Hormonal Depression: Signs, Causes, & Treatment Options

What Is the Connection Between Hormones & Depression?

Changes in hormone levels, particularly estrogen and progesterone, can trigger or exacerbate depression. Biologically, these hormones shift during puberty, menstrual cycles, pregnancy, postpartum, and menopause, which increases the risk of a woman developing depression during these times. Additionally, genetic predispositions may make certain individuals more susceptible to hormonal depression.

Can Men Have Hormonal Depression?

Men can also experience hormonal depression. While hormonal fluctuations in men may not be as pronounced as in women, changes in testosterone levels can still affect mood and cause depression in men.³ Factors such as aging, stress, or medical conditions like hypogonadism can lead to imbalances in testosterone levels, contributing to symptoms of depression. Men need to recognize these hormonal influences and seek appropriate support and treatment if experiencing depressive symptoms.

What Can Cause Hormonal Depression?

Hormonal depression can stem from a combination of biological, environmental, and genetic factors. Biological factors include changes in hormones such as estrogen, progesterone, and testosterone, which affect activity in the brain. Environmental stressors like chronic stress, trauma, or significant life changes can worsen hormonal imbalances and contribute to depressive symptoms.

Here are seven situations where hormone changes can trigger or exacerbate depression:

1. Menstruation

When females hit puberty and begin to menstruate, they experience changes in hormones and stress that can impact mood stability, leading to symptoms of depression. Estrogen in the brain helps mood and thinking, which can lift mood. However, progesterone can make mood worse by changing serotonin levels. The week before your menstrual cycle, your body will decrease the production of estrogen and increase your production of progesterone, increasing depression symptoms.²

2. Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) characterized by debilitating emotional and physical symptoms. These symptoms typically occur in the luteal phase of the menstrual cycle and can include intense mood swings, irritability, depression, anxiety, and physical discomfort such as bloating or breast tenderness. Unlike PMS, PMDD symptoms are more severe and can significantly impair daily functioning and quality of life for affected individuals.

3. Perinatal Depression

Perinatal depression, also known as pregnancy or postpartum depression, is a mood disorder that affects individuals during pregnancy or after childbirth. Hormonal changes, particularly a rapid decline in estrogen and progesterone levels following delivery, can contribute to the onset of depressive symptoms. These hormonal fluctuations, coupled with factors such as sleep deprivation, physical discomfort, and the stress of adjusting to parenthood, can exacerbate feelings of sadness, anxiety, and hopelessness in new parents.

4. Menopause

Menopause is a natural process that marks the end of a woman’s reproductive years, typically occurring in their late 40s or early 50s. During menopause, the decline in estrogen levels can contribute to the development of depression. Estrogen plays a significant role in regulating mood, and its reduction can disrupt brain function, leading to symptoms such as sadness, irritability, fatigue, hot flashes, night sweats, and sleep disturbances.

5. Hormonal Contraceptives

Hormonal contraceptives, such as birth control pills, patches, or hormonal IUDs, can impact mood. While some individuals may experience improvements in mood and reduced symptoms of premenstrual syndrome (PMS), others may experience adverse effects such as depression or mood swings. The specific hormonal formulation, dosage, and individual differences in hormone sensitivity can contribute to varying effects on mood.

6. Low Testosterone

Low testosterone levels in men can contribute to depression due to the hormone’s influence on mood regulation and overall mental well-being. Testosterone is crucial in maintaining emotional stability, energy levels, and motivation. When testosterone levels decline, individuals may experience symptoms such as fatigue, decreased libido, irritability, and feelings of sadness or hopelessness, all of which are common indicators of depression.

7. Thyroid Issues

Thyroid function plays a crucial role in mood regulation, with both hypothyroidism and hyperthyroidism capable of causing depressive symptoms. In hypothyroidism, an underactive thyroid gland leads to decreased production of thyroid hormones, resulting in symptoms such as fatigue, weight gain, and low mood. These symptoms can mimic those of depression, leading to feelings of sadness, lethargy, and difficulty concentrating.

Conversely, hyperthyroidism, characterized by an overactive thyroid gland and excessive thyroid hormone production, can also impact mood, causing symptoms such as anxiety, irritability, and restlessness, which may resemble depressive symptoms. Monitoring thyroid function and addressing thyroid disorders through medication or other interventions are crucial for managing associated mood disturbances effectively.

Symptoms of Hormonal Depression

Symptoms of hormonal depression are similar to symptoms of major depressive disorder, so it can be hard to distinguish one from the other. A key differentiating factor is if a person experiences these symptoms before or during their menstrual cycle. Fatigue, lack of energy, difficulty concentrating, and physical symptoms like headaches or muscle aches are common.

