Beyond Blue

Beyond Blue

Hormonally Triggered Mood Disorders

On the message board of my interview with Katherine Stone, author of the blog, Postpartum Progress, reader Cindy (I can’t believe I found it!) wrote this:

Is it possible that the postpartum depression can turn into something that can last for so many years? I wish I knew for sure, but I believe what was diagnosed as postpartum for me was truly just a culmination of depression that finally just took me over. I’ve had plenty of ups and down in my life. I was raised on the “pick yourself up by your bootstraps” mentality, and had done that plenty. But when this hit me, it was different than anything I had experienced before. I’m lucky in that I never had thoughts of hurting my son, but when my depression was diagnosed, the doctors said it was postpartum. Here I am now, four years later, still working through it all.


Cindy, the more I read about hormonally triggered mental illness, the more I believe that experiences like pregnancy, childbirth, and breastfeeding–where so many hormonal shifts happen–can absolutely leave you with a severe mood disorder that you may, unfortunately, have to deal with the rest of your life.

In December, 2006 Danish researchers published a study in the “Journal of the American Medical Association” that was the first to consider schizophrenia and other kinds of mental illness (bipolar disorder, definitely) as different faces of serious postpartum depression.
The Danish study collected civic and health records from over a million first-time parents over a span of three decades, and found that the first three months after women have their first baby is riskiest, especially the first few weeks. During the first 10 to 19 days, new mothers were seven times more likely to be hospitalized with some form of mental illness than women with older infants. Compared to women with no children, new mothers were four times more likely to be hospitalized with mental problems.
In the Fall issue of “The Johns Hopkins Depression and Anxiety Bulletin” written by Karen Swartz, one of the physicians who evaluated me in Spring of 2006, I read even more about the research into hormonally triggered mood disorders:


Major depression is nearly twice as common in women as in men. About 12 million American women (but only 6 million American men) experience an episode of major depression at some point in their lives. And although bipolar disorder is equally common in men and women, bipolar depressive episodes occur more often in women. Moreover, research suggests that, at least in some women, reproduction-related hormonal changes raise the risk of depressive episodes.
Indeed, when levels of the female sex hormones estrogen and progesterone change dramatically, the risk of depression tends to rise. For example, before puberty, girls have the same or even lower rates of depression than boys. During adolescence, however, a girl’s risk of depression increases markedly. (Of course, social factors play a role as well.) Depression is common during and after pregnancy, too. Shifting hormonal levels just prior to menstruation are also linked to premenstrual dysphoric disorder, a condition marked by mood swings, irritability, and depressed mood, which affects about 4 percent of women.
Now research is calling attention to another reproductive stage that may increase the risk of depression: perimenopause, defined as the years leading up to menopause, during which estrogen levels are declining.
Two recent studies published in the “Archives of General Psychiatry” report not only that perimenopause is linked to depression, but also that, in some women, the depression is at least partly the result of hormonal changes. . . .
It is certainly true that most women experience changes in mood associated with hormonal changes. According to Jennifer L. Payne, M.D., Co-Director of the Women’s Mood Disorders Center and an assistant professor of psychiatry at Johns Hopkins, about 80 percent of women report some premenstrual emotional changes, and about the same percentage experiences “baby blues.” Though the numbers are unclear, a significant proportion of women also report perimenopausal mood changes. Of these perimenopausal women, however, a much smaller number experiences significant mood changes or develops a full-blown major depressive episode. In this susceptible subgroup, the hormonal changes might trigger “normal” mood changes that can then “take on a life of their own.”
It is important to note that both the postpartum time and the perimenopausal phase are associated with life events that could, in theory, trigger major depressive episodes in susceptible women. Becoming a mother, for example, is a stressful (though wonderful) life event that is also associated with sleep deprivation. Pinning the blame entirely on fluctuating estrogen levels is likely too simplistic. . . .
Says Dr. Payne: “What we currently refer to as depression is likely several different illnesses or broken parts that lead to the syndrome that we call depression. Hormonal changes might be a major factor in one woman’s illness, but not in another’s.”
“I’m suspicious,” continued Dr. Payne, “that there is a subgroup of women who are particularly sensitive to times of hormonal change—that the hormonal changes by themselves directly trigger mood changes and depression in these susceptible women—and my work is geared towards identifying the biology underneath those mood changes to better understand what the ‘broken part’ is in this type of depression. But it is unlikely that hormonal fluctuations are the culprit in every woman who develops depression at times of hormonal changes.”

