Lowered Mood, Body Image and Appearance

BODY IMAGE AND APPEARANCE

Most of us need to feel we look good to feel good. This includes men and women. To achieve this you need to eat a healthy diet, enjoy adequate exercise and be happy with what you are doing in life. Being dissatisfied with how you are coping with life may in itself be sufficient to distort your body image.

Deep down we all know that few women are born to be super models and most of us are plain old Ms Average, but somehow women have been programmed to physically expect more of themselves, well beyond what they mostly are. It seems that one of the hardest things in life for a woman to achieve is acceptance of herself. But self-esteem is a key ingredient to really be happy and for this each woman has to learn to like herself.

Self-punishment with diets and smoking won’t achieve the new look woman nor will alcohol excess hide feelings of inadequacy. Anti depressants have become the new crutch of a society which cannot face the plight of women struggling to be well and find happiness. Everyone deserves to feel well enough to enjoy life. But for most women it shouldn’t be that this can only be achieved through antidepressant pills.

Many women know deep down that they are not actually depressed but they are searching for the reason that they persistently feel down, tired and have loss their spark.

LOWERED MOOD (DEPRESSION) AND DIMINISHED WELL BEING

Many women experience lowered mood through to depression. Depression affects one in four women, but only one in 10 men. Too often a woman’s complaints of low mood, loss of well being and fatigue are attributed to various life stresses (for example being a working mum, or a relationship difficulty), however there are several underlying causes that should be considered. These include:

Poor diet – iron deficiency is not uncommon in women during the child bearing years. A blood count may be normal even when iron stores are low, so iron levels need to be checked to exclude this as a cause. Iron deficiency may be due to heavy menstrual loss, poor diet or a combination of the two. A generally poor diet can also result in poor health and fatigue.

Being unfit – women who are physically very unfit may experience fatigue at low levels of activity and hence lowered mood.

Thyroid disorders are common in women and may need to be excluded.

Hormonal disorders may underlie many of the health problems women experience.

HORMONAL DISORDERS

A common hormonal disorder in women is polycystic ovarian syndrome. This is characterised by irregular periods, weight gain and development of obesity, excessive body hair and infertility. It is associated with a high risk of developing diabetes in later life. Up to 10% of women may have this problem. Women with this disorder generally struggle with their weight from early adolescence.

Premenstrual symptoms (PMS) are due to a woman’s responses to the fluctuations in her hormone levels towards the end of the menstrual cycle. Some women experience no premenstrual symptoms where as others are quite debilitated. Cyclical depression and headaches are probably the 2 most debilitating symptoms. These can sometimes be alleviated with medical therapies, hence women suffering these symptoms should seek out a physician interested in this field.

Many women begin to experience lowered mood, depression, fatigue or even PMS for the first time, in their late reproductive years (early forties) and in the years leading up to their natural menopause. There is evidence emerging that subtle hormonal changes precede the menopause and may indeed underlie the depression or lowered mood and well being experienced by many women through their forties. Typically such women are labelled as stressed, working to hard or actually depressed.

Hormones produced by the ovaries, androgens, oestrogens and progestins each influence mood and sense of well being. The complex interactions between these ovarian hormones and chemicals that transmit messages in the brain (neurotransmitters) can only be guessed at. Clinical experience indicates that testosterone exerts a major positive influence on mood, however conclusive data is lacking. We have hypothesized that the fall in testosterone during the reproductive years may contribute significantly the symptoms diagnosed as depression in many women.

The classic symptoms with which women with low testosterone present include loss of well being, persistent fatigue and blunted motivation in tandem with diminished libido. Conservatively these are also classic symptoms of depression. So one must consider both conditions when depression is present. Research has now shown that in men mood is significantly and inversely associated with testosterone levels independent of age and weight change. Physical activity and testosterone replacement restores mood and alleviates depression in men with testosterone deficiency.

What is the evidence that testosterone may benefit women? Following removal of the ovaries (surgical menopause) the addition of testosterone therapy to oestrogen replacement results in women feeling more composed, elated, and energetic than with oestrogen alone. Other studies have reported positive effects of testosterone in peri- and naturally postmenopausal women.

Transdermal testosterone replacement by a testosterone patch in surgically menopausal women significantly improves a specific general well being score over placebo (dummy therapy), with the greatest change being in improved general wellbeing and less depressed mood.

DHEA, currently available over-the counter in the USA but not in Australia, given orally (50mg/day) or transdermally (by a 10% DHEA cream) has been associated with a marked improvement in well being over placebo in SMALL studies only. Oral DHEA improves well being and depression and anxiety scores in women with adrenal insufficiency. However not all DHEA trials have been positive. Larger prospective trials with this steroid are required before definitive guidelines can be made for its use clinically.

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