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Can hrt cause depression and anxiety


Effects of Hormone Therapy on Cognition and Mood

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HRT linked to depression – here's what the evidence actually says

A growing number of women are turning to hormone replacement therapy (HRT) to alleviate distressing symptoms of the menopause – including hot flushes, bladder weakness, vaginal dryness, joint pain, brain fog, sleep disturbances, anxiety and depression. For many women, HRT can help manage symptoms and minimise disruptions to daily life.

The past five years alone has seen monthly prescriptions of HRT double in England. Part of this increase is thanks to continued research on the wide-reaching benefits of HRT and awareness campaigns by menopause specialists and celebrities such as Davina McCall.

As research into HRT continues, it’s understandable that women may be concerned when they see studies or headlines showing potential harms from HRT use. Take a recent Danish study which showed a link between HRT use and depression. Many media outlets reporting on these findings initially suggested that HRT “makes women depressed”. But while the study may have identified an association between HRT and depression, it did not actually show that taking HRT made women depressed.

Understanding the results

This was a large study, examining 825,238 women who were 45 years old at the outset and following them for about ten years. The data on the type of HRT the women took and whether they were later diagnosed with depression was available from Danish National registers. The main aim of the study was to examine if there was an increased risk of being diagnosed with depression after having started HRT.

The results show that among women who were given HRT locally (as a vaginal cream, pessary or implant in the womb), there was no increased risk of being diagnosed with depression. Indeed, the researchers found that for women aged 54-56, local HRT was associated with a decreased risk of being diagnosed with depression.

However, women given HRT systemically (either via pills or through the skin using a patch) were more likely to be diagnosed with depression, especially between the ages of 48 and 50, compared with women who were not on HRT. Being diagnosed with depression was also more likely in the year after starting treatment, but then declined over time.

Are we to conclude that HRT increases the risk of depression? In short, no – mainly because this was an observational study and the researchers had no data on the women’s symptoms or reasons for starting on HRT. This means we cannot rule out whether some of the women may have had undiagnosed depression before starting on HRT.

Women may also be more vulnerable to depression in the years before and just after starting the menopause. This could potentially explain why women were more likely to be diagnosed with depression not long after beginning HRT.

And it cannot be ruled out that the women who started using HRT pills or patches did so because of more severe menopause symptoms. This could explain why this group was more likely to receive a subsequent depression diagnosis.

Different forms of HRT may be prescribed depending on the symptoms women are experiencing. wutzkohphoto/ Shutterstock

Similarly, local HRT is usually only given for genito-urinary symptoms such as vaginal dryness – and not for women experiencing other menopausal symptoms such as depression. This could explain why women in the local HRT group were less likely overall to be diagnosed with depression.

In line with current evidence and recommendations, HRT should still be offered to otherwise healthy women during the perimenopause or early postmenopause with moderate to severe symptoms, as the benefits outweigh the risks in this age group. Cognitive behavioural therapy is also recommended for managing depression during the menopause. Women with more severe depression should be referred for a formal mental health assessment.

Reporting the results

Careful reporting of scientific studies is important, as inaccurate or misleading coverage and headlines can lead to years of fear and mistrust. For example, use of HRT declined by as much as 80% in 2002 when a study linked HRT with breast cancer and heart disease. Although this study is now considered flawed – and other studies have since shown that HRT is actually beneficial for women’s cardiometabolic health – the fear created by media coverage of it left a legacy of anxiety and confusion that still persists surrounding HRT today.

Media outlets who erroneously suggested that HRT causes depression in their initial coverage of the study may have inadvertently put some women off from using HRT, which means they may miss out on its benefits.

This is why it’s so important to point out that the study has not shown HRT causes depression. In fact, some studies have shown that HRT might improve and even prevent women’s depression symptoms during menopause. Future, larger studies are needed to confirm these potential benefits of HRT for depression.

Main differences between depression and anxiety

Publication date

June 9, 2022

PSYCHOLOGY

There are many things to worry about in our lives. Some are worried about problems at work, others are worried as a result of a protracted family conflict. The difference is that someone experiences just an emotion that changes together with external circumstances, and someone develops a psychopathological syndrome. In this article, we will look at how depression and anxiety disorder differ from each other, and what physical signs they have. nine0003

Mental differences between anxiety and depression

Not all people are able to distinguish between these states. Each of them has its own characteristics.

