Depression or lack of hormones

Discussion in 'General Health & Wellness' started by frndly, Mar 13, 2009.

  1. frndly

    frndly New Member

    To any ladies out their in depression. After watching the Oprah show a few weeks ago I am now wondering if my depression is being caused by menopause. I am 62 yrs. and taking an antidepressant for the last 12 yrs. After seeing that show am now wondering if I should be taking something for hormone replacement instead. Although I have never had a hot flash lucky me. I have had insomnia, fatigue and depression. I have been off the antidepressants since last October 2008 and am now experiencing the sad moods. Has anyone out there had any experience with the so called bioidenticals.

    frndly
  2. TwoCatDoctors

    TwoCatDoctors New Member

    The Hormone Therapy most woman go through can be linked to breast cancer, so that is something that doctors watch carefully--bioidentical hormones have NOT been evaluated yet for their breast cancer potential. So that is a consideration that those taking them are the guinea pigs for.

    Here is an article from WEB MD to provide information.

    Oprah and Bioidentical Hormones: FAQ
    Oprah Is Talking About Bioidentical Hormones for Menopause; Experts Weigh In
    Can You Take Bioidentical Hormones Indefinitely?

    Hormone therapy has been linked to increased risk of breast cancer, so most health experts recommend that women take the lowest dose for the shortest time, if they need it.

    That research wasn't done on bioidentical hormones. But that doesn't necessarily mean that it's safe to take them for a longer time, Schiff says.

    "If you have the exact same estrogen as one's own body makes, it doesn't mean it's any safer," says Schiff.

    Schwartz counters that bioidentical hormones are chemically different from the hormone therapy drugs that were linked to health risks, saying "there is no reason to compare recommendations because they're not the same product."

    Schwartz says she's been prescribing bioidentical hormones for 14 years and takes them herself, having switched from other hormone therapy years ago. "I feel great and the women I work with feel great," she says. "I have no complaints."

    Schiff doesn't dismiss bioidentical hormones. "If I have a patient who says she wants a bioidentical ... then I personally would prescribe a hormone like estradiol, which is what her ovaries made, and I would give it to her in a skin patch by one of the drug companies that I know; it has oversight by the FDA and it has the exact dose that I want her to have," says Schiff, who has no ties to any drug companies. If a patient is already on a bioidentical hormone, "I try to find out exactly what she's taking and try to make sure that it's a safe dose and that she could be followed carefully," Schiff says.

    Schwartz says she gives her patients a choice between standardized bioidentical hormones or compounded products made by a lab she has vetted. She stresses the importance of doctors being trained about bioidentical hormones by other physicians who are knowledgeable about bioidenticals. "The physician has to work with the patient and the compounder," Schwartz says.

    Are Saliva and Blood Tests FDA Approved?

    Yes, those tests are FDA approved for diagnostic purposes -- but not to tailor hormone treatment.

    "The tests are not approved for use to measure hormone levels to adjust hormone therapy," says Uhl, who points out that hormone levels can fluctuate throughout the day.

    Schwartz says she doesn't believe saliva testing is appropriate and only uses blood tests with her patients.

    What About Oprah's Experience?

    "I'm happy that Oprah feels better," Schiff says. "Every experience is an important experience ... but everybody's individual and they have to work that out with their doctor."

    Some women, Schiff notes, feel better when they start hormone therapy, but he's not sure if bioidentical hormone therapy would give them an additional boost.

    Compounded or not, bioidentical hormones are only part of the picture, Schwartz says.

    "A lot of people just want to follow the celebrity," she says. "Sometimes people come in and what they really need is to address their diet, their exercise, their lifestyle."

    "I think bioidentical hormones are great," Schwartz says. "But if you don't address them in the context of the whole person -- with her diet, her exercise, her lifestyle, with her relationships, with her stresses -- and you don't work with everything, you're not really going to be able to come up with the results that women would like to see."

    L.D. King, executive director of the International Academy of Compounding Pharmacists, suggests that patients look for accredited compounding pharmacies listed on the web site of the Pharmaceutical Compounding Accreditation Board (PCAB).

    "They make sure those accredited pharmacies are adhering to a very high level of practice, which would include pretty extensive quality control," King tells WebMD. He also suggests that because there aren't a lot of PCAB-accredited compounding pharmacies, patients should ask compounding pharmacies what types of quality assurance procedures are in place.

    Manson points out that with FDA-approved "bioidentical" drugs available, "most women interested in bioidentical formulations do not need to take custom-compounded products (exceptions would be women with allergies to ingredients, or intolerances to doses, in commercially available products)."

    Does That Mean Compounded Bioidentical Hormones Are Safer?

    "There is no reason to think that these bioidentical compounded [products] would have a different safety profile than the FDA-approved ones," Uhl says. She points out that some compounded pharmacies have gotten warning letters from the FDA for false and misleading claims about safety and other benefits.

    Isaac Schiff, MD, chief of obstetrics and gynecology at Massachusetts General Hospital, agrees.

