Hormones: A Missing Piece in the Mental Health Puzzle
EPISODE SUMMARY
In this episode of the Letters and Layers podcast, I discusses the impact of hormones on mental health. I emphasize the importance of considering hormones as a potential factor in mental health issues like depression, anxiety, and bipolar disorder. I explain how imbalances in thyroid, cortisol, estrogen, and testosterone can manifest as symptoms similar to various mental health disorders. I encourage listeners to advocate for themselves and ask for hormone assessments if they suspect it may be a contributing factor to their mental health, and conclude by urging listeners to share the episode with others who may find the information beneficial. If you're interested in reading the article in it's entirety, you can find it here.
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About The Letters & Layers Podcast
The Letters and Podcast is hosted by Amaka Gratia, a Yale-educated Mental Health Nurse Practitioner who talks about books she loves and is currently reading, takeaway lessons, and topics focused on therapy and mental health that resonate with Black women today.
TRASNCRIPT
Amaka (00:00:15) - Hey, everyone! Welcome back. This is the Letters and Layers podcast. This is your host Amaka. It is Monday morning when I'm recording. I'm recording a lot earlier than I typically do because of the holiday week that we are in. I am going out of town to New York. And, um, I'm not quite sure how things are going to go with being with family. I feel like I'll have less of an idea of how my schedule will be from day to day, so I wanted to just be a little bit proactive and record before I go. So yes, it is Monday morning. Woke up not too long ago. I am kind of getting my mind right and wrapping my head around. What? This week ultimately will be. I am working one day this week, which is nice. Looking forward to having a break of sorts. Looking forward to seeing my family. Part of my family. Um, I won't be able I won't be able to see everybody, but I haven't seen primarily my husband's family since we moved.
Amaka (00:01:41) - I've seen, like my siblings and my mom and everyone on my mom's side mostly. On my side. I mean, ultimately, since we moved to Chicago because the flight from here to Texas is typically a little cheaper and a lot shorter, like the flight time is almost cut in half. So I don't I don't feel how I used to feel before where I would have to pretty much plan my whole day around a trip. Now I can kind of plan like half my day or an afternoon. So I've seen my family a lot more over the past few months, which has been great. Um, I've really appreciated that time. But what's been different is that I haven't seen, like, my parents in law, um, my niece, my sister in law, um, the people that I have spent the most time with over the past, like. Year and a half before we left, so it'll be a reunion of sorts. Um, after almost six months. So that should be exciting. I miss New York, and I realized, I don't know if I've said this on the podcast before since we've moved, but moving to the Midwest made me realize that I am an East Coast girl.
Amaka (00:03:03) - I... I feel... I feel at home there. Um, you know, Chicago. I can't say anything negative about it. We're going into winter though, so maybe my opinion will change in a few months, but as of right now, I've enjoyed my time here. Um, I don't know if I'll ever feel at home right now. It just feels like I live here. And I'm here for a specific reason, but I realize that I'm an East Coast person. I don't know if I'll ever be able to permanently move away from the East Coast. We'll see what happens, you know, years or decades down the line. But. As far as I know about myself now. Pretty sure I'm going to move back in a few years. I like the idea of raising a family on the East Coast, kind of where I grew up, and I think it's a unique experience. And, you know, it's not just New York. Like I think part of the attachment to the East Coast for me, too, is that I kind of, um, my formative years.
Amaka (00:04:23) - And when I say that, I mean, like my 20s from, like when I was out of college to nursing school, my those years were shaped around living alone. On several in several states on the East Coast, you know, after graduation, after college graduation, I lived in Texas for a few months because my whole family moved there. But then I got my first big girl job in Delaware. So I moved back to the East Coast, and then I worked that job for two years. Um, folks, listen to this podcast for a long time. No, this no, this, uh, backstory. But in case you don't, um. Yeah, I lived in Delaware for two years after graduating. I started that job like the fall of 20, 2011. So I had been in Texas for a few years and then moved back up here, back up to the East Coast, and then lived in Maryland for almost four years working in DC, and then moved to Philly and lived there for a year, and then moved to Connecticut and lived there for almost four years.
Amaka (00:05:37) - So I've kind of been up and down between New York and Maryland. Um, I was going up and down between New York and Maryland for a while and moved here because my husband is doing his medical residency here. So the goal is to move back to the East Coast when he's done. I think we will follow through with that plan, but who knows? I think my feelings around the East Coast will stay the same by the time that time comes. But we'll see. Who knows? Things change. So yeah, I am looking forward to going home, seeing family. I'm looking forward to going to the city. Uh, to Manhattan. I sometimes when I live there, which is like take the train into the city and just walk for like miles, and it's going to be chillier there. But I think I want to do that probably the day after Thanksgiving. Um, and when you're hearing this, all of this will be past tense. But yeah, at the time of the recording, these are my plans, you know, to get into the city a couple of times and get some miles in and just take in my sights and, and the environment and just, you know, feel the pulse of the city for a little bit while I'm there.
