Colette Dowling, LCSW, who wrote the following article on anxiety therapy, depression therapy, and how hormones relate to mood disorders, is the author of "You Mean I Don't Have to Feel This Way?": New Help for Depression, Anxiety and Addiction.

Anxiety Therapy, Depression Therapy, and How Hormones Affect Mood

Colette Dowling, LCSW

Interestingly, estrogen is a requirement for the production of serotonin. Medical research has shown definitively that estrogen’s link to serotonin and other neurotransmitters accounts for women’s vulnerability to mood disorders across the reproductive lifespan–whenever estrogen levels drop.

The Impact of Estrogen

Women’s brain chemistry is exquisitively sensitive to the ebb and flow of our reproductive hormones. The impact of both estrogen and progesterone creates changes in the brain that can lead to disturbed mood. As Sichel and Driscoll have written, in their excellent book, Women’s Moods, the estrogen-serotonin connection is “the critical vital component” in understanding what women need in order to sustain mental health. Too few clinicians in the medical and mental health professions are knowledgeable about the effect of hormone changes on women's mental health.

Estrogen is responsible for maintaining the orderly firing in the brain of a number of neurotransmitters--among them, dopamine, norepinephrine and acetylcholine, as well as serotonin. This orderly firing is what sustains a balanced mental state.

Estrogen can be thought of as the body’s own antidepressant and mood stabilizer. When estrogen levels rise (as they do each month, for example, when menstruation begins), serotonin levels rise too, and mood improves. When estrogen drops (and along with it, serotonin), the reverse happens: mood becomes affected negatively.

As we know, a fair percentage of women have a rough time with anxiety and depression, premenstrually, when their estrogen and serotonin levels are low. (Note that these levels start dropping off suddenly, at mid-cycle, precisely when ovulation begins.) This is a time when women may need to take action to offset lowered hormones--exercise to get the endorphins pumping, meditate to calm anxiety.

The sky-high levels of estrogen during pregnancy often produce enhanced mood states. But within hours of the baby’s delivery, surging levels of estrogen diminish very abruptly, causing a dramatic shift in the amount of serotonin the new mother has in her brain. This is the hormone action that can trigger post-partum depression (and we now know that post-partum depression affects a much higher percentage of women than used to be recognized.)

It is the same action, a fall-off in estrogen bringing down serotonin levels, that can cause anxiety and depression to set in during the perimenopause.

Because hormones of all types are so intricately involved with one another, stress hormones can throw off the complex neurochemical balance required for sustaining a woman’s mental health. The body’s stress hormones are cortisol and adrenaline. These are what send your heart pumping and your stomach churning when you're afraid or anxious. The degree of anxiety determines how much stress your brain is being loaded with. Lose your car keys and your anxiety level may be 3 on a scale of 1 to 10. Lose your child in a crowded store and that anxeity will zoom to 7 or 8. Lose a spouse in a car accident and your anxiety will go off the charts. Such a degree of trauma can trigger the brain to create a hyperalert arousal system that could last for the rest of your life.

But even smaller stressors can set one up for a hyperlert arousal system. For example, the stress of leaving home for college can be enough to chemically dysregulate brain neurotransmitters. I was very young when I went away, and gong off to college stressed me enough to cause a depression that made studying difficult. I couldn’t focus or memorize– both cognitive signs of depression. Eventually, when I got used to being separated from my parents, I began to recover, but not before my grades plummeted so low I was at risk for losing my scholarship. Fortunately, spring came (light enhances serotonin), my little women’s college in Washington began feeling more familiar, and my brain was able to lift my mood again.

Even though the hormones will balance out again once a stressful event subsides, the dysregulation can leave one sensitized. A woman who’s already experienced stress in her life will find that her biology can easily tip into the dysregulated state it learned earlier. It's as if the earlier stress primed the pump.

To sum up, as Sichel and Driscoll write, a series of stressful events will load, strain and eventually change your brain’s mood pathways. “This sensitization becomes so profound that a normal female event such as the premenstrual period can easily trigger the biochemical disruption that leads to depression.”

All too often, women fear that they have some character flaw that is causing their misery, and they can become overwhelmed by feelings of worthlessness. Some, afraid of being judged, will let guilt keep them from seeking treatment.

Women benefit from learning how different parts of their brain may be miscommunicating, and how medication or alternative methods such as stress reduction and mindfulness techniques can improve the communication between brain and hormones, allowing mental/emotional balance to return.

Colette Dowling has written eight books, including "You Mean I Don't Have to Feel This Way?": New Help for Depression, Anxiety and Addiction.

For an appointment contact Colette at dowlingcolette@earthlink.net, or at 718-594-0201.