Hormonal Effects Question

That's a big yes!!!! I felt so much better after taking hormones for 10 ten days. The way mine worked was kinda at the end around 8 months or so is when mine hit. Good luck!

My hormone dump started at 2+ months out and threatened to last for longer. Antidepressants and therapy did zero and zip for it. What worked was taking additional progesterone to balance out the estrogen. There's not really a way to predict it. In my case I was obese for longer than I want to admit...and was crazy huge obese. I guess you (might?) accumulate less estrogen if you were obese for a shorter period of time. For me that wasn't the case, and that's just supposition on my part. Duration is hard to say... mine went on for several months until I caved and took extra progesterone.

The problem is the mood lability that comes from estrogen dumping is not the same as the depression we treat in psychiatry. The cause is not and rooted in environmental and biopsychosocial factors. This is depression caused by an abundance of estrogen flooding the brain. This means antidepressants will not affect it largely. Why?

Estrogen, unlike most substances, can cross what is called the blood brain barrier very easily. This is a physical wall around our brain made of particular kinds of cells clustered very tightly together. Many substances, including glucose, require special help to get across. Sex hormones are cheaters though, because they are made from lipids/cholesterol. This is cheaty because cholesterol and ketone bodies (metabolized fats) get a free pass and unrestricted travel across. This is also why (tangential trivia) most psych meds are lipophilic; they love fat, can bind to it, and hop on over the fence. All the other yahoos stay on the other side of the border. Unfortunately, this includes antibiotics and other substances, too.

At any rate, many areas of the brain used for emotion and executive function have estrogen receptors accordingly. These are basically like keyholes that only estrogen (or things shaped like it) can fit in. Once they lock in they activate the receptor and cause an effect - like depression, for instance. How many do we have upstairs? I had to look this up and was actually surprised, because as it turns out the answer is: a whole freaking lot is how many. So, that's a part of why it also strongly affects mood.

Hormones in general are powerful neuromodulators. They may not directly be neurotransmitters, however they shape and alter our cognition and emotions in potent ways regardless of gender.

So, that's why most psych drugs do *not* affect estrogen receptors - which means antidepressants won't work as well (if at all). It's hard to say, and not much research has been done on it as you might imagine, though they are starting to have some respectable info about PMDD at least.

I'd talk to the psychiatrist...but the reality is you may need to see a gynecologist instead if you become symptomatic, too. See what he says first though. It may be you don't have an issue at all. One option is to pro-actively schedule a gyne appointment 1-2 months in to gauge your hormone stuffage. You can always cancel if you need it.

I do think that his thoughts to titrate off antidepressants show that he is both progressive and competent, as many doctors don't necessarily do that, and one can make the argument that at least it is worth attempting. You have a very good doctor. However, it may also be good to wait a bit after surgery. You could always consider taking a lower dose now and seeing how it goes, with a plan to follow up with him 1-2 weeks after (or when he would suggest). That way you still have the medication in your system so there won't be the waiting period, and also an option if things get worse. You also get the benefit of seeing how a lower dose goes for you too. However, talk to him to gauge and see what the plan might be.

And once again, Donna, you rock.

I learn so much from your posts here.

Best,

Ann

Thank you so much! I love the explanation of how it all works, including the tangential trivia. You've given me some things to think about and discuss with my doctor. (He is great.) I feel better prepared now.

My complete hysterectomy was fifteen years before my RNY and I am sure all of the estrogen was gone long before my weight loss surgery.

I never had any estrogen dump or mood changes after surgery.

I felt better every day after surgery and happier with every pound that disappeared.