Common symptoms of hormonal depression are:

• Persistent sadness: Individuals with hormonal depression may experience persistent sadness or feelings of emptiness that last for extended periods, often without a clear reason. This can include random bouts of crying or feelings of unexplained despair.
• Irritability and mood swings: Heightened irritability and frequent mood swings are common manifestations of hormonal depression, causing individuals to react more strongly to minor stressors. Often, this experience is referred to as PMS, which can be misleading.
• Appetite and weight changes: Hormonal depression can lead to significant changes in appetite, resulting in either increased or decreased food intake, which may consequently lead to weight fluctuations. Changes in hormones can lead to different food cravings or a lack of desire to eat.
• Sleep disturbances: Disruptions in sleep patterns are common, with individuals experiencing insomnia (difficulty falling or staying asleep) or hypersomnia (excessive daytime sleepiness) despite adequate rest. Progesterone may increase sleep, while estrogen may decrease it.⁴
• Fatigue and lack of energy: Persistent fatigue and feelings of lethargy are characteristic symptoms, even after sufficient rest. Depression can make it difficult to get out of bed, making it challenging to engage in daily activities.
• Difficulty concentrating: Hormonal depression often impairs cognitive function, making it difficult to concentrate, remember information, or make decisions effectively.
• Loss of interest and hopelessness: Individuals may lose interest in activities they once enjoyed and feel a pervasive sense of hopelessness or worthlessness about the future, which can significantly impact their overall quality of life.

How Is Hormonal Depression Diagnosed?

To determine whether a person’s depression is due to changes in hormones requires a comprehensive evaluation by a healthcare provider. This may include a thorough medical history, physical examination, and psychological assessment. Laboratory tests to measure hormone levels, such as estrogen, progesterone, testosterone, and thyroid hormones, may also be conducted to identify hormonal imbalances.

Diagnosing hormonal depression can be challenging due to the overlap of symptoms with other mental health disorders and the variability of hormone levels among individuals. Additionally, hormonal fluctuations throughout the menstrual cycle or life stages such as puberty, pregnancy, or menopause can further complicate diagnosis, highlighting the need for careful consideration of symptoms and collaboration between healthcare providers to diagnose and treat hormonal depression accurately.

When to Seek Professional Support

Individuals should consider seeking professional help for hormonal depression if they experience persistent and severe symptoms that significantly interfere with daily functioning and quality of life. Professional support can be found through primary care physicians, mental health professionals such as psychologists or licensed therapists, or specialized clinics focusing on hormonal health. An online therapist directory is a great way to find local therapists or counselors who take insurance and specialize in treating hormonal depression.

It is recommended that women track their menstrual cycles and/or symptoms for 1-3 months to accurately show what they are experiencing. Finding a provider who specializes in women’s health and wellness can reduce some of the frustrations that occur when seeking support.

If symptoms warrant medication management, individuals may consider seeing a psychiatrist, who can assess symptoms, prescribe appropriate medications, and provide ongoing monitoring and adjustments as needed. Online psychiatrist options can be a convenient choice for finding depression medication management, offering flexibility and accessibility for individuals who may have difficulty accessing in-person appointments or prefer the convenience of virtual care.

Treatment for Hormonal Depression

In addition to therapy and medication that is typical of depression treatment, a comprehensive treatment plan for hormonal depression may involve specific interventions targeting hormonal fluctuations. Engaging in regular physical activity, maintaining a balanced diet, getting adequate sleep, and reducing stress through relaxation techniques or mindfulness practices can all support overall mental well-being and alleviate symptoms of depression.

A comprehensive treatment plan for hormonal depression may involve: 

• Hormone therapy: Hormone therapy involves administering hormones, such as estrogen, progesterone, or testosterone, to address hormonal imbalances and alleviate symptoms associated with hormonal depression. By restoring optimal hormone levels in the body, hormone therapy can help regulate mood, improve energy levels, and reduce symptoms of depression.
• Cognitive behavioral therapy (CBT): CBT for depression can help individuals recognize and challenge distorted thinking related to hormonal fluctuations, develop effective coping strategies, and improve mood regulation skills. By addressing both cognitive and behavioral aspects of depression, CBT equips individuals with practical tools to manage symptoms and enhance overall well-being.
• Dialectical behavior therapy (DBT): DBT for depression helps individuals manage emotions, improve interpersonal relationships, and develop coping skills. In the context of hormonal depression, DBT can assist individuals in regulating intense emotions often exacerbated by hormonal fluctuations.
• Medications: Medications for depression, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), or atypical antidepressants, may be prescribed to alleviate depressive symptoms by regulating neurotransmitter levels in the brain.
• Support groups: Participating in support groups or peer counseling programs can provide individuals with a sense of community, validation, and encouragement from others who have experienced similar struggles with depression.
• Lifestyle changes: A balanced diet of fruits, vegetables, whole grains, and lean proteins can support hormonal balance and well-being. Regular exercise, such as brisk walking, yoga, or swimming, can help alleviate depressive symptoms by releasing endorphins and reducing stress.
• Stress reduction techniques: Stress reduction techniques like mindfulness meditation, deep breathing exercises, and progressive muscle relaxation can also be beneficial in managing hormonal fluctuations and promoting emotional stability.
• Transcranial magnetic stimulation (TMS): TMS for depression is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain. It is often used for individuals who have not responded to antidepressant medication.
• Electroconvulsive therapy (ECT): In cases of severe or treatment-resistant depression, ECT may be considered, involving the administration of electric currents to the brain to induce controlled seizures, which can help alleviate symptoms.