What impact do hormones have on mental health?

Hello everyone! Welcome, or welcome back, to the Mental Health for Romania podcast! I’m Andrada, a volunteer with Mental Health for Romania, and in today’s episode I’ll be wearing my biologist’s hat and sharing something I’ve learned over the past month which, as the saying goes, has rather changed my life. Today, I’ll be touching on a few key points about the impact hormones have on mental health, and I hope to shed some light on a few lesser-known details.

I started the month feeling under the weather. I didn’t really feel like doing anything. I was constantly irritable, I wasn’t sleeping well, and even the thought of the next day would trigger little bouts of anxiety. Needless to say, it wasn’t a particularly good period. At first, I very quickly fell into the cliché that so many women find themselves falling into. I assumed that these changes in how I was feeling were simply down to the hormonal fluctuations associated with premenstrual syndrome. I have to admit, I didn’t give it much thought at the time. It was just an automatic assumption, because it’s something you hear all the time, something that’s constantly repeated, so it was very easy to say, “Yes, that’s obviously the cause.”

However, once I realised how unhelpful that way of thinking was and had spent quite a bit of time reflecting on everything that was going on, I came to understand that my anxiety and irritability were actually being caused by the incredibly stressful period I was going through. I’d been through something similar before, so I more or less understood the process. I knew that this time it wasn’t oestrogen to blame, but another hormone released during periods of stress: cortisol. Of course, for many people these feelings are, or can be, caused by premenstrual syndrome,

which can also produce similar symptoms that affect mental health. In my case, however, that wasn’t what was happening. And now that I’ve taken you through that little introductory story, you can probably see why I’ve chosen to dedicate today’s episode to

the role hormones play in our mental health.

At the risk of repeating myself, hormonal changes and their impact on our mental wellbeing are generally thought of as something that mainly affects women or people who menstruate. In reality, though, anyone’s mental health can be affected by hormonal changes, regardless of their age or gender. Before we go any further, I’d like to point out something that may already have become apparent: hormones themselves don’t have a negative effect on our mental health when they’re in balance. What actually affects all of us is a hormonal imbalance, or periods when our bodies go through sudden hormonal changes.

And since we’ve been talking about them so much, what exactly are hormones? Well, the textbook definition is that hormones are chemical substances that influence the activity of a particular part of the body. In other words, they’re messengers that regulate and coordinate the activity of our organs and tissues. Normally, hormones are released by an organ and then travel through the bloodstream until they reach their target. So how do they know where they’re supposed to go? Well, their target contains what are known as receptors, which they bind to selectively. You can think of it like a key finding the right lock, except that each key has thousands of matching locks located in different parts of the body, often producing different, or even opposing, effects. That’s why the whole process has to be regulated with remarkable precision. The good news is that, under normal circumstances, our bodies know exactly what they’re doing to keep us going without much input from us. After all, we don’t have to tell our bodies to produce more or less thyroid hormone, do we?

I’d also like to point out that, besides the two best-known hormones that everyone has heard of – oestrogen and testosterone, often referred to as the sex hormones – the body produces dozens of other hormones as well. Quite often, we don’t even think of them as hormones, even though we’ve probably heard of at least some of them: insulin, cortisol, adrenaline, noradrenaline, melatonin, oxytocin and dopamine. So, let’s dive straight into serotonin, dopamine and oxytocin, which are the best-known chemicals involved in regulating our sense of happiness, and by extension, our mental wellbeing. When I was deciding what to include in this list, serotonin and dopamine caused me the most difficulty because they function both as hormones and, more importantly, as neurotransmitters – substances that carry information from one neuron to another. But I suppose that’s just one of the compromises our bodies have to make: they need to perform countless different functions using a limited number of chemical substances. Even so, I’m going to include them here because they’re simply too important to leave out.

Serotonin is a substance that plays a wide range of roles in the body. It influences memory and learning, regulates body temperature, sleep, appetite and sexual behaviour, and, most importantly for today’s discussion, our sense of happiness and emotional wellbeing. Low levels of serotonin have been linked to depression, anxiety and even manic episodes. Serotonin is often referred to as the “feel-good” hormone because it’s associated with a sense of calm, emotional stability and even improved focus. Together with dopamine, it plays a crucial role in regulating sleep, both our sleep-wake cycle and the quality of our sleep. And I don’t think I need to tell you just how important a good night’s sleep is when it comes to our mental health.

And since I’ve already mentioned it, dopamine is also often referred to as the “happiness hormone”. It’s the hormone that makes us feel good, particularly when we achieve our goals. You may have heard that dopamine is involved in the brain’s reward system – the mechanism that keeps us motivated and encourages us to pursue rewarding experiences in the future. The way it works is fairly straightforward: you do something that’s essential for survival, such as eating, and your brain releases dopamine. That makes you feel good, which in turn makes you want more dopamine, encouraging you to repeat the behaviour. Overall, dopamine plays a key role in keeping us happy, motivated and alert. Low dopamine levels have been linked to a lack of motivation, low mood and feelings of fatigue, and they’re often associated with depression. On the other hand, excessively high levels of dopamine can contribute to addictive behaviours and, once again, manic episodes. And yes, dopamine is also involved in Parkinson’s disease, but that’s entirely due to its role as a neurotransmitter rather than as a hormone, so I won’t be discussing that here.

