Anxiety, depression, fatigue, and weight gain are common complaints in my practice. The presence of these symptoms is very high in the nation and throughout the world. Many people are told it may be stress, they may be put on medication, or their symptoms might be dismissed. However, I have found many of these symptoms are related to hormones and this is supported in the medical literature.
Hormones act in the brain and interact with other hormones and have widespread effects. When they are not optimal, they can cause mood disorders such as anxiety, depression, and fatigue as well as weight gain and other symptoms.
There is a wide range of what is normal but normal and optimal are not the same. Treatment must be individualized using not only lab values but symptoms and response to treatment. Let’s explore what has been shown in studies as well as my clinical experience.
Many people with symptoms of low thyroid hormone don’t get treatment because they don’t meet the strict clinical definition of hypothyroidism which is a TSH (thyroid stimulating hormone) of over 5. Symptoms can be fatigue, weight gain, anxiety, depression, feeling cold, constipation, dry skin, poor memory, and brittle nails being the most common. You don’t have to have all the symptoms and even if you are experiencing some, you may have what is called subclinical hypothyroidism. Subclinical means you are not suffering from overt symptoms and lab values don’t meet the definition of clinical hypothyroidism. Labs may be high normal.
Giving someone T3 thyroid hormone with symptoms of low thyroid even if they don’t meet the clinical definition has been shown to augment the effectiveness of tricyclic antidepressants. Some clinicians recommend using thyroid hormone in patients with TSH levels in the high normal range in depressed patients that fail to respond to other treatment, Thyroid hormone could also address fatigue and weight gain if low thyroid hormone is the root cause of these symptoms. You don’t have to have all the symptoms of low thyroid to benefit from treatment. Treatment must be individualized and more detailed measurement of free T4, free T3 and thyroid antibodies should be done.
Fluctuations in ovarian hormones are associated with increased risk of depressive states and the medical literature supports this. Estrogen is a potent modulator of mood, energy, and weight. It can cause fatigue, weight gain and depression as well as many other symptoms if it is too high or too low. There are estrogen receptors in the brain that regulate mood and memory.
Progesterone also has receptors in the brain, and it protects neurons. It is broken down or metabolized to allopregnanolone which has anti-anxiety and anti-depressant effects and minimizes the weight gain and fluid retention that estrogen produces. It can aid sleep and improve energy levels if fatigue is caused by disrupted sleep.
Changes in allopregnanolone levels, the breakdown product of progesterone have been implicated in in postpartum depression and PMDD (pre-menstrual dysphoric disorder). Women tend to get depressed, moody, bloated and gain weight during the last week of their cycle when progesterone and its breakdown allopregnanolone, progressively rises, then rapidly falls. Progesterone may lessen these effects however the type of progesterone used matters. Some synthetic progestins in oral contraceptives may make symptoms worse.
You will read about mixed reviews of the risks and benefits of hormone replacement therapy because studies are conflicting due to the type of hormone used (synthetic vs bioidentical), the population they used it in (pre or post-menopausal, more than or less than 10 years post menopause), how it was administered (cyclic vs. no break, oral or through the skin) and the severity of symptoms. All in all, the recommendation after analyzing many conflicting studies is that hormone replacement therapy is most likely to be successful if introduced in perimenopause and early menopause. It can optimize mood, energy and weight as well as many other symptoms.
High cortisol can cause weight gain, especially around the belly, as well as anxiety, depression, and fatigue. You can treat cortisol that is too high or too low with a low glycemic, nutrient dense diet, adaptogenic herbs, phosphatidylserine, behavioral and lifestyle modifications such as rest, sleep, and relaxation and avoiding stimulants such as alcohol, caffeine and stimulating medication. The type of herb will depend on whether the cortisol is too high, too low or fluctuating so measuring is important.
The most accurate way to measure cortisol is in saliva. Cortisol should be high in the morning and get lower as the day progresses and it should be lowest at night. Any deviation from the normal cortisol curve can lead to symptoms of fatigue, anxiety, depression, and weight gain as well as other disorders. A low cortisol in the morning could be a sign of burnout and it may be difficult to get started, whereas a high cortisol at night will interfere with sleep. The point to drive home is that even if you don’t fit the definition of the extreme, hormones will have effects if they are not optimal.
It is important to measure all your hormones because they interact with each other. High cortisol can lower thyroid and sex hormones and only treating one hormone disorder may not help if the other hormones are affected and if you don’t address the root cause.
Looking at lifestyle, environment, diet, hormones, and hormone balance is important if you want to address anxiety, depression, weight gain and fatigue. There are other conditions that can cause these symptoms, however most medical professionals miss the hormone piece. If you want a more holistic approach, consider a free no obligation clarity call to determine if the functional medicine approach is right for you and to see if we are a good fit.