Introduction

Hormones are tiny chemical messengers produced by endocrine glands in the body. They travel via the bloodstream and reach various body organs to help regulate growth, energy usage, fight-or-flight response, and reproduction.¹ However, with stress, unhealthy lifestyle, dysfunctional endocrine glands, or other medical problems, these hormones can go out of order and lead to an imbalance that can disturb the normal body functions. These hormonal instabilities can further result in psychiatric issues like nervousness, depression, irritability, inability to focus, and altered eating patterns, thereby worsening not only the mental health but also the physical well-being.²

Key hormones and their effect on mental health 

Cortisol: stress regulator

Cortisol is an emergency alarm system of the body. It is secreted by the adrenal glands that sit above the kidneys. Cortisol helps manage stress, reduce swelling, and control blood pressure. 

• High cortisol: repeated stress or disturbed sleep-wake cycles can cause cortisol levels to rise sharply, thus leading to impaired mental functions and verbal memory. This, in turn, also results in decreased levels of the feel-good hormones³
• Low cortisol: cortisol levels can fall when the immune system starts attacking the adrenal glands. It can also decrease due to the presence of a tumour or the intake of drugs like short-term anaesthetics and antifungal agents. Thus, making it a potent cause leading to psychiatric disorders⁴

Serotonin: feel-good chemical

Serotonin carries messages between nerve cells in the brain and promotes a balanced mood. It is produced in the brainstem and controls emotions, memories, and stress responses. 

• Low serotonin: can lead to depression, anxiety, sleep disturbances, attention deficit/hyperactivity disorder (ADHD), and even schizophrenia.⁵ It results from a poor diet (lacking dairy products, poultry meat, corn, chickpeas, and bananas) and genetic factors⁶
• High serotonin: can cause serotonin syndrome, which may result in an altered state of mind, problems with automatic body functions, and muscle spasms.⁷ This rise can occur from taking high doses of certain medications that increase the concentration of the hormone in the brain, or mixing them with other serotonin boosting drugs 

Oestrogen and progesterone: female sex hormones

Oestrogen and progesterone are produced by the ovaries in females. These hormones help maintain reproductive well-being, menstrual health, and bone strength. 

• Oestrogen: low levels can cause mood swings, anxiety, and depression. This often happens after childbirth, during the menstrual cycle, or around menopause⁸
• Progesterone: In stress, progesterone acts like cortisol, contributing to increased anxiety, irritability, and potential depression, especially during the premenstrual and postpartum period⁹

Testosterone: male sex hormone

Testosterone is produced in the testes in males and by the ovaries (small quantities) in females. In people assigned male at birth (AMAB), it is responsible for sexual development, while in people assigned female at birth (AFAB), it helps with oestrogen production. With ageing, testosterone levels gradually decrease in both people AMAB and AFAB.

• AMAB: imbalanced testosterone can cause tiredness, irritation, laziness, sleep disturbances, reduced stress tolerance, and bipolar disorder¹⁰ 
• AFAB: low concentration of this hormone after the removal of the ovaries, or because of ageing, can result in depression and antisocial behaviour¹¹

Thyroid hormones: metabolism, mood, and energy regulator

The thyroid-stimulating hormone (TSH) triggers the thyroid gland to release the Triiodothyronine (T3) and Thyroxine (T4). These hormones are essential for maintaining vital functions, like metabolism and the growth of various organs.¹² 

• Low: can cause forgetfulness and emotional imbalance (myxedema madness). Evidence reveals that 40% of individuals with low thyroid levels show signs of significant depression¹²
• High: lead to irritation, anxiety, psychosis, and confusion, mainly in elderly patients 

Hormonal imbalances across life stages

Puberty

Puberty is driven by hormonal fluctuations, and during this period, the risk of depression is higher in people AMAB. However, as people AFAB begin their first period (menarche), this ratio reverses due to a rise in estrogen hormone. Furthermore, studies have also found that AMAB with higher testosterone levels during puberty tend to be aggressive and disobedient.¹³ 

Menstrual cycle

Every month, the AFAB reproductive system goes through a rise and fall of hormones. These ups and downs are accompanied by premenstrual symptoms (PMS) like anxiety, irritability, anger, fatigue, restlessness, mood swings, and crying in 47.8% of people AFAB. The exaggerated form of PMS is premenstrual dysphoric disorder (PMDD) that causes severe emotional instability and is categorised as a depressive disorder.¹⁴

Pregnancy and postpartum

During pregnancy and the postnatal period, anxiety disorders, like generalised anxiety disorder (GAD, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and tokophobia (an extreme fear of childbirth), can occur in combination with depression or independently. Postpartum psychosis affects 1-2 people AFAB in 1000, with no previous history of psychiatric disorders.¹⁵

Perimenopause and menopause

While perimenopause raises the susceptibility of mood disorders, menopausal people AFAB have been found to experience sleep disturbances, depression, and anxiety. A study reported that 45% of people AFAB who are referred to menopause clinics were clinically depressed.¹⁶

