Depression, weird hormones, and altogether too much uprooting. What do?
June 26, 2018 2:29 PM   Subscribe

I've been mildly depressed and dysthemic for several years and it’s exhausting. I’m female, in my late thirties, and I suspect my depression has a hormonal component. I’m not sure how to pursue a treatment (allopathic or otherwise) that approaches this as a potential hormonal imbalance, rather than starting with antidepressants as a first course of action. As an added complication, I travel a lot. Please offer me advice, anecdata, or anything else to help me figure out a way forward.

I have some theories about what the matter is. 1) Getting a Mirena IUD a few years ago [now removed] that threw my hormones out of whack, 2) The stress of too much travel and uprootedness, and 3) My particular brain chemistry and self-doubt and anxiety [aka "the usual]. It seems like my next step should be getting a referral to an endocrinologist, or finding a skilled herbalist with a specialization in women's health. Right? How?

Some useful details:

  • I live in the East Bay and have Kaiser. I don't have a therapist because finding one is exhausting even under the best of circumstances, and I'm gone too often anyway.

  • I have Hashimoto’s Hypothyroiditis (aka autoimmune hypothyroidism), and take 75mcg of Levothyroxine daily; my TSH levels are under 3.0 as of last month’s blood work. My past few doctors at Kaiser have done blood work at my request (which all checked out just fine) and upped my Levothyroxine dosage a couple years ago to get my TSH under 2 (which changed nothing--I've never noticed symptoms when untreated, or a change with treatment).

  • I also take 10mg of Adderall 3-5 days/wk for ADD, and one of the things I really loved about it at first was the way it quelled my negative self-talk, my constant itching insecurity and low-grade anxiety, which I’ve wrestled with my entire life. But after taking it for about a year, it’s no longer as magical as it was initially (and upping the dosage doesn’t seem like workable solution long term, since my tolerance will just increase in turn).

  • I take a variety of supplements pretty regularly (though stop for weeks/months at a time) but am not so good at granularly figuring out how they affect me, which is to say that they could all be sugar pills and I'd be blithely unaware.

  • I've never taken antidepressants, and while I'm totally open to them, they don't quite seem like the best first approach in this case, although maybe they're a component of it.

  • Some less useful details, which were helpful for me to write out as I zeroed in on my question, but may just muddy the waters:

    In general, my moods have been fairly cyclical and pronounced all my life—pleasant, non-self-destructive hypomania followed by lows of brainfog and sadness, with plenty of ordinary neither-bad-nor-good in between. But for the past few years, my lows have been lower and more frequent, and my sparkling hypomania rarer and muted. To some degree these highs and lows seem to sync with my menstrual cycle, although aside of a few days of foggyheadedness that coincides with other PMS symptoms, I’ve never found a clearly discernible pattern. But recently my emotional and intellectual lows seem to have intensified, and I find myself crying in public every so often—or, hell, at poignant Folgers commercials—though by all accounts (including my own, when I'm happy!), my life is pretty good.

    I think the onset of this long low-grade depression coincided with getting a Mirena in autumn 2016, which made me feel like a stranger in my own body, acting out someone else’s emotions. I got it removed after 8mo and felt a palpable fog lift over the following month. But I still feel strikingly more depressive than I did before, and this depression has a volatile, hormonal quality that's texturally unfamiliar compared to my pre-Mirena lows. For the past several years, I’ve also noticed that my mind seems slower: I’m less sharp, less able to parse complex ideas, become mentally exhausted more quickly, and have definitely noticed a decline in my short-term memory. Some of this may be age: I’m about to turn 38. Some may be information overload in the age of Trump, and social media, and my own despair at coming to terms with routine career and life setbacks. Some of it is the internet, which I have a pretty compulsive, numbing-myself-to-life’s-problems relationship with. Certainly a lot of it comes from the perpetual uprootedness of the life I’ve built, which includes a lot of travel and seems to resist my developing routines and positive habits.

    I’ve always struggled with routine, and through happenstance and preference, have built a life that repudiates it: my career is academia-adjacent, which means I have summers and winter holidays off, and my teaching/work schedule changes every semester. On one hand this is fantastic, because I do research that involves international travel during these months, or get to travel for fun or visit family. On the other hand, constant travel and uprooting is also a source of stress that I don't quite know how to cope with. But I’ve never been good at routines, even when I'm not traveling much. I've always been the kind of person who wakes up at 7AM one day and 10:30 the next, responsibilities permitting—despite struggling to change this for literally my entire life. For years I've made attempts at exercising regularly—but I'm always in flux, just getting settled at home after a few months away, or getting ready to leave after a few months at home. I cannot "just make myself" go running every night, though I'm excellent at feeling guilty about it. I'm not a complete sloth; I bike commute, and go on long walks, and at least one 500-mile bike tour every year—so instead of exercising several hours a week, I cram it all into 6-8hrs/day for a couple weeks (which, yes, is ridiculous). In general, I do most things in focused bouts, and only I stick with slow-and-steady when it’s externally imposed. (For example, I'm a writer—and by most accounts fairly successful at it in an under-the-radar way—but despite writing seriously for nearly twenty years, I've never had a regular writing routine that's outlasted the project that demanded it.) Now that I’m not in school and don't have a 9-5 job, the external structures and reward systems that once gave me structure no longer do, and I tend to fail at trying to impose them on my own.

    Also, much as I enjoy the opportunities a flexible schedule offers, it always seems to take me a few months to settle back into my life at home after I’ve been away for a few months. I was overseas (for work) for nine months last year, and although it was lovely and low-stress by all accounts, an alarming amount of my hair fell out, and it took three or four months of being home again for my memory to return to normal. Which I found really unsettling, and which lasted long past the time it took for me to feel "settled" at home again. Which is probably to say, my ability to deal with stress seems to be pretty low, and I become overwhelmed altogether too quickly.