Alarm

Anxiety is the body's response to stress. There are two types of anxiety:

  1. Adaptive. Healthy people may experience discomfort in conditions that seem dangerous to the brain. However, adaptive anxiety passes quickly and does not have a negative impact on life. nine0023
  2. Pathological. With regard to this type of anxiety, it has a pronounced all-consuming feeling, accompanied by a feeling of helplessness and intense threat. This reaction can occur without any reason. Pathological anxiety can be chronic, paroxysmal and post-stress.

Persistent, or chronic, anxiety is the most common and has a negative effect on a person's emotional health and life. nine0003

With an anxiety disorder, a person experiences constant fears that something is about to happen in the future. He constantly has thoughts that something will go wrong. He tries to avoid things that cause anxiety.

Depression

A person can be depressed for weeks or months. The presence of this disease may even affect how quickly he can recover from illness. Most often, depression occurs as a result of a combination of several traumatic factors. Often it is provoked by events such as the death of a loved one, moving, a serious illness, childbirth. nine0003

In a depressed state, a person feels sadness, and it seems to him that the future is hopeless. He does not believe that something good is waiting for him, and if he feels anxiety, then very little. There may be suicidal thoughts.

Physical state differences

Both conditions often have physiological manifestations. In the case of an anxiety disorder, they appear after intense anxiety. In depression, the physical symptoms are almost constant. nine0003

The most typical manifestations of anxiety:

  • Tension in the body and muscles.
  • Tachycardia.
  • Excessive sweating.
  • Chill.
  • Dizziness.
  • Nausea.
  • Tremor.
  • Pain in the abdomen, head and other parts of the body.
  • Difficulty breathing.
  • The degree of manifestation of the disorder largely depends on the stage of the disease and its neglect. To prevent depression from appearing against the background of a psychopathological state, treatment of anxiety should be started at the very first of its symptoms. nine0023
  • The main physical manifestations of depression are:
  • Apathy.
  • Constant fatigue.
  • Sleep and appetite disturbance.
  • Lack of energy.
  • Lethargy.

Often these two diseases are also confused for the reason that depression can arise as a result of experienced anxiety. A person can feel completely empty and hopeless even if the alarming situation has been eliminated. nine0003

Helping people with depression in Minsk includes sessions with a specialist and drug therapy, which helps to understand yourself and your thoughts. Conversations with a psychotherapist allow a person to develop the skills of correct behavior and reaction to stressful situations, as well as form the correct attitude to what is happening.

Common mistakes in treating depression and anxiety

Since the effectiveness of treatment largely depends on the patient, it is necessary to listen to all the recommendations given by the doctor. However, many people make mistakes that can negatively affect recovery: nine0003

  • Delay with the start of therapy.
  • Self-treatment.
  • Self-correction of the treatment prescribed by the doctor.
  • Alcohol use during therapy.

Starting early and following the advice of a psychotherapist helps to mitigate the manifestations of the disease, reduce the duration of treatment and the risk of recurrence of depression and anxiety.

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What do we know about anxiety and depression?

Evgeniy Gennadievich Ilchenko, psychotherapist of the Department for the Treatment of Borderline Mental Disorders and Psychotherapy of the National Research Center for Psychiatry and Neurology. V.M. Bekhterev. nine0152 Anxiety, depression are conditions that are characteristic of violations of the state of the emotional sphere. Today, about 110 million people in the world suffer from depression. According to the World Health Organization, one in five women and one in fifteen men suffer from depression in major cities around the world. It is believed that by 2020 depression will take one of the first places among all diseases. Approximately 70% of depressed patients show suicidal tendencies, and depressed patients older than 75 have the highest rate of suicide. nine0003

