Progesterone and Depression and Anxiety

by Tuline Baykal
(Oakland, CA)

I'm a 37 year female with a long history of depression and anxiety issues...for about the last 12 years I've been on a variety of antidepressants. None of which i feel have really solved the problem. I've always had terrible PMS- since a teen and it only seemed to get worse with age. It was recently recommended by my therapist to go see a Naturopath Endocrinologist. After doing saliva testing, it was found that my progesterone levels were in the low 50's, whereas, i'm told, they should be closer to 180. These results were mirrored by some blood work that my OBGYN had me do one week post ovulation for 3 cycles. My progesterone levels were a 5, where they need to be a 10. So, it is abundantly clear that I am deficient in progesterone indeed. With that diagnosis, my naturopath and the compounding pharmacy she works with developed a special cream with about 19% bio identical progesterone. After a couple of months, we tested again and much to my dismay, but not surprise, my levels had dropped a point. I was not feeling ANY of the promised beneficial effects of the cream. So with that, they went back in and changed the cream a bit and now it has 36% bio identical progesterone plus some additional amino acids to help my body absorb it better. After about 10 days on the new cream, i start to feel less depression, less anxious, clear thinking etc..and i thought i has hit the jack pot! however, I only supposed to take it on days 7-28. Problem is, that when I stop taking it, the benefits seem to disappear.
I'm torn on what to do.
The cream is VERY expensive and I'm wondering if I switched to NatPro, would i see the same benefits at a much much lower level of progesterone in your cream?
Honestly, I'm feeling a bit hopeless about it and am seeking some works of wisdom and light to help me get through this. I'm working on increasing prog levels mainly for depression and anxiety treatment, but secondarily because I would like to get pregnant in the next few months. Right now, as my levels are so low, I am told by the Reproductive Specialist that I will have to take fertility drugs to ensure a pregnancy that will not end in miscarriage b/c my prog is too low to hold the ovum.
Essentially, I just don't know what to do.
I can't afford to continue to buy this cream if I'm not going to see lasting results (it's nearly $100 per tub).
Can you please share any insight, similar stories, solutions, suggestions?
Many thanks, TB

Comments for Progesterone and Depression and Anxiety

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Mar 26, 2012
correction
by: tuline

Correction to my original post.
The cream is not 36% progesterone.
It has 38mg bio identical wild yam per 1/4 teaspoon.
Thoughts?
How does this compare to the ingredients in Natpro?

Mar 30, 2012
Progesterone and Depression and Anxiety
by: Wray

Hi Tuline It appears your progesterone level has been very low from puberty. PMS is easily corrected with sufficient progesterone. Saliva follicular levels range from 12-100 pg/ml (serum <1). Whereas luteal levels range from 75-270 pg/ml (serum 5 to 20 ng/ml). We do have a page on Hormone Testing with all the levels. I'm glad you sent in the correction about the strength of the cream, as you could never dissolve 36g of progesterone in 100g of carrier! The cream you are currently using is a 3.04% strength, Natpro is 3.33% in strength, slightly more progesterone per ml of cream. And that price you pay?! You don't say how much you are using, as this is critical to the success of progesterone. I've found 100-200mg/day or more is needed, dependant on symptoms. Often more is needed, particularly if Oestrogen Dominance is experienced. I have found 400mg/day, sometimes more, prevents this occurring. I have no idea why they told you to use it from day 7 to 28, as it can act as a contraceptive if enough is used. It should be used from ovulation to bleeding, ie during the luteal phase, which lasts in all women 12-14 days. Progesterone is not produced during the follicular phase, although there is a pre-ovulatory rise in progesterone the 50 hours prior to ovulation. This surge comes from the brain, see here, here, here and here. Researchers suggest this surge is the reason for the surge in LH, which initiates ovulation. Prior to this discovery it was believed oestrogen was responsible for the LH surge. This thought still persists! So instead of trying progesterone, they give women ovulation induction drugs. I only advise using it daily, through any bleeding, if women have severe symptoms. This ensures progesterone becomes the dominant hormone, and suppresses any excess oestrogen. For more info on How to use progesterone cream please look through this page. Continued below.