    Personally, I know I should quit traveling as much. I should make a life that's more compatible with routine and regular schedules. I should exercise regularly and meditate and drink more water. There are a lot of things I should do, and I do them irregularly, with varying degrees of success. But I'm fairly certain that there's an underlying hormonal component to this that I shouldn't ignore, and I'm not really sure what to do about that. I'm also going to be traveling a ton for the rest of the year (and will be out of the country all autumn), which makes it harder to experiment with treatment, or figure out a baseline (of depression, of a treatment’s effects, of my life). But I figure I’ll still be dealing with depression next year, so any promising advice I can’t use now will be valuable next spring. Help?
    posted by knucklebones to Health & Fitness (7 answers total) 10 users marked this as a favorite
    Best answer: Are you tracking your cycle and mental health stuff with something like Clue right now? That'd be my first stop as far as working out whether it's just volatile or if it actually tracks with your hormones as much as you think it does.
    posted by Sequence at 2:38 PM on June 26, 2018 [3 favorites]

    Best answer: In general, my moods have been fairly cyclical and pronounced all my life—pleasant, non-self-destructive hypomania followed by lows of brainfog and sadness, with plenty of ordinary neither-bad-nor-good in between.

    This sounds hormonal and like something I experience. What helps an incredible amount for me is to, a week before my period, start taking melatonin at bedtime and continue every night until I'm a few days into my period.

    Explanation about progesterone and melatonin for why this might work.
    posted by congen at 3:15 PM on June 26, 2018 [2 favorites]

    Best answer: I am not a health care professional, this is anecdata. I have had chronic fatigue, autoimmune issues and inflammatory arthritis for a long time, plus depression. Some doctors blame all ills, especially in female patients, on depression. I think the depression is caused by the autoimmune stuff. Just sayin'.

    some things that help: Vitamin D from sunshine and supplements, Vitamin B12 from meat, exercise. Sunshine, nature, adequate sleep, a regular schedule, good nutrition, coffee, thyroid supplement. I still eat more sugar than is ideal, a little in coffee and a little in food, but have reduced 95% of soda pop and candy. It helps a lot. I find I need to have animal protein several days a week, and red meat once a week; if you don't do this, consider a supplement. A doctor started me on thyroid supplements because I met the criteria, even though the test was low normal; it helps a bit. Following a friend's example, I start my day with at least some protein, and that helps.

    For me, good nutrition means making whole grain muffins with dried fruit & nuts and other nutrition add-ins. I make them myself because store-bought versions are very high in sugars. It's non-trivial to get good nutrition when working full time and traveling.

    I have taken zoloft/ sertraline for many years and am down to a very small amount; one doctor called it a subclinical dose. I can tell if I miss it for more than 1 day. I hate that I rely on it, and caution that many people end up on anti-depressants for a long time, but it has made all the difference at various times. When my health insurance got borked, and before I found out that Walmart has generic zoloft for very cheap, there were some very bad times.
    posted by theora55 at 5:05 PM on June 26, 2018

    Best answer: I have read that PMDD can get worse as you age and also when you enter perimenopause, which could be happening for you now. Have you considered continuous use of oral contraceptives? Can help with other perimenopause symptoms as well!

    (I’m a current Mirena user; I find it works great for me when I’m nursing heavily and so presumably not having much of a menstrual cycle. But once I wean, the cycling comes back and with it the horrible mood swings. When I have switched to a continuous oral contraceptive, BAM the mood swings disappeared entirely. Am about to try and make this switch again.)
    posted by wyzewoman at 5:32 PM on June 26, 2018

    Have you tried other ADD meds? A lot of this stuff sounds potentially related to that.
    posted by windykites at 8:45 PM on June 26, 2018

    Best answer: Sadness, brain fog, Adderall not working as well, bouts with hair loss and memory loss last year, lowered resistance to stress overall... it's possible you would feel better upping your thyroid medication, or pairing it with liothyronine, or switching over to a naturally desiccated thyroid medication containing a range of thyroid hormones. Levothyroxine alone couldn't treat my Hashimoto's thyroiditis.

    Also, I feel better when my TSH is on the low end, which is not unusual for patients with autoimmune hypothyroidism; keeping it that way can mean courting some health risks (possible heart issues, in anyone, and specifically osteoporosis concerns for older women).

    The thyroid is the master regulator, and yours is already on the fritz from an autoimmune disease (plus your erratic schedule may be triggering flares), so I'd start there to address your symptoms.
    posted by Iris Gambol at 9:47 PM on June 26, 2018

    Best answer: If I were in your shoes, I might seek an endo referral, but I would also want to meet up with a practitioner who was able to spend a decent amount of time with me, and who I could see for repeated check-ins (think concierge MD practice/herbalist/etc). Everything is interconnected, and your nutrition could be affecting your hormones, or you could be depressed for a reason that hormones triggered but involves other processes too. A medic who can talk to you for a long time can try to tease out some of those threads. And if you're doing monthly follow-ups that might help you adhere to some routines.

    (I'm not very good at routines either, but I did a thing this year where I spent a month working on improving sleep habits, then a month on food, then a month on exercise. A lot of it didn't stick, but some of it did, and even the 30% that worked has increased my health and life quality considerably. And If I'd had someone checking up on me I bet I would have retained even more.)

    There are bound to be a bunch of great doctors in the East Bay -- maybe ask friends who they loved for chronic / mysterious illness work?
    posted by sockkitude at 2:06 PM on June 27, 2018

    « Older Parabolic mirror for light redirecting?   |   An activist/resistance book club looking for a... Newer »
    This thread is closed to new comments.