Hormonal Impacts on Mental Health - Part 2

The influence hormones have on mood and mental health is incredibly diverse. As a naturopath, my role is to determine what underlying factors contribute to symptoms of anxiety and depression. By addressing these underlying factors, it optimizes the body’s ability to handle emotional stressors. In Part 1 of the Hormonal Impacts on Mental Health, I outlined how imbalances in the female hormones estrogen and progesterone can lead to symptoms of anxiety and depression, and particular situations where I see this in practice. Here in Part 2, I’ll be shedding light on various other hormones that may be underlying mental health concerns. These include thyroid hormone, vitamin D (surprise, it’s a hormone!), and cortisol.



THYROID


The thyroid is an underrated gland that sits at the front of the neck above the sternum and wraps around the windpipe. It is a key player in regulating metabolism of the cells in our body. When the thyroid is not producing enough thyroid hormone this results in symptoms of hypothyroid including weight gain, constipation, dry skin, thinning hair, cold intolerance, brain fog, low energy, and depression.


The prevalence of hypothyroidism is higher in those diagnosed with major depressive disorder than within the general population (1). Interestingly, the rates of hyperthyroid (overactive thyroid) are also higher in those with major depressive disorder than the general population, highlighting the importance of testing thyroid function.


Testing thyroid function is done by looking at blood levels of TSH (thyroid stimulating hormone) and thyroid hormones (most commonly T4). TSH levels tend to be high in those with hypothyroidism (low functioning thyroid). For severe depression, TSH should be below 4 MIU/L, however optimal TSH is found to be below 2.5 MIU/L (2).


Treating the thyroid can be helpful for depressive symptoms particularly in those with overt hypothyroidism (3). In overt hypothyroidism, thyroid hormone replacement therapy may be required. In those with sub-optimal functioning thyroid, nutritional and herbal therapies are often employed.


VITAMIN D


Although it is commonly considered a vitamin, vitamin D actually acts as a hormone in the body due to its chemical structure. It plays important roles in bone health, immune function, and mood. An insufficiency or deficiency in vitamin D may contribute to Seasonal Affective Disorder (SAD) and even mild to severe depression.


Testing of vitamin D levels is done in the blood to determine whether an insufficiency (sub-optimal level) or deficiency is present. In Canada, around 30% of people have insufficient levels of vitamin D with those age 20-39 years old most likely to fall below the cut off (4).


Vitamin D supplementation may be effective in reducing symptoms of depression (5). The form of supplementation depends on whether an individual in considered insufficient of deficient in vitamin D and may include oral supplementation or intramuscular injection. Of course, the most enjoyable way of getting vitamin D is through sunshine!


CORTISOL


Cortisol is one of the body’s stress hormones. It is produced by two small glands that sit on top of each kidney known as the adrenal glands. Cortisol is typically highest in the morning to promote wakefulness, and slowly decreases throughout the day so that by the time we got to sleep it is lowest. In times of stress, the adrenal glands produce greater amounts of cortisol and at certain times this may be beneficial. Elevated cortisol levels however, are related to high blood pressure, sleep disturbances, and anxiety. A dysregulation in morning cortisol levels in particular is associated with anxiety disorders (6, 7).


Cortisol can be tested through blood or saliva. Blood testing can look at morning and evening cortisol levels, while saliva testing allows us to measure cortisol at different time points throughout the day. A healthy ‘cortisol curve’ should look like the following:

Cortisol is also interrelated with blood sugar levels. An increase in cortisol results in a spike in blood sugar. A subsequent drop in blood sugar can contribute to ‘hangry’ feelings such as shakiness, sweating, irritability, and even anxiety. Because the two are so interrelated, it is important to balance both cortisol and blood sugar levels in order to avoid drastic changes that may lead to mood disturbances.


Cortisol balancing involves regulating blood sugar levels as well as supporting overall adrenal function. This is done through promoting low glycemic dietary changes, as well as using adrenal supporting nutrients and herbs.


OPTIMIZING MENTAL HEALTH involves addressing these and other underlying physiological factors such as neurotransmitter imbalances. Not to be forgotten however, is the mental and emotional work that is required to overcome unhealthy thought patterns as well as past traumas. As a naturopath, I emphasize the importance of treating both mind and body.

If you’re interested in learning more about how your hormones may be affecting your mental wellness and what options are available, come see me at Juniper Family Health (778-265-8340) in Victoria, BC.


References:


1. Wu, E., Chien, I., Lin, C., Chou, Y., Chou, P. (2013). Increased risk of hypothyroidism and hyperthyroidism in patients with major depressive disorder: a population-based study. Journal of Psychosomatic Research, 74(3), 233-237.


2. Talaei, A., Rafee, N., Rafei, F., Chehrei, A. (2017). TSH cut off point based on depression in hypothyroid patients. BMC Psychiatry, 17, 327.


3. Gulseren, S., Gulseren, L., Hekimsoy, Z., Cetinay, P., Ozen, C., Tokatlioglu, B. (2006). Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction. Archives of Medical Research, 37(1), 133-139.


4. Janz, T., Pearson, C. (2015). Vitamin D blood levels of Canadians. Statistics Canada, Retrieved from https://www150.statcan.gc.ca/n1/pub/82-624-x/2013001/article/11727-eng.htmShaffer


5. J., Edmondson, D., Wasson, L., Falzon, L., Homma, K., Ezeokoli, N., Li, P., Davidson, K. (2014). Vitamin D supplementation for depressive symptoms: a systematic review and meta-analysis of randomized controlled trials. Psychosomatic Medicine, 76(3), 190-196.


6. Vreeburg, S., Zitman, F., van Pelt, J., DeRuk, R., Verhagen, J., van Dyck, R., Hoogendijk, W… Pennix, B. (2010). Salivary cortisol levels in persons with and without different anxiety disorders. Psychosomatic Medicine, 72, 340-347.


7. Hek, K., Direk, N., Newson, R., Hofman, A., Hoogendijk, W., Mulder, C., Tiemeier, H. (2013). Anxiety disorders and salivary cortisol levels in older adults: a population-based study. Psychoneuroendocrinology, 38(2), 300-305.

Naturopath Victoria, BC

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