HormonesMessages from the glands that regulate stress, sleep, bonding and emergencies, affected by substance use, withdrawal and recovery

1What are hormones?

When you wake up in the morning with energy, feel sleepy as night falls, feel your heart race at a sudden danger, or feel safe in the arms of someone you love, chemical messages are traveling through your blood to coordinate all of it. These messages are hormones.

The US National Library of Medicine defines hormones as the body’s chemical messengers, which travel in the bloodstream to tissues and organs and affect growth, metabolism, sexual function, reproduction and mood. They are released by the endocrine glands, specialized groups of cells, and a very small amount is enough to cause big changes in cells or in the whole body.

According to Cleveland Clinic, the body has more than fifty different hormones that directly or indirectly affect nearly every aspect of health. But this page does not cover all hormones; it focuses on the hormones that affect the brain and mental state and are affected by substance use and recovery. The general difference between a hormone and a neurotransmitter is explained on the main brain chemistry page.

2Which glands release the hormones that affect the brain?

The hormonal system, or endocrine system, is a network of glands spread through the body. The most important ones for mood, stress and sleep are the following glands:

Cleveland Clinic describes the hypothalamus as the main link between the nervous system and the hormonal system; it is a part of the brain that receives signals from emotions, light and stress, then translates them into hormonal commands that usually pass through the pituitary gland. So it is no surprise that sadness, fear or sleeplessness change your hormones, and that your hormones in turn change how you feel.

3How does the brain control hormones?

Most hormones work through a system like the thermostat of an air conditioner: when the hormone level drops, the brain sends a signal to raise it, and when it rises enough, the message reaches the brain, which eases the signal. This is called negative feedback, and it keeps things balanced under normal conditions.

The best-known example of this system for our topic is the HPA axis, the axis that links the hypothalamus to the pituitary gland and then to the adrenal gland, and it is the body’s stress axis:

1. The brain senses a stressful situation, real or imagined, and the hypothalamus sends a hormonal signal to the pituitary gland.
2. The pituitary gland releases a stimulating hormone that reaches the adrenal gland through the blood.
3. The adrenal gland releases cortisol, so blood sugar rises, energy is mobilized and the body copes with the pressure.
4. Cortisol reaches the brain and eases the initial signal, and the axis returns to calm after the situation passes.

4Types of hormones in the Eradah guide

We chose the four hormones most closely tied to stress, sleep, bonding and emergencies, and to the stages of substance use, withdrawal and recovery. Each has a full guide and separate pages, and here is a short card for each hormone:

5What is the difference between cortisol, adrenaline, melatonin and oxytocin?

The four hormones differ in source, speed and function, but they overlap a great deal in the lives of people going through addiction and recovery. The table summarizes the main differences, and the details are on each hormone’s page:

It is worth noting that these hormones also follow a daily rhythm. Cortisol usually rises in the early morning to help us wake up and then falls gradually through the day, and melatonin rises as darkness falls to prepare for sleep. So staying up late and sleeping in the daytime, a common pattern during substance use, throws both hormones off, and energy, mood and concentration suffer.

6What other hormones affect mental state?

We have not dedicated separate guides to all hormones, but the psychiatrist often keeps these hormones in mind, because disturbance in them can cause psychological symptoms or worsen them:

• Thyroid hormones: the US National Library of Medicine lists depression, fatigue and weight gain among the symptoms of an underactive thyroid, while overactivity can cause nervousness, palpitations and insomnia that resemble anxiety.
• Sex hormones: testosterone is linked to energy and sexual desire, and fluctuations in estrogen and progesterone affect mood in some women before the period, after childbirth and around menopause.
• Insulin and blood sugar: severe low blood sugar can cause tremor, sweating, nervousness and confusion that is sometimes mistaken for anxiety attacks.
• Prolactin: the breastfeeding hormone, which some psychiatric medications may raise, and which the doctor sometimes monitors.

That is why the doctor sometimes orders thyroid, sugar or other tests at the start of a psychiatric assessment, not because depression is a “hormone disease,” but to rule out a treatable physical cause before reaching the final diagnosis.

7How do drugs and alcohol affect hormones?

Talk about addiction usually turns to dopamine, but the hormonal system pays a heavy price too, and many complaints from people who use substances and people in recovery, such as exhaustion, low sexual desire, menstrual disturbance and sleep disturbance, have a hormonal side:

A review published in the StatPearls medical library explains that chronic opioid use can disrupt both the sex gland axis and the adrenal axis, producing symptoms such as sexual dysfunction, loss of periods, fatigue and depression. The reassuring news in the same reference is that most of these disturbances improve after stopping opioids. The role of the stress hormone in craving and relapse is explained on the cortisol and addiction page.

8Can gland diseases resemble mental illnesses?

Yes, and this is one of the main reasons the psychiatric assessment should be comprehensive. There are well-known hormonal conditions that may at first look like a purely psychiatric disorder:

This does not mean that everyone who feels anxious should suspect their glands; these conditions are less common than anxiety and depression themselves. It means that a good doctor asks about physical symptoms and orders the appropriate tests when something calls for them. Details on the last conditions are on the high cortisol and high adrenaline pages.

9What are the common myths about hormones and mood?

10When should you see a doctor about symptoms that may be hormonal?

You do not need to identify the responsible hormone before asking for help. Seek a medical assessment if you notice the following; an endocrinologist and a psychiatrist may both be involved. This list is for awareness and is not a diagnosis.

• Severe, persistent fatigue or a clear change in weight with no understandable reason.
• Insomnia lasting weeks, or a reversal of sleep times you cannot correct.
• Low sexual desire or menstrual disturbance during or after substance use.
• Palpitations, sweating attacks and headache with high blood pressure.
• Severe sadness or persistent anxiety after childbirth, or any thoughts of harming yourself or the baby; here, seek help immediately via 123 or 16328.
• If you have been taking cortisone medications for a long time and are thinking of stopping them, do not do so except with your doctor.

At Eradah, the psychiatrist looks at the whole picture: psychological and physical symptoms, medical history, and the substances and medications used, then orders the necessary tests and refers to an endocrinologist when needed, within a single integrated and confidential treatment plan.