Menopausal brain chemistry and SSRI antidepressants

Trigger warning: this article mentions depression and suicide. If you feel it would impair your current wellbeing to read about these topics, please skip this discussion.

Elsewhere on this website we discuss the use of SSRI antidepressants as a non-hormonal remedy for some symptoms of menopause. This offends some women because it seems to suggest that menopause is an illness that must be treated with drugs. It offends other women who are offered antidepressants in lieu, they feel, of properly balancing their hrts. Other women aren't offered any help with the brain impacts of sudden surgical menopause by doctors who don't feel that hormonal deficiencies cause any symptoms other that hot flashes, and their doctors simply refer them to psychiatric practitioners for "failure to adjust" to the implications of their surgery. But there are real and valid ways that SSRIs may be used in menopausal brain disruptions, and that's what we're going to take a look at right now.

Selective Serotonin Reuptake Inhibitors (SSRIs) are drugs that work to enhance the amount of a hormone called serotonin in our brains. Serotonin is one of a class of chemicals in the brain called neurotransmitters. Others include dopamine, acetylcholine, norepinephrine. They chemically link one brain cell with another, and create the chemical context for consciousness, including thought and mood. In other words, thought does not occur without neurotransmission. Serotonin is particularly involved with transmissions involving mood, behavior, emotional balance.

Women have more of this chemical than men (you can digress a considerable ways following this through to sex roles, thought patterns, etc, but that is beyond the scope of this particular discussion). Suicide victims have lower levels of serotonin upon autopsy, and portions of the brain that control judgement, balance, mood show higher-than-normal numbers of serotonin receptors. Suicide is, of course, the ultimate brain disruption, in which an ailing brain seeks its own destruction.

Serotonin is made up out of a protein called tryptophan. Estrogen promotes tryptophan availability in the brain and it also increases the general availability of serotonin. It helps regulate orderly firing of neurons (nerve cells) and enhances glutamate activity, which accelerates neurotranmission times. All of these things contribute to orderly and prompt brain function, hence mood and behavior stability.
When estrogen levels fluctuate or drop, the availability of seratonin and the ability of communications to pass from one cell to another decline. This literally disrupts our basic ability, on a cellular level, to carry out the physical process of thinking in a smooth and timely fashion.

Progesterone functions by exerting the brakes in this process: it limits estrogen receptor activity within the brain. At proper levels, this is a positive function. The "hyper" state of estrogen excess (up to and including seizures) demonstrates how serious the lack of progesterone can be to balanced brain function. In excess, however, it slows and disrupts brain activity in ways we call "depression." The two hormones must be present in the right proportions or optimal brain communications (hence, thought and mood) will be disrupted.

I am going to quote a couple paragraphs from Women's Moods by Sichel and Driscoll here because I think they capture this pretty well:
Usually when a part of your body is in distress, you become aware of it through the symptoms of pain, discomfort, fever, and malaise. If you have bronchitis, you cough, wheeze, and suffer chest pains. If you have a urinary-tract infection, you feel burning when you urinate and must do so frequently. These symptoms force you to take care of the problem beause they are uncomfortable. Indeed, they send you straight to your health-care provider, where you will receive medication that targets the biological cause. 
But have you ever thought about the signals your brain gives to show it is in distress? Most people are unaware of what their brains tell them regarding the state of its internal functioning. Yet responding to signals tht your brain is in trouble is one of the first lines of defense in mood and anxiety disturbances. This, too, should send you to your mental-health care provider, seeking relief and treatment. 
How does your brain tell you that it is hurting? Brain tissue itself does not feel pain, so there is no simple way to know. Yet a brain in distress does produce a range of symptoms. Like my patient Sarah, you may experience these as the emotions of fear, anger, sorrow, or depression. Or they may manifest themselves physically, as chest tightness and heart-rate changes, nausea and vomiting, abdominal pain and diarrhea, sleep and appetite disturbances, lethargy, frequent urination, muscle tension, and general aches and pains. 
These symptoms are some of the ways that the brain tells you it is overloaded. In fact, a simple way of understanding depressive or anxiety disorders is to think of them as the brain's slowing down in response to being biochemically overburdened.
In other words, hormone disturbances disrupt brain function, causing symptoms related to impaired brain activities. Now, this isn't news, but it focuses on where we're going with this.

We all would prefer to support our brains with proper levels of the needed hormones. This is a primary mechanism that is intellectually satisfying to us, not to mention that it is served by using hormones to meet other goals throughout our bodies.

But sometimes we can't reach that goal of delivering the right amount of the right hormones to the right parts of our brains right away. In fact, that can be made more difficult by the very brain disruption we're suffering. We are, for the most part, unable in any fundamental way to distinguish our chemical brain function from our conceptualization of "self" and "reality." This is, in the very worst cases, why we need psychiatrists: the more our thinking is disrupted, the less able we are to tell that it is.

This is where the use of SSRI antidepressants can come into it. They are not "feel good" pills that place a bandaid over the hurt and hide it. Instead, they act by various mechanisms to directly alter the availability and functioning of these same brain chemicals we've been discussing. The drugs of this class use a variety of methods to prevent the breakdown of serotonin, thus extending the supply in ways that are independent of estrogen function. By restabilizing our brain chemicals, they can thus give us the functional stability to continue working for a primary (hormone-related) solution and they can relieve some of the other physical effects of brain "pain." Like the crutches that allow us to regain some mobility and re-normalize our lives while a broken leg heals in a cast, so an antidepressant can provide us the tools to move on while a "broken" brain is resting and healing.

In current medical practice, there's a fine line between antidepressants as a brush-off and antidepressants as a critical tool. I appreciate that they are often used in the former capacity and by unqualified practitioners. That does not in any way negate their value in the latter case nor in qualified professional hands. Healing may of necessity come in stages. We should reach for as much healing as we can get by whatever tools we may have available, and use those enhanced resources to then turn our attentions to more preferable long term solutions. We would not continue walking on a broken leg, insisting that it heal completely on its own at night when we are asleep. We similarly should not fear doing everything we can to promote the healing of our brain.

We're not saying antidepressants are for everyone. We'll just ask each of you to look in the mirror and ask yourself: am I doing as much for my brain as I am for the rest of my body? We snicker at jokes about how men think with their genitalia, but are we not just as guilty when we give our vaginas more respect and help than our brains?