    Schiff led an American College of Obstetrics and Gynecology (ACOG) committee that reviewed the scientific evidence on compounded bioidentical hormone therapy in 2005. That committee concluded that there wasn't scientific evidence to support claims of increased efficacy or safety for compounded estrogen or progesterone regimens. The North American Menopause Society (NAMS) and the Endocrine Society have issued similar statements.

    "It may be safer, but that study hasn't been done yet," Schiff tells WebMD. He says he would like to see a large, lengthy, rigorously designed study on the topic.

    "I'm not inherently negative about it," Schiff says. "I hope they'd be good ... and if it turns out to be safer, fabulous. I would like, as a physician, to prescribe the safest hormones to my patients who want to be treated."

    Erika Schwartz, MD, a New York doctor who prescribes FDA-approved biodentical hormones and compounded bioidentical hormones, says there have been studies that support the safety of bioidentical hormones, compared to other hormone therapy.

    Schwartz asks, "If NAMS or ACOG says there are not enough studies, well, why haven't you done the studies if you think you need more? If this had been men's health, would we be having this conversation, or would we have answers?"

    Schwartz says she has long wanted to see large, government-sponsored studies compare bioidentical and other hormone therapies head to head.

    "She's allowed to have her opinions," Uhl says. "The evidence that FDA has seen and what's available in the medical literature leads us to believe that there are the same concerns" with bioidentical and other hormone therapy for menopausal symptoms.

    Uhl adds that "the FDA is not prohibiting the compounding of bioidentical hormones. There is definitely a niche for them and certain patients do need this, but it's not for everybody, and the people who are taking it need to realize that the risks are probably the same for the FDA-approved drugs as they are for the [compounded] bioidentical."

    Can You Take Bioidentical Hormones Indefinitely?

    Hormone therapy has been linked to increased risk of breast cancer, so most health experts recommend that women take the lowest dose for the shortest time, if they need it.

    That research wasn't done on bioidentical hormones. But that doesn't necessarily mean that it's safe to take them for a longer time, Schiff says.

    "If you have the exact same estrogen as one's own body makes, it doesn't mean it's any safer," says Schiff.

    Schwartz counters that bioidentical hormones are chemically different from the hormone therapy drugs that were linked to health risks, saying "there is no reason to compare recommendations because they're not the same product."

    Schwartz says she's been prescribing bioidentical hormones for 14 years and takes them herself, having switched from other hormone therapy years ago. "I feel great and the women I work with feel great," she says. "I have no complaints."

    Schiff doesn't dismiss bioidentical hormones. "If I have a patient who says she wants a bioidentical ... then I personally would prescribe a hormone like estradiol, which is what her ovaries made, and I would give it to her in a skin patch by one of the drug companies that I know; it has oversight by the FDA and it has the exact dose that I want her to have," says Schiff, who has no ties to any drug companies. If a patient is already on a bioidentical hormone, "I try to find out exactly what she's taking and try to make sure that it's a safe dose and that she could be followed carefully," Schiff says.

    Schwartz says she gives her patients a choice between standardized bioidentical hormones or compounded products made by a lab she has vetted. She stresses the importance of doctors being trained about bioidentical hormones by other physicians who are knowledgeable about bioidenticals. "The physician has to work with the patient and the compounder," Schwartz says.

    Are Saliva and Blood Tests FDA Approved?

    Yes, those tests are FDA approved for diagnostic purposes -- but not to tailor hormone treatment.

    "The tests are not approved for use to measure hormone levels to adjust hormone therapy," says Uhl, who points out that hormone levels can fluctuate throughout the day.

    Schwartz says she doesn't believe saliva testing is appropriate and only uses blood tests with her patients.
    What About Oprah's Experience?

    "I'm happy that Oprah feels better," Schiff says. "Every experience is an important experience ... but everybody's individual and they have to work that out with their doctor."

    Some women, Schiff notes, feel better when they start hormone therapy, but he's not sure if bioidentical hormone therapy would give them an additional boost.

    Compounded or not, bioidentical hormones are only part of the picture, Schwartz says.

    "A lot of people just want to follow the celebrity," she says. "Sometimes people come in and what they really need is to address their diet, their exercise, their lifestyle."

    "I think bioidentical hormones are great," Schwartz says. "But if you don't address them in the context of the whole person -- with her diet, her exercise, her lifestyle, with her relationships, with her stresses -- and you don't work with everything, you're not really going to be able to come up with the results that women would like to see."

    FROM: http://women.webmd.com/news/20090115/oprah-and-bioidentical-hormones-faq?page=3
  3. TwoCatDoctors

    TwoCatDoctors New Member

    The maternal side of my family (the women in my mother's side) all developed breast cancer. With a hysterectomy with one ovary left, my doctor did a test that showed I was past menopause--I didn't even know I had gone through it and the ovary has shriveled into dust.

    BUT with the very strong family history of breast cancer, no doctor will allow me to go on hormone therapy, even bioidentical, because it's like poking the sleeping bear and the bear is breast cancer. Plus, I don't need hormone therapy and the mistake is that women automatically think they all must have hormone therapy or estrogen creams to use--even when they don't need it. So before doing anything, talk to the OB/GYN about any types of hormone therapies and estrogen creams and be sure to discuss your family history because it impacts your life.