Mar 30, 2012
Progesterone and Depression and Anxiety Part 2
by: Wray

Hi Tuline It appears you are possibly not getting this pre-ovulatory surge, and that you have a defective luteal phase, see here, here, here, here, here, here, here and here. It's been found that a steep early luteal phase rise in progesterone is essential for successful implantation, see here. This would be ensured by the pre-ovulatory rise in progesterone, followed by ovulation. If you should consider continuing with progesterone, I would suggest you start using it within the 50 hours prior to ovulation, to assist this in taking place. We do have a page on Pregnancy you could look through, plus this page here. Vitamin D is vital for ovulation, conception, a successful pregnancy and for the growth of the foetus, see here, here, here, here and here. Continued below.

Mar 30, 2012
Progesterone and Depression and Anxiety Part 3
by: Wray

Hi Tuline And more here and here. These are excellent videos to watch too, see here and here. Please have a test done. For more info on vitamin D levels, test kits etc see the Vitamin D Council, GrassrootsHealth, Birmingham Hospital and Vitamin D Links websites. Blood levels should be 70-100ng/ml or 175-250nmol/L and not the 30ng/ml or 75nmol/L most labs and doctors regard as adequate. The minimum daily dose should be 5000iu's per day, although the latest research indicates it should be 10,000iu's per day, see here. Another nutrient you could consider taking is taurine. This amino acid is vital for the growth of the foetus, and the newborn, see here, here and here. Take care Wray

Mar 30, 2012
thank you and more info
by: Tuline

Wray, I can't thank you enough for your comments, feedback and information. I look forward to exploring the links you suggest. In terms of Vit D, yes, I'm very on top of that one. My levels are good...after much work, and I take 6,000 iu daily. In regards to the progesterone cream that i'm currently using, i'm worried that i'm using it days 7-28 and not just the post ovulation-bleed part of the cycle as you suggest. i'm currently using 1/4 teaspoon twice a day. I have no idea how much that is in terms of dosage. I think i'm going to order your cream and give it a try and see how I feel using that and not the cream that I'm on now. Yes, it's very very expensive and for a small tub. I'm also taking plenty of supplements including Magnesium, Taurine, Vit B, E, C, a multi and an immune booster b/c I also have Epstein barr virus.
Once I get your cream, how much would you recc that I use?
Again, thank you so very much for your time and support. This has been a loooong and often hard journey.
Best, Tuline

Apr 02, 2012
thank you and more info
by: Wray

Hi Tuline Very pleased you're taking enough vitamin D, that's good news. And the magnesium, it's the most important co-factor for vitamin D. It is strange how they tell women to use the cream. I've seen so many variations it's remarkable! You're currently using about 76mg/day progesterone which I believe is too low. I've found if initially a high amount, ie 200mg/day or more is used, it works quicker to relieve symptoms. It can then be reduced slowly till the optimum is found. Although 400mg/day is needed to prevent any oestrogen dominance occurring. But this does depend on how much oestrogen is present, it's trail and error. If you have EBV you need to take more vitamin D, but best to have a test done first to find out your current level. Vitamin D stimulates the production of two natural 'antibiotics' the body makes, defensin and cathlecidin. These work wonders against any pathogen. I would really recommend getting your vitamin D level to 100ng/ml. You should also consider taking N-acetyl cysteine (NAC), glutamine and glycine. These three amino acids are the precursors to glutathione, the cells master antioxidant. The cells main defence against any invading pathogen is nitric oxide (NO), it releases this which kills the pathogen. But NO is a free radical, so the GSH absorbs the NO to protect the cell from free radical damage. But it becomes oxidised in the process. If there is insufficient GSH to mop up the NO, this will in turn damage the cell itself. It's pointless taking glutathione (GSH) as it's a protein, or tripeptide, so it's broken down in the gut like any protein. GSH is usually low in any disease. NAC is also a potent antioxidant too. Take care Wray

