USE OF HRT DRUGS WITH ANTI-DEPRESSANTS/ANTI-ANXIETY MEDICATIONS
It is extremely common for gender patients to be concurrently using an anti-depressant medication with their HRT drugs. What doctors are NOT telling their patients, and is (to the best of my knowledge) generally not stated in the prescribing or patient information for the drugs, is the possible negative interactions between anti-depressant and hormone replacement therapy medications.
ESTROGEN - acts upon neurotransmitters in the same way as MAOI anti-depressants by increasing 5-HT-2 serotonin receptor binding as well as activating additional serotonin receptors and the overall concentration of serotonin. It also increases norepinephrine binding to receptors and the turnover (breakdown and replacement) rate for norepinephrine.
PROGESTERONE - acts upon neurotransmitters in a similar manner to SSRI anti-depressants. It inhibits re-uptake of serotonin by receptors and also inhibits the breakdown of the neurotransmitter thus increasing concentrations of it. Progesterone also increases the serum levels of norepinephrine but inhibits binding of it to receptors. Synthetic progestins appear to have a similar chemical action on neurotransmitters and have been directly linked to HRT-associated depression.
As a quick primer on these neurotransmitters:
Serotonin - low levels of activity (absorbtion) are associated with depression, high levels of activity are association with anxiety disorders. SSRI's increase the amount of serotonin by inhibiting how much the body can act on the body via receptors. For those with a naturally low amount the increase in intracellular concentration can alleviate depression. For those with a naturally high amount the inhibition of the receptors prevents some of the concentrated amount from acting on the body, reducing anxiety.
Norephinephrine - one of the metabolites of dopamine, this chemical is part of the body's system for responding to stress. Low levels of norepinephrine are associated with sluggishness, mental stress, and depression while high levels increase heart-rate, respiration, and increase energy levels (sometimes leading to nervousness or anxiety).
Serotonin and Norepinephrine levels are apparently linked and, in a healthy individual, are kept in balance to prevent episodes of depression or anxiety. The fluctuations in hormone levels experienced by women during their cycle (and the drop in hormones at menopause) adversely affect BOTH of these neurotransmitters, leading to mood disorders. SSRI and MAOI drugs prescribed to treat depression and anxiety problems also affect BOTH serotonin and norepinephrine levels.
Few transgendered people seem to be aware of the MAOI and SSRI effects of estrogen and progesterone, nor are they aware of potential adverse interactions between their HRT and anti-depressant/anti-anxiety medications. If you were taking an MAOI or SSRI for depression or anxiety before beginning HRT you may need to adjust your dosage once you are taking hormones (I'm inclined to say you'll probably have to reduce it, but you should talk to your doctor first). If, after you've been on HRT for a while, you are experiencing anxiety or depression an adjustement to your HRT regimen may be in order, and as a last resort the addition of an MAOI or SSRI.
Depression and anxiety disorders plague the majority of transgendered people, for which many are taking either SSRIs or MAOIs. Evidence suggests that the suicide rate alone among trangendered people is a whopping 50 percent* (* see update info Morbidity & Mortality) and the author of this site has to now wonder how many of those suicides were chemically induced because patients (or even their doctors) were unaware of the action hormone therapy has on serotonin and norepinephrine. Since estrogen, progesterone, SSRIs, and MAOIs do not appear to be listed as counterindications in patient and prescribing information, even though they act on the same neurotransmitters, seems a horrible oversight.
It is extremely common for gender patients to be concurrently using an anti-depressant medication with their HRT drugs. What doctors are NOT telling their patients, and is (to the best of my knowledge) generally not stated in the prescribing or patient information for the drugs, is the possible negative interactions between anti-depressant and hormone replacement therapy medications.
ESTROGEN - acts upon neurotransmitters in the same way as MAOI anti-depressants by increasing 5-HT-2 serotonin receptor binding as well as activating additional serotonin receptors and the overall concentration of serotonin. It also increases norepinephrine binding to receptors and the turnover (breakdown and replacement) rate for norepinephrine.
PROGESTERONE - acts upon neurotransmitters in a similar manner to SSRI anti-depressants. It inhibits re-uptake of serotonin by receptors and also inhibits the breakdown of the neurotransmitter thus increasing concentrations of it. Progesterone also increases the serum levels of norepinephrine but inhibits binding of it to receptors. Synthetic progestins appear to have a similar chemical action on neurotransmitters and have been directly linked to HRT-associated depression.
As a quick primer on these neurotransmitters:
Serotonin - low levels of activity (absorbtion) are associated with depression, high levels of activity are association with anxiety disorders. SSRI's increase the amount of serotonin by inhibiting how much the body can act on the body via receptors. For those with a naturally low amount the increase in intracellular concentration can alleviate depression. For those with a naturally high amount the inhibition of the receptors prevents some of the concentrated amount from acting on the body, reducing anxiety.
Norephinephrine - one of the metabolites of dopamine, this chemical is part of the body's system for responding to stress. Low levels of norepinephrine are associated with sluggishness, mental stress, and depression while high levels increase heart-rate, respiration, and increase energy levels (sometimes leading to nervousness or anxiety).
Serotonin and Norepinephrine levels are apparently linked and, in a healthy individual, are kept in balance to prevent episodes of depression or anxiety. The fluctuations in hormone levels experienced by women during their cycle (and the drop in hormones at menopause) adversely affect BOTH of these neurotransmitters, leading to mood disorders. SSRI and MAOI drugs prescribed to treat depression and anxiety problems also affect BOTH serotonin and norepinephrine levels.
Few transgendered people seem to be aware of the MAOI and SSRI effects of estrogen and progesterone, nor are they aware of potential adverse interactions between their HRT and anti-depressant/anti-anxiety medications. If you were taking an MAOI or SSRI for depression or anxiety before beginning HRT you may need to adjust your dosage once you are taking hormones (I'm inclined to say you'll probably have to reduce it, but you should talk to your doctor first). If, after you've been on HRT for a while, you are experiencing anxiety or depression an adjustement to your HRT regimen may be in order, and as a last resort the addition of an MAOI or SSRI.
Depression and anxiety disorders plague the majority of transgendered people, for which many are taking either SSRIs or MAOIs. Evidence suggests that the suicide rate alone among trangendered people is a whopping 50 percent* (* see update info Morbidity & Mortality) and the author of this site has to now wonder how many of those suicides were chemically induced because patients (or even their doctors) were unaware of the action hormone therapy has on serotonin and norepinephrine. Since estrogen, progesterone, SSRIs, and MAOIs do not appear to be listed as counterindications in patient and prescribing information, even though they act on the same neurotransmitters, seems a horrible oversight.