Amaka (00:07:02) - So yeah, that's what's, you know, in the forefront of my mind just to travel in the next few days. There really isn't much else going on right now. I wanted to focus this episode not on a book. We just finished up in Dopamine Nation, which was great. I'm very happy that I was able to talk to you guys about that book. I wanted to focus this episode today, not on a book, but just on a topic that was mental health focus and involved how hormones can affect how we feel and our mental health when. Someone starts exhibiting symptoms. You know, related to depression symptoms like low mood and sadness and things like that. Our mind goes to depression first. Our mind goes to. The brain being the reason behind the change in how the person is acting. But I think it's a conversation worth having, and it's worth making an episode around what else can impact how you feel mentally. My colleague, who I work with at the Private Practice, shared this article about how hormones can impact your mental health.
Amaka (00:08:31) - And I was like, I think this is worth turning into a segment, if not a whole episode, because this is valuable information and. We are taught as mental health practitioners to check for some of these things, but not all. And there has been more conversation in few circles about how hormones can impact our mental health. Um, but not to the point to where I think it has really changed how particularly depression is generally assessed. We are taught to get labs on our clients because there are other things that can impact it. But hormones in particular, some of them aren't really standard when it comes to pursuing lab work or asking about it during assessments and follow ups and things like that. So I think if there's anything I can do about this, I can share this. And, um, anyone who listens and takes to heart what I say can at the very least, you know, ask for it to be assessed or ask for it to be added to their labs if they see a mental health practitioner.
Amaka (00:09:55) - So the main points that I'm going to talk about are the thyroid cortisol, estrogen and testosterone, starting with the thyroid. The thyroid is a gland in our body that. Takes care of a lot of essential functions, but when it is out of whack, when it is not functioning, how it should. When there's something wrong, a person can exhibit symptoms of depression. And ultimately, what it might mean for them is that they might need thyroid medication instead of it being, you know, an SSRI or an antidepressant. Thyroid levels are usually when we when we get lamps on new clients and follow a client's thyroid hormone like thyroid levels are usually included in that information that we put out orders for. So that's good. The thing is, though, as far as treatment is concerned. And I think this varies honestly, but based off of the knowledge I know to be true, mental health practitioners can't really prescribe thyroid treatment. What we do primarily is refer clients that we see have abnormal thyroid levels to their PCP.
Amaka (00:11:26) - If the PCP can't prescribe the thyroid medication, then they can refer the client to like an endocrinologist or someone who specializes in that field so that they can be properly treated. And, you know, there's a there's such a thing as, um, secreting too much of your thyroid hormones or secreting not enough. And that's how we know the terms hypothyroidism or hypothyroidism. So as far as hypothyroidism symptoms go or symptoms of an. Underactive thyroid. You can. Your mood can be low, which mimics depression. You can be tired. You can have brain fog. You can have difficulty concentrating, you can feel anxious, and you can have problems with your memory. You can have a hard time remembering things, and it can go as far as to having symptoms of psychosis, like paranoia and not being able to know what is real versus what is fantasy. So those are symptoms that can fall under anxiety, depression, or even like schizoaffective disorder. I don't want to go as far as to say schizophrenia, but like symptoms of psychosis.
Amaka (00:12:46) - And when you hear psychosis, a lot of people's minds go to schizophrenia. But I don't want to go that far. But the paranoia piece or not being able to discern imagination or fantasy from reality would fall under that like wider umbrella. As far as an overactive thyroid is concerned, you might not be able to fall asleep or stay asleep. You might be restless. You might be irritable. Your thoughts might race. You might exhibit symptoms of mania. You might also have trouble with memory or concentration. Um, you could feel anxious. And the paranoia can be an issue too. So when it comes to an overactive thyroid, these are more so symptoms that are consistent with bipolar disorder. And for someone who comes to a clinician and explains these symptoms, um, it's possible, unfortunately, that they would be treated for bipolar disorder and be put on meds that they don't need to take if they are not assessed for their thyroid levels. So it's really important, especially if you are someone who has never really been assessed for mental health issues, but think maybe you have to take it more seriously pursuing it.