And finally, we’ve come to oxytocin, also known as the “love hormone”. It’s released particularly when we’re touched or when we’re spending time with the people we care about. That’s why a hug or a conversation with friends can make us feel so good. Oxytocin is often associated with feelings of contentment and emotional connection. It’s produced in both women and men, although its effects on mental wellbeing tend to be more pronounced in women. The way it works is fairly simple: it helps reduce anxiety while also stimulating the release of dopamine and serotonin. That brings me to a small spoiler for one of the key takeaways I’d like us all to leave with after today’s episode. Very rarely do any of these hormones act in isolation. More often than not, they influence one another, which is one of the reasons why happiness is such a complex and difficult thing to define.

Now that we’ve covered the hormones most commonly associated with mental health, let’s also take a look at the sex hormones, oestrogen and testosterone, which also influence the way we feel. Our brains contain receptors for both oestrogen and testosterone. Naturally, however, their effects differ simply because the amounts produced by our bodies vary depending on the reproductive organs we have.

When testosterone levels begin to fall, people may experience mood changes, irritability, and even anxiety and depression. According to some researchers, low testosterone levels can also increase the amount of stress we perceive. As I was reading more about the relationship between testosterone and mental health, I came across something I found particularly interesting: depression caused by low testosterone is often the type that’s resistant to treatment. In other words, it’s a form of depression that persists even after treatment with antidepressants from two different classes, given at appropriate therapeutic doses for a sufficient period of at least six weeks. In most cases, however, testosterone levels decline gradually with age, which is why the effects aren’t usually experienced as particularly severe by most men.

A similar phenomenon occurs in women when they reach the menopause, although in their case it’s oestrogen levels that are affected. Unlike testosterone, which tends to decline gradually, oestrogen levels drop much more abruptly. Many women, if not the majority, experience symptoms of depression during the menopause, both because of fluctuating oestrogen levels and the sharp decline that follows. This sudden drop in oestrogen is also one of the main reasons behind postnatal depression. These effects occur because oestrogen has receptors in areas of the brain involved in regulating our emotions, but it also influences the production of serotonin and the number of serotonin receptors in the brain. Some studies have even suggested that serotonin plays a role in protecting nerve cells. Once again, this is a much more complex process than it might appear at first glance. Interestingly, when people experiencing postnatal depression or menopause-related depression were treated with oestrogen, their symptoms did not improve, suggesting that we still don’t fully understand how this process works. The takeaway, then, is that both testosterone and oestrogen have an impact on our mental health. We have a somewhat better understanding of how oestrogen works in this context than testosterone, but both are involved in highly complex biological processes, and it’s impossible to point to a single, straightforward cause, particularly because the production of sex hormones is itself regulated by other hormones. Even so, disruptions to their normal levels can contribute to anxiety, feelings of euphoria, confusion, low self-esteem and social withdrawal, particularly during adolescence, when these hormones begin to be produced in much greater quantities.

The final group of hormones I’d like to talk about are the stress hormones, specifically adrenaline and cortisol. I think adrenaline is one of those hormones that just about everyone has heard of. When we find ourselves in a dangerous situation, our bodies – more specifically, a pair of glands located just above the kidneys called the adrenal glands – release adrenaline into the bloodstream. This increases our heart rate and blood pressure and gives us a burst of energy. Cortisol, which is also released during stressful situations, helps regulate blood sugar levels, making energy more readily available to the brain. Together, these hormones act like an alarm system, signalling to the body not to waste energy on processes that aren’t immediately essential and instead to prepare for the well-known “fight or flight” response. Naturally, all of these changes throughout the body also affect the brain, influencing our mood, emotions, motivation and levels of fear, and therefore our experience of anxiety.

Of course, all of these processes are beneficial. The problem arises when we’re under constant stress. In those situations, adrenaline and cortisol levels can remain elevated for prolonged periods, often leading to anxiety, depression, memory problems, headaches and sleep disturbances, as well as issues affecting the digestive system, the heart, and the muscles and bones. And although we’ve spent quite a bit of time talking about hormones and the role they play in mental health, the truth is that we still understand relatively little about what’s actually happening and how many of these hormones really work. It’s easy enough to say that “low oestrogen levels can lead to depression”, but the next step is to understand the underlying mechanisms – how these hormones actually function and the ways in which they influence mental health. Why does that matter? The simple answer is that a better understanding of hormonal fluctuations could improve the prevention of mental health conditions and make more personalised treatment possible.

Thank you so much for listening. Until next time, take care of yourselves and your mental health!