 24, 2001, at 16:29:13
> Major study just published on Medscape advising docs to use estrogen FIRST for Depression in *any* woman who might be even perimenopausal. Never would have believed it, til it happened to me. . .but it's that profound.
>
> ZoNot to be really picky, because I'm really grateful that you brought up the study. But the exact recommendation is a little tighter:
... "if someone comes into your office with signs of depression, perimenopausal symptoms, and a
clinical indication for estrogen replacement therapy, perhaps estrogen should be used as a first-line
therapy,"So basically, he saying use it for depression instead of an antidepressant, if indications ARE ALREADY THERE to use estrogen replacement therapy. If it is not needed, he feel that a regular AD is a safer alternative.
So I am in the right age range, but so far no perimenopausal symptoms. So I'm not sure that it would be a first line therapy for me, especially since my sister had breast cancer and estrogen replacement increases the chances. On the other hand, I do feel that my sudden lack of response to nardil, about a year and a half ago could well be due to hormone changes. And being a vegetarian I eat (drink) a lot of soy, so that may be why I'm not feeling any perimenopausal symptoms.
Shelli
Posted by Lorraine on June 26, 2001, at 15:52:57
In reply to Re: To All Women Over 45: Estrogen = Major AD! » Zo, posted by shelliR on June 26, 2001, at 15:35:31
Shelli:
Do you have any symptoms of menopause? Missed periods? I ask because the "standard" blood tests are a "point in time" and depending on your hormone levels at that particular moment. I was clearly peri-menopausal when I fell into my depression, but my gynocologist kept telling me I wasn't based on the blood test (I was missing lots of periods--it got to be absurd, seven months without a period). Anyway, the saliva test is supposed to be better because it measures over a period of time.
Posted by shelliR on June 26, 2001, at 17:01:29
In reply to Re: To All Women Over 45: Estrogen = Major AD!, posted by Lorraine on June 26, 2001, at 15:52:57
Hi Lorraine. No, so far no symptoms. But I've got to be in that category. My sister stopped having perimenopausal symptoms when she added soy to her diet. Then after chemo and radiation for breast cancer she had one horrible, almost hemmoraging period and none after. So I attribute two glasses of soy milk a day to my lack of symptoms. But I don't know whether I would even consider estrogen replacement for my depression. My pdoc brought it up when I saw him on Monday. I think I would want to talk to my gyn. According to the statement coming from the estrogen study, it would not be a first line treatment for me. Did you consider estrogen replacement when your depression began?
BTW, how are your treatments going?
Shelli
Posted by Lorraine on June 26, 2001, at 23:14:02
In reply to Re: To All Women Over 45: Estrogen = Major AD! » Lorraine, posted by shelliR on June 26, 2001, at 17:01:29
>
>
> Hi Lorraine. No, so far no symptoms. But I've got to be in that category. My sister stopped having perimenopausal symptoms when she added soy to her diet. Then after chemo and radiation for breast cancer she had one horrible, almost hemmoraging period and none after. So I attribute two glasses of soy milk a day to my lack of symptoms. But I don't know whether I would even consider estrogen replacement for my depression. My pdoc brought it up when I saw him on Monday. I think I would want to talk to my gyn. According to the statement coming from the estrogen study, it would not be a first line treatment for me. Did you consider estrogen replacement when your depression began?
>
> BTW, how are your treatments going?
>
> ShelliI begged for estrogen and was dismissively told I wasn't perimenopausal at 45 because I was "too young". When the estrogen was finally added (a year ago), it helped my cognitive function but I think the ship had sailed on derailing my depression train.
My treatments right now consist of holding steady on 15 mg Adderall a day; 5 mg Selegiline a day; and 900 Neurontin a day while I do neurofeedback. Neurofeedback is wierd. I can see that I can control my brain waves by the screen (i sees it with my own eyes). Each day that I go (and I'm going everyday because I really want quick results and it's the number of training sessions that counts), they ask me how I slept, how I feel and how I am eating. They adjust the training based on my feedback. Basically, they have been upping the amps every couple of days and today they started working my frontal area as well (ok, i give, is that my frontal lobe?) Some days I think i feel a definate effect (though, as you can see, i don't fully trust myself in this). Some days I have really broken down with weeping and stuff. (this is why I'm not sure the mood support is there.) But then when I go in, they up the amps and when I leave I feel my mood life. The other thing is my sleep patterns are disrupted for the first time since I've been depressed. The last is that I have lost some appetite. So I just don't know. I also have a hunch that I cycle in my moods, although I haven't kept a mood diary. Anyway, I figure I'm going to give it a bit more time to make sure it's been completely explored. (With vacations and all, it's a good three-four weeks before I know.) I also think I need a new pdoc in LA. One that's good with TRD and polypharmacy; one that is not shy about using amphetimines, TCAs and MAOs (although not all at once). How is your selegiline? Did you stay on it?