I am suffering, I am afraid…
What is depression? Depression is a disease that can throw a person out of emotional balance for a long time and significantly impair the quality of his life. It can be difficult for you to concentrate, nothing is interesting, nothing pleases, doubts and fears are constantly overcome. Depression usually comes after a psychological trauma or negative event. Often it develops as if for no apparent reason. It can be caused by constant stress, accumulating fatigue, fears. Depression is more than just low mood. In this case, the work of the whole organism changes, as a person suffers from insomnia or early awakenings, he loses his appetite or begins to seize his anxiety, which leads to obesity and the development of metabolic syndrome, there is a hormonal imbalance. A person changes his attitude towards others and himself. nine0003

Sadness, apathy, anxiety…
How does depression manifest itself? The first symptoms include weakness, fatigue, unwillingness to do anything, strain once again, contact and communicate with people, go to work. Later, bodily symptoms may join these complaints - palpitations, sweating, trembling in the body, hot or cold flashes.
Three areas are involved in depression - emotional, mental and physical. At the emotional level, depression, melancholy, apathy, and anxiety are observed. On the mental level - thoughts about one's guilt, self-accusations, a negative vision of the future, a feeling of hopelessness, that "no one will help me." On the physical level - chronic pain, muscle tension, constipation, dizziness, heaviness in the head. And all these symptoms can constantly change: “Today my head hurts, and yesterday my joints hurt, the day before yesterday my heart hurt.” nine0003

Maybe it's psychosomatics?
It is worth noting that there are different types of depression. According to the classification, depressions are diverse: major, minor, neurotic, autumnal, endogenous, psychogenic, reactive, etc. There is depression associated with the reproductive function of a woman, this is prenatal and postnatal. There is age-related depression associated with the physiological restructuring of the body, there is an obvious one that occurs with a sharply reduced mood, melancholy, and depression. There is a masked depression that hides under the guise of another disease. For example, chronic pain syndrome - pain in different parts of the body. There is depression, which is masked by gastrointestinal symptoms - diarrhea, constipation, stomach pain. Patients go to doctors for a long time and unsuccessfully, are treated by different specialists. But there is no improvement. At this stage, it is important to recognize psychosomatic disorders. It is worth looking, but what gives a person a disease? How is she good for him? It is quite possible that in this way a person attracts attention to himself, seeks location, manipulates loved ones and relatives. nine0003

How can I help?
Sometimes patients with depression try to alleviate their mental state through physical pain, inflicting injuries and injuries on themselves. This is definitely not an option. How can others help such patients? First of all, do not ignore or forbid complaining, do not try to cheer up the patient, do not appeal to conscience and faith, do not demand the adoption of any important decisions, but simply be there and listen patiently. As for direct treatment, there is no “magic” remedy for depression. Various methods are used here: psychotherapy, pharmacotherapy, electroconvulsive therapy, physiotherapy, aroma and color therapy, physical activity. If we talk about the prevention of depression, then this is a healthy lifestyle and a positive attitude, communication with nature. nine0003

Experiences about the future
Depression is a negative experience of past life events that we cannot change, while anxiety is an experience for the future, this is a vague, unpleasant emotional state characterized by the expectation of an unfavorable development of events, the presence of bad forebodings, tension and anxiety. It is directed to the future, it is the expectation of something indefinite. The state of anxiety is pointless, but anxiety is a personality trait of a person prone to experiencing anxiety, and constantly experiencing it. Most often, a person's anxiety is associated with the expectation of the social consequences of his success or failure. nine0152 Risk factors for the development of anxiety include childhood trauma, stress, personality traits, genetic predisposition, alcohol and psychoactive substances. Anxiety can be normal or excessive. In pathological cases, anxiety becomes constant and harmful, appearing not only in stressful situations, but also for no apparent reason, and then anxiety not only does not help a person, but begins to interfere with his daily activities.

Panic attacks
The largest category of anxiety disorders are phobias, with about a hundred variants. Anxiety disorders include post-traumatic stress disorder, social anxiety, panic attacks, and separation anxiety. Speaking of anxiety, it is worth mentioning panic attacks separately. How do they appear? Unexpected internal tension, pointless fear, timidity, stiffness, feeling of danger, unreality of what is happening, "lump in the throat", chills, sweating, heart palpitations, suffocation, nausea, diarrhea, dizziness, goosebumps, restlessness.

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