Saul Marcus, ND - Naturopathic Doctor

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Hormones and Mental Illness

Hormones are chemical messengers that the body uses to self regulate itself. An imbalance or drop in certain hormones can lead to numerous symptoms including fatigue, depressed, anxiety and poor cognitive function.

Gland Hypothalamus / Ovaries/Testes Adrenals Thyroid Pancreas
Hormones TSH, ACTH, FSH, LH Estrogen, Testosterone Cortisol Thyroid Hormone Insulin
Function Endocrine regulation Sexual function Stress Response Metabolic Rate Blood sugar

Our hormonal system strive for balance. Each hormone acts in concert with the other, along with the rest of the body. Simply testing one hormone and seeing that it is low, doesn't really give much information by itself. Is the low level of a hormone the primary problem itself, or due to some secondary factor. Hormone testing should always be interpreted in context to the rest of case history.

The adrenals, cortisol and stress

Cortisol is the stress and survival hormone. It has a profound effect on the entire body. More in depth information on the adrenals and cortisol is covered here: adrenal exhaustion page.

Here I'll briefly review three major functions of cortisol as it relates to mental symptoms

The stress response

Stress is our body's response to any extra demand. Regardless if the extra demand is psychological, physical, or physiological, there is the same stress response.

Cortisol is our major stress hormone, and goes up during times of increased stress. However, after a period of prolonged stress the adrenal glands may loose the ability to produce adequate cortisol. This is called adrenal exhaustion.

Symptoms of low cortisol which relate to psychiatric diagnoses include:

Cortisol, hypoglycemia and sleep

2 - 3 AM insomnia which wakes you up in the middle of the night is often caused by cortisol deregulation. Often cortisol is too high (although conversely it may too low during the day). Sometimes cortisol may be too high during the night. This can also cause insomnia, as someone may wake up as an emergency response to low blood sugar.

Can't fall asleep insomnia may be related to low 5-htp, low serotonin and low melatonin, especially is accompanied by depression or muscle pain.

Poor, or total lack of dream recall may be caused by low levels of vitamin B6.

Hormonal deregulation in children

Most places you read about low cortisol and adrenal exhaustion paint a picture of a 40 year old professional under high stress for several years who all of a sudden has no energy.

This stereotypical presentation may have more to do with the sort of person who is likely to walk into a holistic practitioner's office for adrenal fatigue. In truth, anyone can have adrenal fatigue, including children.

Children should ideally not have conditions related to stress. However, considering the sorts of diets children are fed, and busy schedules it can happen. If a child's symptoms match those of adrenal fatigue, then it makes sense to test for it.

Hormonal issues (either cortisol or thyroid) should always be considered in children who have problems paying attention, or concentrating in school.


Premenstrual dysphoric disorder

According to psychiatry, if a women has really bad periods, it's a psychiatric condition. They call this premenstrual dysphoric disorder, or PDD. [1]

Symptoms that comes and goes with a women's period indicates an obvious hormonal component. It's not caused by some mysterious "chemical imbalance" in the head.

PMS or PDD, is generally caused by an imbalance of estrogen and progesterone. Most people have too much estrogen, which come from several sources:

Treatment for PMS and "PDD"

There are many supplements on the market for female hormone symptoms. I've found in practice that symptoms around a women's period respond very well to detoxification which helps eliminated excess estrogen. So most of the supplements I recommend are for the liver and then digestive system.

It's also important to take a full history and see what other hormonal/toxicity issues there are.

I do no recommend anti-depressants or birth control pills. Even if they "work" they don't truly treat the real problem, but just cover up symptoms. Later on there is a good chance that the underlining hormonal imbalance will pop up again as another symptom.



Many people with hypothyroidism are told that they are fine and their labs are all "normal."

Hypothyroidism is typically tested with the hormone TSH. Conventional ranges for TSH go from about 0.4 to 4.0 (approximate range, each lab is slightly different).

This reference range is far to large. A more optional range for TSH is about 1.5 to 2.5. Additionally, TSH should never be used by itself to diagnose thyroid conditions. Thyroid hormone (in the form of T3 and T4) should also be tested. Additional thyroid tests include reverse T3 and the antibodies thyroid peroxidase and thyroglobulin.

Symptoms for hypothyroidism should also be considered regardless of what the labs say.

If you have been told that your thyroid labs are "normal" but feel you do have hypothyroidism it may be best to review your labs with someone in natural health who will interpret them from a more functional perspective.

Causes and treatment of hypothyroidism is a large topic. For more information go to the hypothyroidism guide.


Hyperthyroidism is caused by having too much thyroid hormone. There are several causes for this, the most common are and auto-immune condition (Graves disease) and also acute inflammation.

Even if TSH is still in reference range, if it is high normal (along with either T4 or T3), then there may be hyperthyroidism.

Some of the more common symptoms include:

Hyperthyroidism is very serious, even potentially fatal condition. However, there is a very large range of symptoms which people may present with. Symptoms range from very severe to mild. It is particularly with the more mild presentation where patients may find themselves with diagnoses such as "anxiety" or "depression" when in fact they have hyperthyroidism. [2]

Thyroid labs should be considered basic blood work for just about anyone with "anxiety." The labs must be interpreted carefully so misdiagnosis does not happen.

Go here fore more information on hyperthyroidism



[1] Diagnostic Criteria from DSM-IV-TR. Washington, D.C.: Association, 2000. 178. Print.

[2] Depression and anxiety in hyperthyroidism. 2002 Nov-Dec;33(6):552-6. Demet MM, Ozmen B, Deveci A, Boyvada S, Adigüzel H, Aydemir O. Department of Psychiatry, Department of Internal Medicine, Medical Faculty, Celal Bayar University, Manisa, Turkey.