Posted by AMenz on June 27, 2001, at 10:43:52
In reply to Re: To All Women Over 45: Estrogen = Major AD! » Zo, posted by shelliR on June 26, 2001, at 15:35:31
Anyone out there besides me have horror story of the effect of perimenopause or menopause on their BPII symptoms or medication regimen?
>
> > Major study just published on Medscape advising docs to use estrogen FIRST for Depression in *any* woman who might be even perimenopausal. Never would have believed it, til it happened to me. . .but it's that profound.
> >
> > Zo
>
> Not to be really picky, because I'm really grateful that you brought up the study. But the exact recommendation is a little tighter:
>
> ... "if someone comes into your office with signs of depression, perimenopausal symptoms, and a
> clinical indication for estrogen replacement therapy, perhaps estrogen should be used as a first-line
> therapy,"
>
> So basically, he saying use it for depression instead of an antidepressant, if indications ARE ALREADY THERE to use estrogen replacement therapy. If it is not needed, he feel that a regular AD is a safer alternative.
>
> So I am in the right age range, but so far no perimenopausal symptoms. So I'm not sure that it would be a first line therapy for me, especially since my sister had breast cancer and estrogen replacement increases the chances. On the other hand, I do feel that my sudden lack of response to nardil, about a year and a half ago could well be due to hormone changes. And being a vegetarian I eat (drink) a lot of soy, so that may be why I'm not feeling any perimenopausal symptoms.
>
> Shelli
Posted by somebetter on June 27, 2001, at 11:28:13
In reply to Re: To Women Over 45: Estrogen BPII, posted by AMenz on June 27, 2001, at 10:43:52
> Anyone out there besides me have horror story of the effect of perimenopause or menopause on their BPII symptoms or medication regimen?
> >I don't have BPII diagnosis but have many of symptoms and have numerous sibs and other family members with BP illness. My doc doesn't believe in such diagnoses.(complicated explanation) I can tell you that the spit hit the fan during perimenopause with physical and emotional ups and downs and sideways and I have embraced HRT. I have always consumed large quantities of soy products-I even made my own tofu! It just didn't help me. What I'm taking now is plant based and that eases my mind somewhat. HRT alleviated the physical symptoms, but I've had a time trying to get a good mix of drugs to control mood difficulties.
Posted by Cece on June 27, 2001, at 14:31:37
In reply to Re: To Women Over 45: Estrogen BPII, posted by AMenz on June 27, 2001, at 10:43:52
My BPII symptoms really ballooned in my 40's, which my pdoc said was often the case. I was not far into beginning treatment for the first time for BP- because of an early bad experience with meds I was afraid of them, and spent years and a fortune trying to 'work it out' in therapy, not even knowing that I was BP. My ballooning symptoms were increased mood instability, lability, and very increased depression.
So, with the help of my great gynecologist, I first went on birth control pills at about age 44, which helped, then I began hormone replacement therapy at about age 47 (pills- obviously a very personal decision) before the tests said that I was officially ready to do so. That helped.
Then, I lost libido, even after going off zoloft (I was also on mood stabilizers), so I asked my gyn to test my testosterone a couple of years ago, (I'm now 52) and it was way low. So, I began taking methytestosterone (a low, gentle med and dose, okay for women if not overprescribed). My health plan (Kaiser) has to send the RX to an outside pharmacy to have it formulated but it's cheap and they haven't complained. I got my libido back! And my energy level improved somewhat. I'm very happy to feel sexual again.
I believe that all these steps and treatments have been quite helpful for me.
Cece
Posted by Waterlily on June 27, 2001, at 19:39:21
In reply to Re: Women under 45?What about testosterone?, posted by Roo on June 25, 2001, at 13:40:52
I'm also 32 and estratest didn't do a thing for me. Would have been an easy solution to a nagging problem.