Common causes of hormonal imbalance

Lifestyle factors

• Diet: nutritional imbalance (low vitamins and high refined sugars) can result in unstable stress hormones and possible inflammation, which further increases the frequency of mood disorders and depressive symptoms¹⁷ 
• Lack of exercise: individuals with moderate or low levels of fitness exhibit a 23% and 47% risk of developing a mental health problem¹⁸ 
• Poor sleeping pattern: individuals with disturbed sleep are about 10 times more prone to develop depression and 17 times more likely to experience anxiety¹⁹
• Chronic stress disrupting hormonal balance: exposure to everyday occupational, or personal stress alone, or in combination, can lead to major depressive disorder (MDD)²⁰

Medical conditions 

• Polycystic Ovary Syndrome (PCOS): PCOS contributes to mood disturbances, amplifying the risk from 28% to 39% for anxiety, and 11% to 25% for depression among women²¹
• Diabetes: according to research, people with diabetes have a 50% to 100% increased risk of experiencing depression²²
• Thyroid disorders: these may cause major depressive disorder (MDD), bipolar disorder, dementia, confusion, and personality changes²³

Medications

Psychiatric side effects (PSEs), such as sleep impairment, psychosis, depression, dysphoria, and delirium, can arise because of long-term use of medications like steroids, cardiovascular agents, and anticancer drugs, among others.²⁴

Mental health conditions linked to hormonal changes

Depression

Depression causes a constant feeling of sadness and loss of interest. It occurs due to an imbalance of cortisol, sex, and thyroid hormones. High cortisol levels, especially in teens and new mothers, can cause depression.²⁵ Also, 80% of postpartum women may encounter depressive symptoms due to a sudden drop in hormones after childbirth.²⁶ A defective thyroid function may lead to symptoms of depression. 

Anxiety 

Ranked as the ninth most common health-related cause of disability, anxiety is characterised by symptoms like stress, performance fear, unexpected panic attacks, anticipatory anxiety, and avoidance behaviours. It is believed that low serotonin activity and elevated morning cortisol activity are responsible for feeling anxious.²⁷

Bipolar disorders

In bipolar disease, one may feel frequent alternating bursts of high energy and happiness, followed by depression. It occurs due to an imbalance in serotonin, cortisol, oestrogen, progesterone, and thyroid hormones. Individuals with bipolar disorder also have other conditions, like personality disorder, binge eating disorder, or substance use, which can lead to more mood swings and a higher risk of suicide.²⁸ 

Post-traumatic stress disorder (PTSD)

It is a condition that impairs daily functioning after experiencing a stressful event like a war, physical or sexual assault, natural disasters, accidents, or other life-threatening situations. PTSD is characterised by flashbacks, nightmares, intrusive thoughts, hyperarousal, avoidance behaviours, and emotional numbness. It is linked to excess serotonin activity.²⁹

Eating disorders

Unhealthy eating patterns, along with excessive concerns about body weight, can harm physical health and mental well-being. Altered serotonin and cortisol levels can lead to binge eating disorder and purging behaviours indirectly. These hormonal changes also contribute to the complications of eating disorders, including altered appetite, reproductive dysfunction, stress response, and metabolism.³⁰

Panic attacks

Panic attacks are sudden waves of intense fear or a feeling of losing control that often peak within minutes. They present themselves in combination with anxiety, mood swings, suicidal ideation and behaviour, substance use, and even medical disorders. These attacks are often associated with imbalances in hormones like serotonin and cortisol.³¹

Diagnosis and treatment

Healthcare providers are the first point of contact as they assess your symptoms, order initial tests, and manage mild hormonal or mental health concerns.

• Common Tests for Hormonal Imbalances: Blood, urine, and saliva tests can be carried out to examine your hormonal levels
• Lifestyle Modifications: A diet rich in fruits, vegetables, nuts, legumes, moderate poultry, eggs, and dairy, along with increased physical activity, can soothe some mental health disorders. Stress reduction techniques and relaxation practices also support hormonal balance and mental well-being
• Medical Interventions: hormone replacement therapy and medications (antidepressants, anti-anxiety medications, stimulants, antipsychotics, and mood stabilisers)

Preventive measures and coping strategies

• Psychotherapies: cognitive behavioural therapy (CBT) and interpersonal therapy
• Sleep Hygiene: proper schedule, avoiding alcohol, caffeine, and beverages, and a sleep-stimulating environment³²
• Relaxation Techniques: like box breathing, progressive muscle relaxation, relaxation imagery, autogenic training, and applied relaxation³³

Summary

Hormones are chemical signals used by the body. When out of balance, they can contribute to mental health issues, such as depression, anxiety, PTSD, and more. Hormones like cortisol, serotonin, estrogen, progesterone, testosterone, and thyroid hormones influence various stages of life, such as puberty, pregnancy, and menopause, and may be affected by lifestyle and medical factors. Diagnosis typically involves lab tests, while treatment options may include lifestyle changes, medications, hormone therapy, psychotherapy, and relaxation techniques.