HORMONE TREATMENTS FOR MOOD DISORDERS
Strictly speaking, hormones (especially thyroid and estrogen) are not mood stabilizers, but, in my experience, need to be addressed first in all mood disorders.
THYROID
The thyroid hormone T4 (Synthroid) helps to stabilize mood, but needs to be in the upper 1/4th of the normal range. Another thyroid hormone, T3 (Cytomel), acts more like an antidepressant. Thyrolar and Armour thyroid provide T4 + T3.
TESTOSTERONE
In men with depression and low testosterone - supplemental replacement hormone has anti-depressant effects. Unfortunately, oral testosterone is not effective in men. Injections are a hassle. Patches and gels are expensive and frequently not covered by insurance.
DHEA
A recent study found that supplemental DHEA, which is an inexpensive over-the-counter, may help depression. It is a normal hormone that slowly declines in both men and women. It turns into partly estrogen, partly testosterone.
ESTROGEN & PROGESTRONE
I have treated many women over the years that were perimenopausal or menopausal in whom I was not able to control their depression or mood swings without supplemental estrogen. There is confusion and controversy regarding the use of hormone replacement therapy (HRT) in menopausal women. Each study seems to contradict the one before.
The confusion is due to multiple factors - usually not addressed in the studies. The simplest factor is dosage - lower doses are probably effective and don’t have significant risk issues. Menopausal women who still have their uterus have to take progesterone if they take estrogen. Progesterone takes away from the estrogen benefits in the brain (mood, memory, verbal, fluency). It also makes a difference what kind of progesterone is taken - synthetics (Provera and others) or natural (prometrium and others). More important is how progesterone is provided. Intra-uterine or intra-vaginal probably does not interfere with brain benefits of estrogen.
Another factor is what type of estrogen and how it’s taken. Conjugated estrogens (Premarin and Cenestin), containing many of the different types of estrogen, can probably be taken by mouth without causing possible reductions of many hormones.
Taking Estradiol (the most active form of estrogen) by mouth (Estrace, Estradiol, most birth control pills) causes the liver to make more binding proteins for thyroid, testosterone and the Estradiol itself. This reduces the effect of each of these unless the woman compensates by making a lot more of this hormone. Each woman is different, but I have seen many patients where the oral Estradiol causes low effective hormone levels.
Then there are the studies that scare women away from HRT. These studies usually focus on a small subgroup of women and aren’t relevant to the average woman.

Mood stabilizers are the most powerful and most important medications that physicians/psychiatrists have to treat the most severe stress disorders, including bipolar disorder, schizophrenia, agitation and/or psychosis associated with many disorders, even Alzheimer’s and other dementias. They are the most effective treatment for all forms of excess anger/aggression. More recently, we have learned that they are effective in highly recurrent clinical depression or depression that doesn’t fully respond to antidepressants. They include all the "atypicals," some anticonvulsants and Lithium. They can be used alone or added to other meds. Atypicals are sometimes added to an SSRI for treatment resistant OCD.
The goal in treating any stress disorder is complete resolution of all symptoms allowing for optimal functioning and quality of life. We first maximize any particular medication - best dose, best time(s) of day. If not helping significantly or not well tolerated, we stop it. After maximizing the benefit of a particular med, if we still have significant symptoms remaining, we will carefully add another med.
In bipolar disorder, multiple meds are the rule not the exception. In one study, less than 20% of bipolar patients needed only 1 med and 35% needed 4 or more.

All of these medical treatments are in the context of counseling about important aspects of lifestyle, especially sleep, physical activity, and general health habits. Addiction counseling or psychotherapy is often but not always needed.
The average person with a stress disorder has an average of 3 different conditions, each of which needs to be considered. Since there’s so much overlap, sometimes we can choose one medication that treats 2 or 3 concurrent conditions. Implicit in all this is that a complete evaluation needs to be done before a decision can be made for what treatment is most likely to work best.
Unfortunately, at our current stage of neuroscience, there is no way to determine with certainty which treatment will be best in any individual. Soon, we will be able to make better choices because we will be able to look at each person’s genetic profile and do brain imaging to show which areas are over or under active. We will also have many new treatment options.
For now, we combine the best current science with the art of medicine to make the best educated guesses. We will use trial and error. We will always start with a complete evaluation and also monitor outcome in a comprehensive manner. If what we are doing isn’t working, we will do something else. We will think systematically, but also listen to our intuition, which is smarter than we are. We will work as a team, and we will not settle for less than the optimal quality of life.

