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Combating Stress, Anxiety and Depression in Women |
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by Hyla Cass, M.D.
Combating Stress, Anxiety and Depression in Women
Statistics show that twice as many women than men are diagnosed with depression and anxiety. True, women are more likely to be aware of their moods, talk about their feelings and seek help when they are out of sorts. However, their moods are also strongly affected by monthly shifts in hormones. As the famous psychoanalyst Sigmund Freud said, “Anatomy is destiny!” While conventional medicine may see these as psychological problems needing psychotherapy or Prozac™, they are often due to an underlying chemical imbalance, related to nutritional and hormonal factors. Symptoms can include stress, depression, anxiety, poor concentration, weight gain, insomnia, anxiety, fatigue, PMS, menopausal symptoms, and/or sexual dysfunction.
Hormone levels also affect neurotransmitters, the “feel good” chemical messengers in the brain—serotonin, norepinephrine and dopamine—that influence mental and emotional well-being. The delicate balance of female hormones can be affected by stress, toxic chemicals and inadequate diet, as well as deficiencies in certain essential nutrients—vitamins, minerals, essential fatty acids and amino acids.
Vitamin and Mineral Deficiencies
Essential for good mental health are a well-balanced diet and sufficient vitamins and minerals. Cofactors or chemical helpers in our metabolic processes, deficiencies in almost any of the vitamins and minerals can lead to emotional or mental symptoms such as depression, anxiety and poor memory and concentration. A high potency multi-vitamin mineral formula, with at least 25 mg of each of the B vitamins, will supply the Cofactors needed for adequate brain function.
Protein provides the amino acid building blocks for the neurotransmitters while fats make up 60 percent of brain tissue. Fish is an excellent source of both omega-3 fatty acids and protein, making it the perfect “brain food.” Carbohydrates provide the blood sugar or glucose that fuels our body and brain metabolism, with complex carbohydrates providing a steady supply over the day. High sugar diets, on the other hand, cause fluctuating blood glucose levels and are a sure route to emotional instability.
Specific Conditions:
In older women, look for vitamin B12 deficiency resulting from poor intestinal absorption of this particular vitamin. It is easily detected by a blood test and corrected by supplementing with sublingual tablets.
Magnesium deficiency, an all-too-common problem, can produce anxiety, irritability and hypersensitivity to noise. Often worse during PMS, it can be rapidly reversed with magnesium, 200–400 mg daily.
There are drug-induced causes of mood problems as well: birth control pills can lead to depression, fatigue, confusion and irritability due to deficiencies of vitamins B6, B12, C and folic acid. Supplementing with B6 (50 mg), folic acid (800 mcg) and vitamin C (1–2 gms) daily should remedy this. Vitamin C is actually a natural tranquilizer. As long ago as the 1950s, the pioneering nutritional psychiatrists, Hoffer and Osmond, reported patients’ responding to 10 grams of vitamin C daily when tranquilizers had been found ineffective.
Herbal Treatments
There are many useful herbs for treating mental and emotional imbalance, including?St.-John’s-wort as a mood elevator and natural relaxant, kava and valerian for relaxation and sleep and ginseng for energy and stress resistance.
Extremely popular for the treatment of depression, and for good reason, is St.-John’s-wort (hypericum perforatum). Despite its strange name (“wort” is old English for plant), it has become a lifesaver for many women. Research has shown it to work as well as the synthetic antidepressants such as Prozac™, but it is less expensive, without the side effects and is available without a prescription. The recommended dose is 300 mg of standardized extract (0.3 percent hypericin), three time daily. It is also an excellent treatment for PMS, menopausal anxiety and depression and menstrual cramps.
For anxiety, sleep problems and stress, as well as PMS, menstrual cramps and menopausal symptoms, try kava (piper methysticum), 60–75 mg of kavalactones two to three times daily (equivalent, for example, to a 250 mg capsule of 30 percent kavalactones).
Another favorite for the treatment of anxiety is valerian (Valeriana officinalis), sometimes referred to as “nature’s valium.” Derived from the dried rhizomes and roots of the plant, it has been used for thousands of years as a folk remedy. As a natural relaxant it is useful for treating restlessness, nervousness, insomnia and menstrual problems. It has also been used as a sedative for “nervous stomach.” Using standardized extract (0.8 percent valeric acid), the dose is 50–100 mg, two to three times daily for relaxation. For bedtime sedation to promote sleep, take 150–300 mg about 45 minutes before going to bed.
A word of caution. Both kava and valerian can interact with alcohol, certain antihistamines, muscle relaxants, psychotropic drugs and narcotics. Those taking any of these drugs should take valerian only under the supervision of a healthcare provider.
Siberian ginseng (eleutherococcus senticosis) is called an adaptogen because it helps the body deal with stress. It acts as a mood and energy enhancer at doses of 200–400 mg a day of extracts containing at least 1 percent eleutherosides.
Premenstrual Syndrome (PMS)
Despite the assumption of many women, and even their doctors’, that premenstrual syndrome is natural and acceptable (“just live with it”), it is not a normal state and can be treated successfully. Occurring during the second two weeks of a woman’s 28-day cycle, it has a wide range of symptoms: bloating, water retention, fatigue, cravings for sweets or caffeine, weight gain, irritability, insomnia, depression and weepiness.
Most women will respond to the following regimen within a month or two. This is to be followed all month long, with an increase in the supplement doses during the premenstrual period.
Diet: eliminate caffeine, alcohol, dairy and salt. Supplements: vitamin B6 (50 mg daily) with a B complex, omega-3 essential fatty acids such as flaxseed oil, 1 tablespoon twice daily; omega-6 fatty acids such as evening primrose oil, or borage oil, supplying about 250 mg of GLA daily; tyrosine, good for PMS as well as depression 500–1000 mg once or twice daily; magnesium (500–1000 mg daily).
