56 year old Susan suffered from anxiety and panic
attacks, and had been prescribed Valium™, Effexor™ and Wellbutrin™ by her
primary care doctor. This cocktail of
psychoactive drugs caused Susan adverse side effects, and didn't seem to be
helping, so she stopped taking them. A
few years ago, after she went through menopause, she started having hot
flashes, and this is when she first noticed the anxiety attacks, preceding the
Deficiency Causes Anxiety
We sent Susan to the lab for a hormone panel, and
sure enough, Susan's estrogen level was low. Susan's symptoms were caused by
menopausal estrogen deficiency, a finding commonly seen in the post menopausal
age group. Symptoms are promptly relieved with bioidentical estradiol applied
as a topical cream twice a day.
Additionally, Susan's tests revealed vitamin and mineral deficiencies
which were, no doubt, aggravating the anxiety attacks. Susan was started on her bioidentical hormone
program which included estradiol and progesterone as a balanced topical cream.
She was also started on vitamin B12 and magnesium supplements. Six weeks later, Susan reported that her
anxiety and panic attacks had improved and were almost gone. She also noticed better sleep and more
clarity of mind, and her night sweats and hot flashes had resolved as well.
is Associated with Hot Flashes
A study published in 2005 Menopause reported that
anxiety is strongly associated with menopausal hot flashes, and usually
precedes the hot flash episode. (13) Hot
flashes are caused by estrogen deficiency, and are treated with bioidentical
estradiol, which virtually eliminates them.(15)(16)(17)
Benefits of Bioidentical Estrogen
Previous chapters have discussed the safety and the
importance of bioidentical hormones.
Uzzi Reiss's book, “Natural SuperWoman”, contains an excellent
discussion of bioidentical hormones.
Chapter 4 covers anxiety, panic attacks and relief with bioidentical
estrogen.(1) Numerous articles (see
below) summarize the medical literature showing that low estrogen levels cause
anxiety and depression in humans and animals.
Estrogen treatment relieves anxiety and depression as well as virtually
eliminates the hot flashes.
Flashes, anxiety and panic attacks are estrogen deficiency symptoms, relieved
with bioidentical estrogen. SSRI
anti-depressants do not contain estrogen, and their use for estrogen
deficiency is an abuse and victimization of women who suffer from estrogen
deficiency. SSRI drugs should not be
used to treat estrogen deficiency symptoms.
What is the Mechanism of Action of Estrogen in Eliminating Anxiety and
Estrogen receptors have been found in the brain, and
estrogen increases the expression of an enzyme in the brain called tryptophan
hydroxylase-2 (TPH2). This enzyme’s job
is to convert tryptophan to serotonin, an important neurotransmitter
responsible for anti-anxiety and calming effect in the brain. These estrogen receptors have been isolated
to specific areas of the brain called the DRN, or the Dorsal Raphe Nuclei (2-6).
Effective for Perimenopausal Depression
study published in the 2001 Archives of General Psychiatry evaluated
bioidentical estrogen as treatment for peri-menopausal depression. They evaluated fifty women ages 40-55 years,
suffering from a depressive disorder and irregular menstrual periods. These women were treated with bioidentical
estrogen or placebo over 12 weeks.
Remission of depression was observed in 17 (68%) women treated with
bioidentical estradiol compared with only 5 (20%) in the placebo group. The authors concluded, "Transdermal
estradiol is an effective treatment of depression for perimenopausal women."(7)
Effective for Post-Partum Depression (after child birth)
Postpartum depression is seen in approximately 13%
of women who have recently given birth, and often remains untreated. (10) Various treatments have been tried, including
antidepressant drug therapy (SSRI's), bioidentical estrogen, individual
psychotherapy, and group psychotherapy. (10)
A study published in the 2001 Journal of Clinical
Psychiatry showed that bioidentical estrogen is effective for post-partum
depression.(8) Twenty-three women suffering from postpartum depression were
recruited from a psychiatric emergency unit.
The women were treated over 8 weeks with bioidentical estradiol
(sublingual form). Baseline serum
estradiol levels were very low suggesting ovarian failure. During the first
week of estradiol treatment, depressive symptoms resolved rapidly, and serum
estradiol levels increased considerably.
