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56 year old Susan suffered from anxiety and panic attacks, and had been prescribed Valium, Effexor and Wellbutrin by her primary care doctor. The drugs had adverse side effects and didn't seem to be helping, so she stopped taking them. After further discussion, she told me that symptoms started a few years ago when her monthly cycles stopped and with the onset of menopausal hot flashes. She noticed that the anxiety and panic attack seems to precede an episode of hot flashes.
Left Image: Actress demonstrating Anxiety, Fear and Panic courtesy of Wikimedia commons
Estrogen Deficiency Causes Anxiety
We sent Susan to the lab for a hormone panel, and sure enough, Susan's estrogen level was low. Susan's symptoms were caused by menopausal estrogen deficiency, a finding commonly seen in the post menopausal age group. Symptoms are promptly relieved with bioidentical estradiol applied as a topical cream twice a day. Additionally, Susan's tests revealed vitamin and mineral deficiencies which were, no doubt, aggravating the anxiety attacks.
Susan was started on her bioidentical hormone program which included estradiol and progesterone as a balanced topical cream. She was also started on vitamin B12 and Magnesium supplements. Six weeks later, Susan reported that her anxiety and panic attacks had improved and were almost gone. She also noticed better sleep and more clarity of mind, and her night sweats and hot flashes had resolved as well.
Anxiety is Associated with Hot Flashes
A study published in 2005 Menopause reported that anxiety is strongly associated with menopausal hot flashes, and usually precedes the hot flash episode. (13) Hot flashes are caused by estrogen deficiency, and are treated with bioidentical estradiol, which virtually eliminates them.(15)(16)(17)
The Benefits of Bioidentical Estrogen
My previous articles discuss the safety and the importance of bioidentical hormones.
Uzzi Reiss's new book Natural SuperWoman contains an excellent discussion of bioidentical hormones. Chapter 4 covers anxiety, panic attacks and relief with bioidentical estrogen.(1) Numerous articles (see below) summarize the medical literature showing that low estrogen levels cause anxiety and depression in humans and animals. Estrogen treatment relieves anxiety and depression as well as virtually eliminates the hot flashes.
What is the Mechanism of Action Of Estrogen in Eliminating Anxiety and Depression?
Estrogen receptors have been found in the brain, and estrogen increases the expression of an enzyme in the brain called tryptophan hydroxylase-2 (TPH2). This enzyme converts tryptophan to serotonin, an important neurotransmitter responsible for an anti-anxiety and calming effect in the brain. These estrogen receptors have been isolated to specific areas of the brain call the DRN, or the dorsal raphe nuclei (2)(3)(4)(5)(6).
Estrogen Effective for Perimenopausal Depression
A study published in the 2001 Archives of General Psychiatry evaluated bioidentical estrogen as treatment for peri-menopausal depression. They evaluated fifty women ages 40-55 years, suffering from a depressive disorder and irregular menstrual periods (FSH >25 IU/L). These women were treated with bioidentical estrogen or placebo over 12-weeks. Remission of depression was observed in 17 (68%) women treated with bioidentical estradiol compared with only 5 (20%) in the placebo group. The authors concluded, "Transdermal estradiol is an effective treatment of depression for perimenopausal women."(7)
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