Psychoneuroendocrinology.com
R.S. Isaac Gardner M.D.
R.S. Isaac
Gardner M.D.

525 College Ave.
Santa Rosa,
California, 95404.

Visit two new
additions to this
website about
PTSD and
Bioidentical
Hormone Therapy

Depression, Thyroid and Menopause      (printer friendly page)

You may also visit www.psychoneuro.com to access this website.

As a psychoneuroendocrinologist, I have over 35 years of experience
diagnosing and treating depression, anxiety, thyroid and adrenal disorders,
menopausal and perimenopausal depression, osteoporosis, and
nutritional imbalances. If you are in California and would like a consultation
or further information, click here. My practice is currently located in Northern
California, Sonoma County, in Santa Rosa.

What is Psychoneuroendocrinology?

Psychoneuroendocrinology is the clinical study of hormone fluctuations and
their relationship to human behavior and psychiatric illness. It is the blend of
endocrinology and psychiatry.

Clinical Relevance

Many patients, whether medical patients or psychiatric patients, feel they
are receiving suboptimal care and feel their hormones are somehow playing
a role in their illness, and yet this is commonly ignored in their treatment.

Patients often sense that they have a chemical imbalance. Appropriate
endocrine testing can rule out subtle endocrine influences that may play a
role in their illness. For example, subclinical hypothyroidism may be
diagnosed, indicating a thyroid disorder that has more than subtle influences
on the patient's sense of wellbeing. The mind/body dichotomy is never more
apparent than in dealing with illness effecting the brain. Obviously, so called
physical illness coexists with psychological illness so frequently that it is the
rule rather than the exception. When one has a heart attack it
may be initiated by neuroendocrine changes triggered by psychological
events originating in our brains and propagated to end organs, including the
heart. It is virtually never mind OR body; it almost always is a mind/body
event. So ignoring the psychological elements of illness sometimes leads to
inadequate medical care. My goal is to integrate the mind/body in a
comprehensive approach to the patient's care. Therefore, during an
interview we may switch from psychological to physical in a split
second with no thought to that shift. After all, our mind/body knows of no
such split.

Psychoneuroendocrinology is particularly relevant to understanding the
perimenopause and menopause. Part of this understanding includes
considering hormone replacement therapy with bio-identical hormones as a
therapeutic option after considering the patient's genetic, family and medical
history. When hormone replacement therapy is contraindicated, other
treatments are often an effective alternative. For information about other
treatments, vitamins, and nutraceuticals visit farmacopia.net.

Psychoneuroendocrinology is playing an increasing role in the diagnosis and
treatment of mood and anxiety disorders.  The study of the
hypothalamic-pituitary-adrenal axis has become a fertile area of
investigation in studying psychiatric disorders. Cortisol, an adrenal hormone,
is frequently elevated in depression. This has led to the Dexamethasone
Suppression Test that is positive in 50% of clinical depressions. The
regulatory factors involved in cortisol secretion, including the hypothalamic
hormone, CRF, are being studied as starting points for the identification of
CRF receptor antagonists, which may become useful antidepressants.  (See
Neurocrine Biosciences).  Prolactin is a pituitary hormone that is a useful
marker of neuroendocrine dysfunction.  Its elevation can lead to suppression
of menstrual periods and associated psychiatric illness. Premenstrual
depression is another neuroendocrine mediated disorder that is being
carefully studied  (see Psychoneuroendocrinology. p. 245). The role of stress
in many disorders is an active area of investigation in
psychoneuroendocrinology.  One of the stress disorders, Posttraumatic
Stress Disorder paradoxically is associated with a low serum cortisol. The
thyroid disorders including hypothyroidism and hyperthyroidism commonly
occur, or are causative factors, in mood disorders and should be ruled out in
any complete evaluation of depression or mania. Vitamin deficiencies can
provoke depression in susceptible individuals, and therefore screening for
B12 and folic acid deficiency should be a part of the evaluation of mood
disorders.  Finally, in men a low testosterone level can be associated with a
clinical depression with decreased libido, and therefore should be ruled out
in men presenting with a mood disorder.

Headline: Statin Drugs and Coenzyme Q10

The statin drugs including Lipitor, Lescol, Mevacor, Pravachol, Crestor and
Zocor which are commonly prescribed to lower cholesterol all have the
inherent property of inhibiting the synthesis of Coenzyme Q10. This
mitochondrial coenzyme is an important cofactor involved in energy
production in cells. This is relevant to side effects of statin drugs including
muscle pain and weakness leading to myopathy. Because the pathways
leading to cholesterol synthesis and Coenzyme Q10 synthesis overlap, the
statin drugs interrupt both pathways. To prevent this complication it is
recommended that anyone on statin drugs takes at least 100 mg of
Coenzyme Q10 a day. The International Coenzyme Q10 Association sent a
letter to the FDA in 2001 regarding this recommendation. See letter to FDA.
Copyright 2008 R.S. Isaac Gardner.