Amaka (00:14:09) - Um, if it's not brought up in your initial sessions, or at least before you guys start talking medication, please advocate for yourself and ask for a set of labs to be done on you, and make sure that your thyroid levels are included in what is ordered, because you might find that those are out of whack and those can be causing how you're feeling, especially if you know to have a family history of abnormal thyroid levels because it can be a family thing. Moving on to the next hormone. It is a hormone that we hear about pretty frequently, actually. We liken it to what causes stress. And it is cortisol. Cortisol can definitely impact our mental health and it has a role in the body. Cortisol is meant to help as a function in the fight or flight response. But what we. Process as dangers in modern day society is much different than what you know would have been the case over the course of evolution. And instead of running away from an animal like a bear or something, you're, um, worried about work, you're worried about family.
Amaka (00:15:38) - You know, you're worried about finances or bills, worried about not having enough money. Those are stressors. Those are, um, things that our body perceives as dangers and can raise our cortisol. And if you are someone who is chronically stressed, your cortisol could be at a level consistently that is detrimental to how your body functions. So as far as symptoms of cortisol, it's very, um, similar to depression. Low motivation, decreased ability to kind of get yourself up and moving. You don't really want to do anything. You feel like isolating yourself. Typical symptoms of depression and anxiety, or just general desire, which is low mood in general, can be precipitated by high cortisol levels. Being chronically tired, not being able to sleep, having trouble with memory, having brain fog. All these things are symptoms that we have talked about before about depression, but it can be cortisol induced. Now, as far as treatment goes, you're less able to request that your cortisol levels be assessed. To be honest, I'm not even quite sure if that's something that can be done.
Amaka (00:17:01) - Um, maybe it doesn't hurt to ask, but based off of what I know to be true, it's more of encouragement of lifestyle changes when it comes to decreasing your cortisol. And I know that that is so much easier said than done, especially with just how stressful life can be in general, depending on what you're dealing with. I don't want to sound preachy at all. Um, but if there's anything I can say about that is even if it is five minutes a day doing some deep breathing, I've talked on the podcast before about how we, you know, in a, in a chronic, in a persistent state of heightened awareness and stress and not relaxing, we are usually not taking in as much air and breathing as deeply as we should. Um, breaths tend to be more shallow because of that anxiousness, but just taking deep breaths can deactivate your sympathetic nervous system that cortisol associate is associated with and activate the parasympathetic nervous system, which causes your body to start relaxing a little bit. It's like I said, it's easier said than done.
Amaka (00:18:16) - I would definitely recommend, if you can, talking to a therapist or counselor, if you're not already, about specific strategies on how to reduce cortisol. Exercise is a big one to. Exercise is a huge stressor, and I know that everyone's relationship to movement and exercise is different, but it doesn't have to be to where you're walking miles a day. Um, even if it's stretching your body at the end of the day to kind of release whatever little t trauma you sustained with work or whatever, that can make a huge difference. And I think that we underestimate how much we can get accomplished and how much we can positively impact ourselves. And in a short amount of time. I like to call these efforts, um, micro moments, because we tend to dismiss what we can do in five minutes or even two minutes or even one minute. Um, but I know in my experience, if I sit down and close my eyes and resolve to take deep breaths for a minute. I know that when I open my eyes.
Amaka (00:19:34) - I always feel better. The degree to which I feel better varies, but I always feel better, so doing that. The we underestimate how much just moving our body, just standing up from our seat during a workday can impact how we feel. Just shifting back and forth and moving our limbs and stretching and, you know, straightening our back, you know, and just doing all those little things, they can make a big difference. They can make a big difference. We're not designed to be sitting at desks for eight, nine, ten hours a day. That contributes to the stress because we're not doing our body's not doing what it's supposed to do naturally. So those little things, if you're able to incorporate them, I think are things you can start today. You can start right now. Since it's not something that you've been doing. It might be a situation where, like you remind yourself or you put a reminder on your phone every 60 to 90 minutes, get up, stretch your body, take deep breaths.
Amaka (00:20:42) - I would recommend hydrating to. A lot of us are chronically dehydrated, and that impacts cortisol levels. That impacts our ability to focus. That impacts our energy, too. So I'm just trying to think of things off the top of my head that. Perhaps folks have not considered, or maybe they haven't done in a while. That can make some changes right away before you have the ability to make those, you know, bigger, more drastic changes. Okay, so that's cortisol, the stress hormone. There are two other hormones that I think folks often don't consider hormones that would impact our mental health. They are typically known within a different context, but they definitely can affect how we feel. And those are what some people know to be our sex hormones or our reproductive hormones, most notably, um, testosterone and estrogen. So testosterone is the primary sex hormone of men, and estrogen is a predominantly known sex hormone for women. And the way that they function in the body, depending on who it is, varies as far as having too much or too little of each hormone.