By the second week of treatment, 83% of patients showed clinical
A second earlier study published in 1996 Lancet
showed that bioidentical estrogen is an effective treatment for post-partum
depression. Sixty One women suffering
from post partum depression were given transdermal estradiol (0.2 mg daily),
and rapid improvement was reported during the first month of treatment.(9)
Many women with post-partum depression are treated
with SSRI antidepressants which does not address the underlying estrogen
deficiency and ovarian failure. In my
opinion, bioidentical hormone treatment is more effective and safer than SSRI
antidepressants or other psychoactive drugs, and should be the preferred
choice. Bioidentical estrogen has none
of the adverse effects associated with SSRI antidepressants which, after all,
may end up in mother's milk, and may have adverse effects on the breast feeding
for Post Partum Psychosis
While post partum estrogen deficiency causes
depression in 13% of patients, a smaller
subset go on to develop full blown post partum psychosis. Bioidentical estrogen
is also effective for this more severely affected group. A study done in Finland published in the 2001
Journal of Clinical Psychiatry evaluated 10 women suffering from post partum
psychosis. All had low serum estradiol
(mean of 50 pg/ml) indicating gonadal failure.
All were treated with bioidentical estradiol, with serum estradiol
levels rising to normal. Remarkably,
estradiol treatment reversed psychiatric symptoms in all patients. (11)
Estradiol Improves Cognition for Alzheimer's Dementia
In a study published in 2001 Neurology, twenty
postmenopausal women with Alzheimer's dementia were treated with bioidentical
estradiol (0.10 mg per day, topical) and compared to placebo. Sophisticated neuropsychological tests showed
improvement in attention, and in verbal, visual and semantic memory compared
with subjects who received a placebo.(12)
Reduces Anxiety in Mouse Model
Alicia A. Walf examined a mouse model in which
Estradiol, a bioidentical estrogen, reduces anxiety- and depression-like
behavior of aged female mice. Her
findings were published in Neuroscience
Research in Feb 2010. (14) Matthew N.
Hill investigated the mechanism of estradiol as an anxiolytic, and he
implicated the enzyme, fatty acid amide hydrolase (FAAH), which degrades the
endocannabinoid anandamide. The enzyme,
FAAH, is regulated by estrogen.(25) This
reveals a biochemical mechanism for how estrogen relieves anxiety. Obviously, this is a fertile area for new
research, as the exact mechanism has not yet been elucidated.
For references and links, see my web site: www.bioidenticalhormones101.com
Articles with related Interest:
Moods Emotions and Aging by Phyllis Bronson
References for 12. BioIdentical
Hormones Relieve Anxiety
The Natural SuperWoman, by Uzzi
Reiss MD and Yfat Reiss Gendell, Avery Trade , 2008. web site page containing references
for the Estrogen chapter.
2009 January 23; 158(2): 456–464. Estrogen decreases 5-HT1B autoreceptor
mRNA in selective subregion of rat dorsal raphe nucleus: inverse association
between gene expression and anxiety
behavior in the open field. by Ryoko Hiroiab and John F.
Endocrinology Vol. 146, No. 2 797-807, 2005 by The Endocrine Society . Novel
Actions of Estrogen Receptor-ß
on Anxiety-Related Behaviors by
Trent D. Lund, Tomislav Rovis, Wilson C. J. Chung and Robert J. Handa
Biol Psychiatry. 2005 Apr 15;57(8):938-42. Estrogen receptor-beta regulates tryptophan hydroxylase-1 expression in
the murine midbrain raphe. Gundlah C et al.
(5) http://www.ncbi.nlm.nih.gov/pubmed/19559077 Neuroscience. 2009 Oct 6;163(2):705-18.
Epub 2009 Jun 23. Estrogen receptor
beta regulates the expression of tryptophan-hydroxylase
2 mRNA within serotonergic neurons of the rat dorsal raphe nuclei. Donner N, Handa
Neuropsychopharmacology (2006) 31, 1097–1111, 2006 Nature Perspective - A Review and Update of Mechanisms of Estrogen in the Hippocampus and
Amygdala for Anxiety and Depression Behavior by Alicia A Walf and Cheryl
(7) http://www.ncbi.nlm.nih.gov/pubmed/11386980 Arch Gen Psychiatry. 2001
Jun;58(6):529-34. Efficacy of estradiol
for the treatment of depressive disorders in perimenopausal women: a
double-blind, randomized, placebo-controlled trial. by Soares CN et al.