• Take responsibility for your health and well-being.
• Develop good health habits and a lifestyle that fosters vitality and fulfillment.
• Continually educate yourself about health issues and research advances through reading, internet, discussions, etc.
• And find a good doctor!

What does it mean to find a good doctor?

Find a physician that you feel good rapport with and that you have confidence in.  You need to feel like you can comfortably discuss any health related issues with your doctor. You need to trust that your confidentiality will be respected. You should feel a mutual respectfulness that your concerns and needs and time are just as important as your physician’s. You get the feeling that your doctor genuinely cares about your well being. You are confident that your doctor keeps current and you should appreciate that your physician has confidence in their knowledge and skills, but is not arrogant.

A good doctor admits there are a lot of things we don’t know and every patient is unique and no treatment works for everyone. A good doctor is open to a variety of approaches and welcomes your questions or information that you bring in - not just about yourself but general information like an article you read about a new study. A good doctor doesn’t get defensive. You never feel that any of your concerns are discounted.

So what if you don’t have this kind of relationship with your doctor? It may be that by being open and honest with them you can gradually build this ideal partnership. So for example, you might say, “Doctor, I sometimes feel rushed - that I don’t have enough time to discuss all of my concerns with you.”   Your physician may say, “I’m sorry, take whatever time you need. My patients understand that I frequently run late because I’m willing to give my patients extra time when they need it.” Or they may say, “I’m sorry but we only have 15-20 minutes scheduled and I really need to stay on time today - but let’s reschedule as soon as possible so that we can address all your questions,” or there may be other considerate responses.

But if the doctor got annoyed or defensive such as “I’m behind, there are other patients to see and besides your insurance doesn’t pay well and you already got your money’s worth.” Or, “you have me confused with somebody who cares.” I hope it goes without saying - unless your doctor is just having a bad day you need to find another doctor.

Your relationship with your primary physician is so important that you have to make the time and take the trouble to find the right doctor for you. Ask your friends, ask your pharmacist, ask other health care professionals, but keep looking until you are satisfied. Your primary physician may be a family doctor, internist, OB-gyn, psychiatrist, or other specialist. If you need more than one doctor you can frequently get a referral from your primary physician and increase your chances. Although preferable, it is not essential that you feel as comfortable with every physician you see - as long as you can check things out with your primary physician.

In order to have complete confidence in your physician, you have to believe that they are thorough. My patients usually see my clinical assistant before they see me and they always fill out forms and symptom checklists. I also require that they check in with us at least every six months (3 months if they are on any controlled substances like stimulants or benzodiazepines). Sometimes we do “med checks” by phone. Every patient has to be seen in the office for a more comprehensive review of their status and treatment at least once a year, even if they are doing well - which fortunately most of my patients are. For new patients and patients not doing well, follow-ups are more frequent and are determined according to each individual situation.

There are a lot of good doctors that don’t use clinical assistants or don’t use many (or any) forms, and that’s fine. But, it will require more time with them to cover everything that needs to be covered.

Change starts with awareness. You can’t fix a problem you don’t know you have. A comprehensive evaluation is essential.

Certain problems like lung cancer and colon cancer have to be diagnosed before they cause symptoms or “you are toast!” So, you have a lot of headaches but Advil takes care of them, “it must be stress.” But what if it’s because you have high blood pressure. The Advil is not protecting your arteries (kidneys, heart, brain). The first symptom of heart disease in a significant percent of cases is sudden death. “Oops!” You are tired a lot, your concentration is not very good - maybe it’s ADHD. But what if it is sleep apnea? Eventually sleep apnea raises blood pressure and may cause a significantly shorter life span if not treated.

You have to have a complete evaluation before treating symptoms. Borrow some forceps if necessary, but get your head out of your sigmoid colon.

Being proactive means thinking about and preferably writing down your medical history and family history (at least to include all 1st degree relatives, parents, siblings, and children). Include all medical and psychiatric disorders. Also include any history of recreational drug use, especially any bad reactions you had.