Depression, Thyroid and Menopause (return to psychoneuro.com)
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 psychiatric illness.
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 http://www.drugintel.com/drugs/statins/
international_coenzyme_q10_assoc.htm ).