Posted by Zo on June 28, 2001, at 2:18:07
In reply to To All Women Over 45:Estrogen = Major AD!/caveat, posted by Sulpicia on June 24, 2001, at 23:26:25
> One caveat tho: exogenous estrogen causes or exacerbates depression in certain women. women who've had bad reactions to oral contraceptives and women with bipolar disorders should seek expert advice before considering estrogen.
My worst, killer depressions were on oral contraceptives.. .from the progesterone. Which I now take as micronized progesterone, and tolerate just fine. My understanding was that progesterone is the primary depressive prob. with o.c.s. . and PMS. .
I get a tiny hit from yr post that you're anti-estrogen? No? There *are* better forms than Premarin. . .
Posted by Zo on June 28, 2001, at 2:20:41
In reply to Re: To All Women Over 45: Estrogen = Major AD! » Zo, posted by shelliR on June 26, 2001, at 15:35:31
> Not to be really picky, because I'm really grateful that you brought up the study. But the exact recommendation is a little tighter:
>
> ... "if someone comes into your office with signs of depression, perimenopausal symptoms, and a
> clinical indication for estrogen replacement therapy, perhaps estrogen should be used as a first-line
> therapy,"Kinda thought that was implicit in my post. . .Would be a pretty lame idea otherwise.
Zo
Posted by Zo on June 28, 2001, at 2:23:20
In reply to Re: To All Women Over 45: Estrogen = Major AD! » Lorraine, posted by shelliR on June 26, 2001, at 17:01:29
>
>
> Hi Lorraine. No, so far no symptoms. But I've got to be in that category. My sister stopped having perimenopausal symptoms when she added soy to her diet.Well, yes, that would be because soy products contain. . .estrogen!
I'm one who needs the dose control of a supplement. I don't think there's anything special about "natural" in this case, but if it works, great!
Posted by shelliR on June 28, 2001, at 9:35:33
In reply to Re: Progesterone and Depression, posted by Zo on June 28, 2001, at 2:18:07
> My worst, killer depressions were on oral contraceptives.. .from the progesterone. Which I now take as micronized progesterone, and tolerate just fine. My understanding was that progesterone is the primary depressive prob. with o.c.s. . and PMS. .
>
> I get a tiny hit from yr post that you're anti-estrogen? No? There *are* better forms than Premarin. . .Hi Zo. No, I'm not anti-estrogen. Just very confused about it. The reason I felt that I needed to quote what was said was because of my situation. That is, no one would automatically suggest estrogen to me now, because I am symptom free in regard to perimenapausal symptoms. (No hot flashes, sweats.) But my depression has definitely been on the rise in the past year.
What I hadn't understood from your post was that everyone in the study had perimenapausal symptoms. From your post I thought all women, 45 and over and depressed should be given estrogen as a first line antidepressant. Anyway, I was just trying to put everything on the table, I wasn't trying to criticize you. Again, I am grateful for the citation.
I am confused also about the estrogen-progesterone balance, since progesterone (natural, in suppository form) helps me so much with my premenstrual physical symptoms. I have a really good gyn; I think a trip to her is way overdue.Also because my sister had breast cancer , that puts me in a higher risk category. So the benefits of ERT have to outweigh the risks. So there are two questions: (1) would ERT help my depression and; (2) How high are the risks involved?
Thanks again for starting this thread; it's really good to be able to have a discussion about it.
Shelli
Posted by Lorraine on June 28, 2001, at 10:19:09
In reply to Re: Progesterone and Depression » Zo, posted by shelliR on June 28, 2001, at 9:35:33
> > My worst, killer depressions were on oral contraceptives.. .from the progesterone. Which I now take as micronized progesterone, and tolerate just fine. My understanding was that progesterone is the primary depressive prob. with o.c.s. . and PMS. .
> >
> > I get a tiny hit from yr post that you're anti-estrogen? No? There *are* better forms than Premarin. . .
>
> Hi Zo. No, I'm not anti-estrogen. Just very confused about it. The reason I felt that I needed to quote what was said was because of my situation. That is, no one would automatically suggest estrogen to me now, because I am symptom free in regard to perimenapausal symptoms. (No hot flashes, sweats.) But my depression has definitely been on the rise in the past year.
>
> What I hadn't understood from your post was that everyone in the study had perimenapausal symptoms. From your post I thought all women, 45 and over and depressed should be given estrogen as a first line antidepressant. Anyway, I was just trying to put everything on the table, I wasn't trying to criticize you. Again, I am grateful for the citation.
