Estrogen, Anxiety, Depression, and Panic Disorders

Estrogen has many effects on the body in both women and men but it’s most pronounced effects are in women due to the increased circulating concentrations of estrogen during various age- and biologic-related intervals. In women, both higher and lower concentrations of estrogen and its metabolites are associated with anxiety, depressive, and panic disorders.

In females, there appears to be an increased risk of anxiety, depressive, and panic disorders during the premenstrual and postpartum (i.e., after giving birth) periods when estrogen levels are actually lower, as well as after the onset of puberty, when estrogen levels are actually higher, and in some cases even prior to giving birth, the so-called “antenatal” period. Indeed, fluctuations in estrogen levels can have similar effects to higher or lower levels of estrogen in the body at different times in the female lifespan.

On the other hand, anxiety and depressive disorders tend to decrease after menopause but not necessarily disappear. The average age of menopause in the US is approximately 51 years of age with a range somewhere between 40 and 61 years of age when there are often clear and present biological signs. Complete cessation of menstruation for one full year or “amenorrhea” is the defining characteristic of having reached menopause. Biological “markers” include, among other things, inconsistent menstrual periods, increase in psychosocial stress, changes in mood states and emotional lability, as well as cognitive and mnemonic adjustments such as decrements in reasoning ability and forgetfulness.  A history of smoking cigarettes or having had a hysterectomy typically brings on menopause sooner.

Hence, the inclination in psychiatry and medicine to stabilize or restore estrogen levels through hormone replacement therapy, use of birth control medications, and other biologic treatments during the postpartum, perimenopausal (during menopause), and postmenopausal periods to alleviate mood swings, depression, and anxiety.