  • Wisdum

    This is my personal opinion, but I truly believe that all mental dis-order and dis-ease is caused by hormonal triggers and or imbalance. It is more manifest and prevalent in females than males, but males obviously have dealt with it. The problem with males, is they are for the most part, not physically adapted to deal with it. Women, since the beginning of time have hade to deal with incredible swings in mood behavior, while men just had to deal with “I think I’ll go fishing !” We now have a serious evolution problem, there appears to be a role reversal syndrome going on here. A lot of it is caused by Way too much pressure to survive (and that coupled with “Instant Gratification” syndrome) In our dire need to find some kind of peace and solitude in our Lives, we have increased our “cost of Living Index” to an unbelievable all Time high.(and you wonder why we need all these drugs and crap to find tranquility ?, hah !) I reccommend Gary Zukav’s book Seat Of The Soul, to be able to get a handle on what in Hell is going on here! Unless we can evolve into a multi-sensory perception, we are ALL done for !
    LUV 2 ALL

  • Jennifer

    Therese- have you read some of the recent work that links depression to inflammations? I have some links and other resources, I’ll try to email them to you this week.

  • Lynn

    My first major depression was in high school, alot was involved in it but as time has progressed I have found that the pre menstrual time is, for me, horrible. I cannot control it at all, but realised that about a week after my period starts I feel like I could conqure the world. It has always been this way. No one believed me about this, I still get grief for it at fifty, no menopause yet( I can’t wait).This hormonal stuff is very valid and there is true suffering that goes with it.Thank you for bring it to light here. I believe for me the main trigger for any of my longer depressions have been hormonal.I do think that thyroid problems are a hugh contributor also. You touch all the bases here on BB. Thank you! :)

  • cathy

    My depression and anxiety are influenced by regular hormone fluxuations; my mood issues deepened dramatically after the birth of my daughter and have continued to get worse as I move through perimenopause.
    It has helped me to realize that depression and anxiety isn’t just “all in my head.” It’s in my *body,* too, and I need to listen to its rhythms in order to get well.
    Lately, I’m trying to improve my mental health by nourishing my whole nervous system with the right foods and some herbs. It has been helping. Some. I guess that’s a good sign. Maybe more improvement will come in time.

  • Michael

    Yes, postpartum can have a lasting effect in women…and men. After having a child in 98, my wife stressed to the point of divorce, claiming I was viloent. She had two restraining orders placed on me which ment jail time. During the divorce she forced me (with the help of the court system..and how she convinced them I don’t know)to pay and ungodly child support based on my best month (self employed). I couldn’t maintain the support and asked for a reduction. Her reply..”You can let my new husband adopt her..then you won’t have to pay anything”. This also ment me or my family could never see her again until the age of accountability. I, having no real choice, accepted. Depression layed on me for 4 years and 5 months until it lifted. I lost my business,truck,home and most of my posessions.Now in 2007 I am just really begining to stand firm on the ground. Yes, postpartum effects everyone. EVERYONE.

  • Lynne

    I’m guessing that it’s far too easy to slap a label on some depressions and call it hormonal. I’m sure there’s WAY more to it! On a slightly lighter note I’ve heard that men go through MEN-OH-PAWS by chasing women and riding motorcycles! Sounds like a lot more fun than we women have. Personally I’d rather go shopping!

  • Cindy

    Thanks for the follow up on this. I can’t remember if I mentioned in that original post that less than six months after my second son was born and my depression was still being considered postpartum, I had to have a full hysterectomy due to stage 4 endometriosis. This, of course, through me into menopause. Reading about all the research and possible links between hormonal changes and depression in women is extremely interesting. But, more interesting to me is wondering why none my doctors have considered putting some of these pieces together. They may not be able to “CURE” me of depression, but I would think they could better understand and plan more effective treatment. I’ve felt like I was in a real “Catch 22″ over these years. My psychiatric drs. are always finding “reasons” from my life that are causing the depression, and my physical drs. are always saying that the depression can cause physical symptoms whenever I have something they can’t stamp a name on, like “it’s just a virus”.
    While I know that it is true that both events that have occurred over these past few years are a part of my depression and I do seem to catch every virus that’s going around, I don’t believe it is simply the concurrence of those things driving my depression. I will start doing some more research into the possible affects my hormonal changes could have in contributing to my depression.
    Well, I must be having a good day! I almost think what I wrote made some sense. :) Hope everyone else has as good a day!