Amaka (00:22:09) - That can also affect how we feel. As far as estrogen goes, it can have us exhibiting symptoms that I've already mentioned. So if you have too much estrogen, you could have trouble with sleeping, you could be tired, your metabolism can be sluggish. Um, your libido can be low, which is something that can happen if you are struggling with depression. It's also something that can happen if you are struggling with depression and you're on an antidepressant, because that is the side effect of some of those medications. Also have trouble with memory or experience. Brain fog and your, um, mood can fluctuate a lot more drastic and widely. You can experience mood swings, essentially, and then when you are. Dealing with low estrogen. Pretty much what I said before. Depression. Symptoms. Tiredness. Cheerfulness. Mood shifts. Trouble with memory. Not getting enough sleep. Not sleeping through the night or, you know, not being able to fall asleep on you and tend to hot flashes are another symptom too that's listed with the article.
Amaka (00:23:24) - I know that that's typically not a mental health symptom, but I think it's worth mentioning as well because this is really important, especially when it comes to women, you know, approaching perimenopause or menopause and having these changes. We think a lot about the physical symptoms, those transitions, but the mental health component is just as important. So I thought it was worth highlighting as well. And when it comes to testosterone, which is primarily the hormone involved in men's reproductive health, if it's too high, the person can be irritable or experience symptoms of psychosis like paranoid thinking, which I mentioned under hypothyroidism. Brain fog and having a lack of empathy, too, is known to be a type of presentation with that. And that is interesting because you wouldn't really associate that type of behavior to a symptom that is medically related in the body. You would just think that that's just how someone is. But it appears to be obviously not every case, but it's something that could be related to high testosterone or higher than normal.
Amaka (00:24:51) - And then on the opposite side, when it comes to low testosterone, a lot, if not most, of the symptoms are related to depression or ADHD. The difficulty concentrating, um, having no motivation or very low motivation, being tired, having trouble sleeping, being moody, being anxious. So these categories that I have highlighted have a lot of similarities. They overlap in a lot of different ways, and I think that just emphasizes how important it is to have as comprehensive an assessment when you are being checked for your mental health as possible, because sometimes the low mood and the sadness and the crying, and then not being able to sleep and the difficulty concentrating and the, um, fatigue and the mood swings are not just depression, it's not bipolar, it's not schizophrenia or what have you. Maybe you are high or low in these particular hormone levels, and you need to get that checked and it needs to be treated if that's the case, if that's what's happening for you, then you don't have to take medications.
Amaka (00:26:19) - You won't end up taking medications that are not intended for you and are not supposed to be prescribed to you. And that's not to say that if this is your case and you are treated as though it's a mental health condition, that you won't see improvements, you could very well go to someone, tell them what you're dealing with, and they prescribe you what they think is best, and you find relief. Um, and you find that you are pulled out of, you know, the funk or whatever you are dealing with. But I say that to say you may find yourself in a situation where you are on that treatment for much longer than you need to be, because the underlying reason for that presentation, the underlying reason for why you are presenting in this way, is not being addressed. And that could lead to, you know, having visits with your provider to where you have to like, increase the medication to get the same effect over time. But I strongly encourage those who hear this episode and, um, you know, are taking in what I'm saying to just keep this in mind if you ever decide to seek help clinically, if the provider does not bring up the prospect of obtaining labs, bring it up.
Amaka (00:27:49) - Ask them if they're going to get labs on you. Ask them if they're going to be including, you know, information about your thyroid levels. I think estrogen and testosterone. Levels can be assessed as well. So ask about that cortisol I'm less sure of. It doesn't hurt to ask. So I hope that this information is helpful to you guys because you know, the more equipped you are, the better the outcome can be. Thank you guys. I think I'm going to end the episode here. I appreciate you all. As always, if you want to reach out to me, please do so at contact at the Letters and Layers comm. Feel free to reach out to me over social media. The way to reach me will also be in the description handle. If there's anything that you want me to contribute my thoughts on that you don't mind me sharing on the podcast? Feel free to reach out. Please share. Please recommend 21 who might benefit from this episode or past episodes. And I hope that by the time you're listening to this episode, um, Thanksgiving has already come and gone, and I know the holidays can be tough for people.
Amaka (00:29:13) - But regardless, I hope you were able to spend it how you want it to. So thank you again and I'll talk to you guys soon. Bye
