Articles

HRT and Maintaining Mental Health

By Paul Hueseman, Pharm.D.

Women at the age of menopause commonly experience feelings of depression, reduced mental clarity, difficulty concentrating, and "fuzzy thinking" that cannot be pinpointed to any specific event. It is common to hear from patients "I am so depressed and have no reason to be - my life is perfect - it is everything I always wanted - but I feel so depressed," or "sometimes I feel like I am losing my mind," or "I just can’t remember like I used to, even the names of people I have known for years." It is very frustrating for these women, because so often the knee-jerk response from their physician is to prescribe an antidepressant, such as "PROZAC" or to imply that these symptoms are just a normal part of aging. Often, there is something else going on - hormone imbalance.

There is a significant amount of data that supports the theory that estradiol and progesterone have a significant impact on elevating serotonin levels, as well as a significant impact on other important neurotransmitters such as dopamine and GABA. Neurotransmitters are the chemical messengers in the brain that transmit signals. When the amount of these neurotransmitters is reduced in the brain, the signals do not travel, which can cause a wide array of problems including depression, mental fogginess, and decreased cognition (i.e. decreased knowing, awareness, perception, reasoning, and judgment) in general. In fact, medications that treat depression work by increasing the amount of these neurotransmitters available to work in the brain.

The results of several studies point to hormone replacement therapy, including estradiol and progesterone, having a positive impact on brain functioning and health. One study demonstrated elderly patients with lower estrogen levels may have cognitive impairment and may be less able to perform common daily activities than those with higher levels. In this study, they looked at the relationship between a person's estradiol level, and the risk of dementia or memory loss in the elderly. Results showed a direct correlation between estradiol levels and cognition and behavior in the elderly. In fact, lower estradiol levels were associated with a higher risk in the occurrence of dementia, worse cognition and more behavioral disturbances. Although researchers believe that optimal levels of estradiol are needed to maintain brain function in later life, estrogen replacement therapy may not be effective once symptoms of Alzheimer's disease are present.1

It also has been shown that the brain is better able to use serotonin after starting on estrogen replacement therapy. Improvements have been shown in working memory, ease of speech and overall cognitive ability.2, 3 Other studies have shown that progesterone helps dopamine work in the brain, although the effect is less potent than estrogenrogen.4 Progesterone also could enhance the effect of estrogen.

Clearly, there is a lot of research in this area. While there seems to be no clear-cut answer, one thing is clear - ask any woman who went for a substantial time period without any hormone replacement therapy, and experienced complaints of short term memory loss, difficulty concentrating, "fuzzy thinking", and then went on hormone replacement therapy - and she will tell you how much better she feels!

1. Archives of Neurology, 2002;59:385-389
2. American Journal of Psychiatry 2003; 160: 1522-4.