(8) http://www.ncbi.nlm.nih.gov/pubmed/11411813 J Clin Psychiatry. 2001
May;62(5):332-6. Estrogen deficiency in severe postpartum depression:
successful treatment with sublingual physiologic 17beta-estradiol: a
preliminary study.by Ahokas A ET AL.
(9) http://www.ncbi.nlm.nih.gov/pubmed/8598756 Lancet. 1996 Apr
6;347(9006):930-3. Transdermal oestrogen for treatment of severe postnatal
depression. by Gregoire AJ ET AL.
(10) http://www.jabfm.com/cgi/reprint/16/5/372.pdf The Effectiveness of Various
Postpartum Depression Treatments and the Impact of Antidepressant Drugs on
Nursing Infants Dwenda Gjerdingen, MD, MS (J Am Board Fam Pract 2003;16:372–
(11) http://www.ncbi.nlm.nih.gov/pubmed/10817099 J Clin Psychiatry. 2000
Mar;61(3):166-9. Positive treatment effect of estradiol in postpartum psychosis: a pilot study. Ahokas A et al.
Neurology 2001;57:605-612, 2001 American Academy of Neurology High-dose
estradiol improves cognition for women with AD Results of a
randomized study by S. Asthana, MD et al.
(13) http://www.ncbi.nlm.nih.gov/pubmed/15879914 Menopause. 2005
May-Jun;12(3):258-66. The role of anxiety and hormonal changes in menopausal
hot flashes. Freeman EW ET AL.
(14) http://www.ncbi.nlm.nih.gov/pubmed/19804793 Estradiol
reduces anxiety- and depression-like behavior of aged
female mice by Alicia A. Walf and Cheryl A. Frye Neuroscience
Research, The University at Albany-SUNY, United States September 2009
Maturitas. 2004 Oct 15;49(2):140-7. A short study in the treatment of
hot flashes with buccal administration of 17-beta estradiol. Gass MS, Rebar RW,
Cuffie-Jackson C, Cedars MI, Lobo RA, Shoupe D, Judd HL, Buyalos RP, Clisham
(16) http://www.ncbi.nlm.nih.gov/pubmed/11400216 Menopause as a Measure of
Population Health - Physiology of hot flashes Robert R. Freedman 1 2 Am.
J. Hum. Biol. 13:453-464, 2001
Journal of Clinical Endocrinology & Metabolism Vol. 61, No. 4 627-632
(18) http://jcem.endojournals.org/cgi/content/full/82/2/703 Cizza
G, Gold PW, Chrousos GP. High-dose transdermal estrogen,
corticotropin-releasing hormone, and postnatal depression [letter]. J Clin
Endocrinol Metab 1997;82:704.
http://science.iowamedicalmarijuana.org/pdfs/psych/Hill%202007.pdf Estrogen recruits the endocannabinoid system
to modulate emotionality. Matthew N. Hill, Eda S. Karacabeyli, Boris B.
Gorzalka.Psychoneuroendocrinology (2007) 32, 350–357
(19) http://www.ncbi.nlm.nih.gov/pubmed/11411813 Ahokas A, Kaukoranta J, Wahlbeck
K, Aito M. Estrogen deficiency in severe postpartum depression: successful
treatment with sublingual physiologic 17B-estradiol: a preliminary study. J
Clin Psychiatry 2001;62:332– 6.
(20) http://www.ncbi.nlm.nih.gov/pubmed/9439497 Ahokas AJ, Turtiainen S, Aito M.
Sublingual oestrogen treatment of postnatal depression [letter]. Lancet
(21) http://www.ncbi.nlm.nih.gov/pubmed/8598756 Gregoire AJ, Kumar R, Everitt B, Henderson AF,
Studd JW. Transdermal oestrogen for treatment of severe postnatal depression.
Lancet 1996; 347:930–3.
(22) http://www.ncbi.nlm.nih.gov/pubmed/10591876 Ahokas A, Aito M. Role of
estradiol in puerperal psychosis. Psychopharmacology (Berl) 1999;147: 108–10.
(23) http://www.ncbi.nlm.nih.gov/pubmed/10706019 Ahokas A, Aito M, Turiainen S.
Association between oestradiol and puerperal psychosis. Acta Psychiatr Scand
(24) http://www.ncbi.nlm.nih.gov/pubmed/11317610 Granger ACP, Underwood MR. Review of the role
of progesterone in the management of postnatal mood disorders. J Psychosom
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