In addition, there are many natural plant-derived products that provide safe relief by mimicking natural hormones. As novel as these supplements may seem, they are simply a return to traditional healing methods, ones our grandmothers used.
Combination formulas containing such herbs as dong quai, black cohosh and vitex promote hormonal balance.
Perimenopause
The perimenopausal years can occur any time between ages 35 and 50 and last for several years. Such women haven’t quite hit full-blown menopause with hot flashes and missed periods. Rather, they find they have an increase in PMS symptoms, maybe even experiencing PMS for the first time in their lives. They may also be tired, forgetful and absent-minded, the latter not surprising since these hormones affect the brain’s neurotransmitters.
What is happening? During perimenopause women are no longer ovulating. Since it is the shed egg or ovum that releases progesterone into the bloodstream, these “anovulatory cycles” deprive perimenopausal women of their monthly dose of progesterone. This causes increased premenstrual symptoms. According to many women, perimenopause is “like having PMS all month long.” The treatment is the same as that for PMS but with an increase in the progesterone-enhancing herbs such as red clover and natural progesterone creams detailed below.
Menopause
Hot flashes, insomnia, night sweats and irritability are not an inevitable part of menopause. Nor do you have to choose between conventional hormone replacement therapy (HRT) on one hand, with its risk of cancer, and menopausal symptoms, heart disease and osteoporosis on the other. Rather, the right combination of supplements, including herbs and if necessary, natural plant-based hormones, can do the job.
To begin with, soy is an excellent dietary source of estrogen-like activity. In countries such as Japan where soy is a dietary staple, there is a very low incidence of menopausal symptoms and of breast and uterine cancer. This same population, when exposed to the typical American diet, however, loses this protection. Why not stack the cards in your favor and eat soy?
Conventional Hormone Replacement Therapy Versus Natural Hormones
In addition to herbal and nutritional remedies, complementary physicians will often prescribe natural hormone therapy for PMS and menopausal symptoms. While conventional medicine uses synthetic estrogen, with its risk of cancer, and synthetic progestins, with their many side effects, a safer, more natural prescription is available. This consists of natural estrogen and natural progesterone, often supplied as topical creams. These are supplied by prescription by special compounding pharmacies that cater to natural health physicians.
Natural Progesterone
Despite conventional emphasis on estrogen, the deficient hormone is more often progesterone than estrogen. A derivative of the Mexican wild yam, the compounded product acts similarly to the body’s own progesterone. It relieves water retention, depression, irritability, swollen and sore breasts. Over the long term it can prevent osteoporosis, bone loss associated with menopause. The hormone is supplied either in oral capsule form or as a skin cream which is applied to fatty areas of the body, such as the abdomen and thighs, and absorbed transdermally (literally “through the skin”) into the bloodstream. A milder (3 percent or less progesterone) formula is available without a prescription.
A laboratory extract, this yam-based natural progesterone is not to be confused with the commonly sold “wild yam cream,” which the body is unable to metabolize into progesterone on its own. Do not confuse it either with the synthetic progestins such as Provera™, used in HRT. This product has many negative side effects and none of the positive effects of the natural progesterone. For example, natural progesterone will enhance fertility. I have had numerous patients who were able to become pregnant once they began using it. During pregnancy the natural progesterone can be continued, enhancing fetal development, while progestins, on the other hand, can actually cause a miscarriage.
Natural Estrogen
Alternative physicians prescribe natural forms of estrogen derived from the soybean, often a balanced tri-est formula of estrogen’s three components—estradiol, estrone and estriol. Estriol is a portion of the estrogen complex that not only does not encourage cancer but actually may protect against it. Estriol, though widely used in Europe for many years, is available in the United States only through compounding pharmacies.
Another important point is that hormone replacement therapy is not necessary to combat osteoporosis. Osteoporosis can be treated very well with natural progesterone, magnesium (500–1000 mg/day), which is as important as calcium in the prevention and treatment of osteoporosis, calcium (1000 mg/day) and boron 2–4 mg/day.
Testosterone
Many menopausal women who complain of decreased libido and low energy are actually deficient in the male hormone, testosterone, made in the adrenal glands. Levels can be measured by means of a blood test and the suitable replacement dose is then prescribed. (No, with the correct dose you won’t grow a beard or lower your voice).
Menopausal Program
The combination of natural estrogen, natural progesterone and testosterone (all based on laboratory measures), a healthy diet containing extra soy plus herbal, vitamin and mineral supplements will most often effectively prevent symptoms of menopause. Of particular interest are vitamin E, 400–800 milligrams daily, which can reduce hot flashes through its estrogen-stimulating properties. Progesterone will have a calming effect. Kava has also been found to be extremely useful in treating the irritability and insomnia.
Conclusion
Women’s health problems through the life cycle have been too long neglected. We now have many tools to combat these, some due to the latest technology and others through returning to the wisdom of nature.
Adapted from Dr. Cass’ book; St John’s Wort: Nature’s Blues Buster (Avery Publishing, 1998). Other books by Dr. Cass: Kava: Nature’s Answer to Stress, Anxiety and Insomnia (Prima, 1998), All About Herbs (Avery, 1999) and All About St. John’s Wort (Avery, 1999).
For information on perimenopause: Ann Louise Gittleman’s Before the Change. (Harper San?Francisco, 1999).
For women’s hormones: John Lee and Jesse Hanley, What Your Doctor Won’t Tell You About Premenopause (Warner Books, 1999).
For compounding pharmacies and physicians who use them: International Academy of Compounding Pharmacists (800)927-4227.
For further information, resources and practitioners see Dr. Cass’ book, or check her Web site http://www.cassmd.com.
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