  • zana

    Wow! I have been wondering about this very thing the past month or so, asking myself “When did this all begin? How did I get here?” I suffered with accelerating PMS from my late 20’s on. I went on the pill partially to lessen the monthly symptoms at 34 but couldn’t tolerate any of the ones I tried every three months for two years. Then I tried Deprovera shots but boy, did they make things worse in the long run. I ended up in the ER! We decided to just stop all the hormone tampering because it seemed my body was just too sensitive.(Hmmm, an acceptable chemical reaction) A short while afterwards I discovered I was pregnant. We were ecstatic. It was going to be my husbands first child. At my 16 week appointment we were going to have the second sonogram. My husband went with me for the 1st time and I was so glad he was there because we discovered our baby had died. We were devastated. My children were crushed as well because they had been so excited that a new brother or sister would be joining our family. My daughters had already started picking out gifts and my 5 year son had prayed for a baby brother so there “wouldn’t be SOOO many girls in our family.” I could not stop crying. It worsened after my milk came in few days later. But, people kept telling me I was lucky, that it was probably natures way of taking care of the something wrong that must have been going on in utero. I read this wonderful book called “Empty Arms” that said “There is no sadder image than that of a woman who has just lost her baby as she looks down at her empty arms.” And I’m not saying that any other grief is less painful here. Just that at that time, those words were a comfort to me because it validated the depth of my sorrow. Even though I didn’t carry the pregnancy to the end, from the moment I knew I was carrying a child, our son or daughter was just as important as my other children. I finally went to the doctors because I didn’t seem able to control my emotions and it scared me. His nurse told me, “I’m so glad you came in. It was the right thing to do. We just had a patient with a four month old baby and post-partum blues…she killed herself.I wish she had come in.” I was put on Prozac but stopped because we were afraid of anti-depressants, thought only “crazy” people took them and eventually believed that it was just normal grief I was experiencing. Two years later the same thing happened. That time we couldn’t even talk about it because we just couldn’t fathom that it had happened again. That was the last time we tried to have a baby. Since then it’s been a roller coaster ride. I had fibroids and other difficulties and finally had a full hysterectomy because I was so tired of all the hormone/reproductive challenges. I’ve been a raging, ranting,irritable woman some days and others, I’ve been so depressed I could barely get out of bed. I’ve felt hopeless for years, never expecting anything good to happen to us and being terrified of the next shoe that would drop. I had a complete and utter breakdown this year after discovering my husbands affair and his departure from our family. Today I received divorce papers in the mail. Months ago, I would have been suicidal again. But thanks to an exceptional mental health center with an amazing staff and program, I am not lying in my bed exhausted from crying. I am not suicidal which has been my gut reflex to anything that creates any kind of stress. I AM sad though, because I believe in my heart that the effects of the hormonal ups and downs had a profound influence on my body and definitely contributed to what I have been through, what we’ve all been through. Sadly, my husband thinks I’m crazy, doesn’t want to hear what he thinks are justifications for my erratic, “overly emotional” responses to out lives and told me he has “moved on.” I still carry hope that somehow, if he became educated about depression and BPD as something I did not create because of character flaws, he might have some compassion for me,could forgive me and still love me as a husband with a wife with any other illness probably would. I know I have to go on and it seems like he is not the least bit interested in our family any more now. I will have to come to terms with his decision. I know I’ve said this before on this blog, but my heart is broken. I miss him and the way my family once was. I want to see my children happy again. I am trying to stay strong but it is hard. I am so grateful to all of you who share your very personal, honest thoughts here… and so glad your all saying what’s real, not just some overly positive Pollyanna fluff. I am trying to look at the glass half full these days and I am beginning to trust in the idea that life can be good, I am not jinxed, good things will happen to me and my “moods” are manageable. Perhaps my husband isn’t strong enough to be real and deal with life as it is instead of as he thinks it should be. Who knows what the future brings? It is a real comfort to see how many times I’ve been thinking something, only to open Beyond Blue and find a discussion that is exactly the thoughts I’ve had on my mind. Amazing! Blessings.

  • Pingback: Male Depression: An Interview with Peter V. Rabins, M.D. « Therese J. Borchard

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