>
>
> I am confused also about the estrogen-progesterone balance, since progesterone (natural, in suppository form) helps me so much with my premenstrual physical symptoms. I have a really good gyn; I think a trip to her is way overdue.
>
> Also because my sister had breast cancer , that puts me in a higher risk category. So the benefits of ERT have to outweigh the risks. So there are two questions: (1) would ERT help my depression and; (2) How high are the risks involved?
>
> Thanks again for starting this thread; it's really good to be able to have a discussion about it.
>
> Shelliwhen i was placed on estrogen, it was estratest until I stabilized (yet to happen, but maybe in this lifetime) because of the depressant effect of progesterone. they do not recommend this, however, because of the risk of uterine cancer so I have an ultrasound every 6 months to check things out.
Shelli--the risk of breast cancer is ambiguous. Studies have gone both ways, with some showing a lower risk (one hypothesis is that the women are more careful checking themselves?). Anyway, a big study is now underway to determine this but by the time we have results, your decision window will have closed. Most of what I have read (I have breast cancer in my family too) is that the risk increases after 5 years of use. Anyway, remember too the decreased risk of heart disease, osteoporosis, and alzheimers. (I will say the skin does improve considerably as a side benefit as does sexual lubrication.) You might try it and see if it works. If it does, then you might consider switching to a natural form after a spell--these forms are supposed to be associated with less risk.
Posted by Zo on June 29, 2001, at 0:46:41
In reply to Re: Progesterone and Depression » Zo, posted by shelliR on June 28, 2001, at 9:35:33
Depends on the story, with your sister. Mine had it abt. 20 years ago, trustworthy doc said that doesn't put me at high risk. . .and besides, it's not like I have any choice. I slid into Major Depression with *all* my other meds in place. . .except that my estrogen level was half of normal. Scary, you bet.
Posted by Trish Baker on July 1, 2001, at 22:26:30
In reply to Re: Progesterone and Depression » shelliR, posted by Zo on June 29, 2001, at 0:46:41
> Depends on the story, with your sister. Mine had it abt. 20 years ago, trustworthy doc said that doesn't put me at high risk. . .and besides, it's not like I have any choice. I slid into Major Depression with *all* my other meds in place. . .except that my estrogen level was half of normal. Scary, you bet.
I am 42 (OCD and depression) and have felt worse and worse since about 5 years ago. I kept having break through symptoms even on my medication. My Dr. finally determined that I was peri-menopausal (no libido, irregular periods, night sweats, migraines, etc.) and he prescribed birth control pills and estratest. Well, I smoke (not much) so I didn't take the BC pills but did try the Estratest for one week and felt horrible. I'm confused, how do you know if you need progesterone and/or estrogen? Were the BC pills for progesterone? My diagnosis is depression and OCD (severe anxiety as well) so I'm very afraid of taking anything that will exacerbate my existing condition. When the one post stated the patch, how is that different from the pill form when it comes to affecting depression, anxiety, etc.?
Thanks,
Trish
Posted by lburas on July 5, 2001, at 15:48:04
In reply to Re: I'm confused, need advice and info on estrogen, posted by Trish Baker on July 1, 2001, at 22:26:30
Hi! Please read a book called "What Your Doctor May Not Tell You About Menopause" by John R. Lee, MD. He discusses the symptoms of estrogen dominance and recommends natural progesterone cream. I have tried it and have been feeling a lot better.
L> > Depends on the story, with your sister. Mine had it abt. 20 years ago, trustworthy doc said that doesn't put me at high risk. . .and besides, it's not like I have any choice. I slid into Major Depression with *all* my other meds in place. . .except that my estrogen level was half of normal. Scary, you bet.
>
> I am 42 (OCD and depression) and have felt worse and worse since about 5 years ago. I kept having break through symptoms even on my medication. My Dr. finally determined that I was peri-menopausal (no libido, irregular periods, night sweats, migraines, etc.) and he prescribed birth control pills and estratest. Well, I smoke (not much) so I didn't take the BC pills but did try the Estratest for one week and felt horrible. I'm confused, how do you know if you need progesterone and/or estrogen? Were the BC pills for progesterone? My diagnosis is depression and OCD (severe anxiety as well) so I'm very afraid of taking anything that will exacerbate my existing condition. When the one post stated the patch, how is that different from the pill form when it comes to affecting depression, anxiety, etc.?
>
> Thanks,
>
> Trish
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