Top Reasons You May Feel Depressed (That Won’t Respond to Antidepressants)
While we all go through mood swings in life, It’s not normal or okay to feel unhappy every single day. A lot of the women I work with tell me that they don’t feel happy (it breaks my heart, but too often a woman will tell me, “I just don’t remember the last time I felt really happy.”).
Life is too short and too precious to go through it without joy or happiness. I work with my patients to uncover the reasons she may be feeling like this, and here’s what we often find:
Her female hormone levels have shifted
Female hormones naturally fluctuate throughout a woman’s cycle, and throughout her lifetime. Often as a woman approaches and enters her forties, her hormones start to decrease. This can have a profound effect on our sense of wellness, especially mental wellness.
We know today that the physiology of depression is far more complex than the serotonin system alone (and most antidepressants work only on, or focus on, the serotonin system). However, serotonin is one neurotransmitter that may have effects on improving mood, because it acts to balance out our brain chemistry and our mood. Interestingly, serotonin also has multiple effects throughout the body including supporting immune function, blood clotting, and promoting digestion.
Estrogen and serotonin work together, and healthy levels of estrogen promote good serotonin function. As estrogen (and its paired female hormone progesterone) decline, so does the level and the efficacy of serotonin. The result is multifold, but can certainly promote a depressed mood along with digestive difficulties and many other unpleasant symptoms.
Another clue that a woman’s shifting female hormone levels may be causing mood changes is an increase in sleepless nights (with or without symptoms like hot flashes and night sweats). Serotonin is converted to melatonin at night, and decreased serotonin levels causes decreased melatonin levels. Without appropriate amounts of melatonin, a woman may have trouble falling asleep, and will certainly have trouble staying asleep.
Her thyroid and adrenal axis is off
Our thyroid and adrenal glands are important parts of the endocrine system, meaning that they make hormones that have effects all over the body. Our thyroid and adrenal glands are closely related; when we’re under chronic stress our adrenal glands will try to pick up the slack. Over time this increased demand on our adrenal function can cause changes in the way our adrenal glands function, which can have major effects on how we think, act, and feel.
Because our thyroid and adrenal glands are so closely related, when our adrenals are under chronic stress our thyroid gland will often upregulate, or increase, its function to try to help us get through this stressful time. The problem here is that most doctors will run blood tests for the thyroid at this time, when women are complaining that they’re tired, depressed, gaining weight, and brain fogged, but traditional doctors are not well trained in functional medicine and so they can miss the warning signs on blood work, telling these women that there’s nothing wrong and that it’s all in their heads. It’s so important to see a doctor who understands thyroid and adrenal physiology and who will run, and interpret, a full thyroid panel for you. I often run TSH, free T4 and T3, T3 uptake, reverse T3, and will sometimes run anti-thyroid antibodies to check for Hashimoto’s thyroiditis, an autoimmune form of hypothyroidism.
By the time a woman is frankly hypothyroid, this has already been going on for years, and many other systems have been overstressed. At this point she’s exhausted, chronically depressed (and may vacillate between anxiety and depression), has gained weight she cannot lose, lives with constant brain fog, has digestive difficulties, is losing hair, and has lost skin vitality and elasticity, has little to no sex drive, and cannot find enjoyment in life. This is a very low place to be; the good news is there is a way out. It all starts with figuring out if a thyroid/adrenal imbalance is part of this woman’s picture.
She has digestive difficulties and a decreased appetite which has lowered her nutrient status
Over time, a woman living in a state of chronic stress and anxiety will move into a depressed state, where she struggles to find happiness and real connection. This usually happens because she spends so much time and energy focusing on nourishing and developing other things: family, kids, relationships, work, projects. Our body will recognize that state and will, over time, shift energy away from nourishing itself.
Stress upregulates certain functions in the brain and body (like respiration, blood flow to peripheral muscles, and heart rate), and downregulates other functions like digestion and reproduction: this all happens in the name of an old evolutionary survival mechanism. Stress was our original response to predators, or things we needed to fight or outrun for our survival. Today, however, we cannot outrun or fight our stresses so our body adapts and learns to maintain itself in a state of chronic stress. Over time living in chronic stress our body stops sending blood and energy (or qi, from a Chinese medical perspective) to our digestive system. First we begin to have digestive difficulties like excess gas and bloating, constipation or mixed constipation with loose, urgent stool. Eventually we notice we’re not hungry anymore, hardly ever, as our brain stops receiving and sending the hunger signal. These all add up to our not breaking down and absorbing our food, as well as not eating enough in the first place. Getting less food + inefficient digestion means that we’re not getting the nutrients we need to be happy and healthy. While our whole body will suffer because of this, our brain really feels it because it is no longer able to make the neurotransmitters (or brain chemicals that send signals inside our brains and to the rest of our bodies). We begin to feel brain fogged, with chronic low moods.
When I begin working with women I start with digestion. If a woman is not eating enough healthy food, and not breaking it down, literally nothing else will really help her. So we start here with targeted dietary therapies and digestive support, along with beginning to change her relationship to stress, to help wake up her digestion and finally get her eating, breaking down, and absorbing her food (and nourishing her body) appropriately.
Her sleep is disturbed
Anyone who is not sleeping at night will tell you how difficult it is to get things done during the day. This worsen’s a woman’s state of overwhelm, stress, fatigue, and hopeless and contributes greatly to her asking herself, “why don’t I feel happy anymore?”
Sleep can be a tricky thing to work on. It begins with knowing a woman’s pattern: does she fall asleep easily but wake up at night? Does she wake up once, or multiple times? Can she get back to sleep? Does she wake in a panic? Does she have symptoms like hot flashes and night sweats? Is she urinating excessively at night? Is she dreaming? You’d be amazed by how many women ask me, “why don’t I dream anymore?” While the answer can vary, we can usually help her resume dreaming by addressing chronic stresses, increasing her nutrient status, and providing targeted brain support and optimization.
If you recall, there is an intimate connection between estrogen, serotonin, melatonin and their effects on sleep. Thyroid and adrenal hormones also play a role here, as does nutrient status, along with other considerations like excessive toxicity and mitochondrial dysfunction (poor mitochondrial function in the brain and body will absolutely contribute to feeling depressed and unhappy, and chronic brain fog, as well.) All of these factors must be assessed and taken into account when we are addressing why a woman feels depressed and unhappy.
Her Cellular Age is Much Older Than Her Biological Age
Anti-aging medicine has taken great and amazing steps forward in our understanding: it’s no longer just about how you look, but about how you feel. We can actually measure the age of our cells to determine their age, independent of a person’s biological age (that’s your age in years). A person with cells much older than her biological age (for example, a woman in her 40’s can have cells that are aged into their 50’s or beyond) will feel depressed, exhausted, brain fogged, can’t lose weight, and often has digestive and sleep difficulties.
Early cellular aging can be due to many factors including a high toxicity burden, chronic stress (stress stresses our cells, too!), improper nutrition, unhealthy epigenetics (that’s genetic expression that is less than optimal, which can cause early cellular aging and all the unpleasant symptoms that go along with it).
We can measure the age of a person’s cells in conjunction with genetics (and at times, a full nutrient status panel) to help her reverse early cellular aging and optimize genetics. Once we know that information, and we’ve gotten her digesting, sleeping, and detoxifying, and we’ve rebalanced hormones, then we can implement long-term strategies to reverse early cellular aging and get her feeling amazing for the long term.