Apr 02, 2012
thank you
by: Tuline

Dear Wray-
Thank you so very much.
I just reviewed my last two saliva test results and here were the results.
9/13/11
Estradiol 1.59 pg/ml
Progesterone 89 pg/ml
I was then on a cream, 1/4 2x/day, with 19mg progesterone.
I felt NO difference.
Tested again on 1/28/12 the results showed:
Estradiol 1.13 pg/ml
Progesterone 82 pg/ml
My progesterone actually DROPPED and as you can imagine, I was very unhappy.
This is when she upped the Progesterone formula amount to 38 mg. Which as I mentioned I apply 1/4 teasp 2x/day. Until your cream arrives, I will try applying this 3x/day to get 228 mg per day.
When your cream arrives, how many teasp should I use daily?
Thank you for the comments about the Vit D and some additional supplements for EBV. Very helpful.
How much of NAC, glutamine and glycine shall I take daily for an effective dose?
Again, Thank you so very much.
Best, Tuline

Apr 03, 2012
additional...CMV
by: Tuline

I just did a ton of blood work for the Reproductive Specialist and was just informed that I also test positive for:
Cytomegalovirus (CMV)
I've never even heard of this, but I'm told it's very common and similar to EBV and Mono (which a had at age 15).
Do you any information about CMV and progesterone?
From what I've read, it's a virus that a healthy immune system can keep at bay. However, my immune system has been an on going issue which is why I'm so vigilant about taking supplements. I've struggled with symptoms of EBV on and off for years, but never have I even heard of CMV.
Any thoughts?
Many thanks, Tuline

Apr 07, 2012
additional...CMV
by: Wray

Hi Tuline Although you're disappointed that your progesterone dropped, the significant figure is the oestrogen, which also dropped. So the progesterone was suppressing the oestrogen, albeit slightly. Your P:E2 ratio was 56:1, it's now gone up to 79:1, so it is creeping up, but taking far too long. We've found from Saliva Tests we run that the ratio should be 600:1 and over to feel well. You're currently using 1/2tsp cream per day, giving you about 76mg/day progesterone. So 228mg/day would require 1 1/2tsp a day. See how you get on with this amount, and if you feel it's working, then stick to it when our cream arrives. You would need 1 1/3tsp cream per day. You say your vitamin D levels are good, how good?! Are they around 100ng/ml? I feel they need to get this high and for many months to help. Any infection will use it up as quickly as you put it in. Mine are currently 92ng/ml. I suggest you get the supps in powder form, it's far cheaper. I take mine in fresh fruit juice, or the boxed variety with no nasties in it. The NAC is very sour and smells of sulphur, I'm so used to it now. Take about 2000mg/day NAC, 2000-8000mg/day glutamine (I take 8000mg/day, it helps with blood glucose dropping and tiredness) and 1000-2000mg/day glycine. Glutamine is also the main fuel for the immune system, yours is probably depleted. CMV is very common, it's one of the herpes viruses, see here and here. You need to get your immune system in high gear, so please let me know your vitamin D levels. Progesterone, like vitamin D, is an antioxidant and anti-inflammatory so will help the immune system, although I have no papers proving it will help CMV. Take care Wray

Apr 09, 2012
follow up
by: Tuline

Greetings Wray-
Thank you so much for decoding those hormone levels for me...it was very helpful to hear and see that progress has taken place.
Your cream is due to arrive any day and until then, I'm taking 1 1/2 teasp of my current cream as per your recommendation. I purchased all the supplements you suggested and started them yesterday. I'm very curious to feel the benefits of these, as my immune system has been very challenged for a very long time. In terms of Vit D. I check my blood work from last year as I was up from 13 to 51.7....much better, but still not nearly close to 100. I'm not taking 10000 iu daily, should I be taking more? I didn't find powder Vit D, but I did find liquid. In regards to the NAC, is it ok to take when I decide to try and conceive? Lastly, I just got another set of blood work results back (she did not test for D in this one). I felt a bit alarmed b/c my TSH levels came back at .86 whereas a year ago my TSH was at 3.430. This is a significant difference and I'm not sure whether it's a good thing or a problematic thing. I've put a call into my doctor, but she's currently out of town. Any thoughts about the TSH levels? What are healthy levels?
Ok, again, many thanks for your wisdom and support.
So very helpful and life changing.
Best, Tuline

Apr 09, 2012
Home Saliva test kits
by: Tuline

One additional question. I see that you use ZRT labs for the hormone testing. I've used them with a previous naturopath, but she did not know how to read it properly and misdiagnosed me. My current naturopath, who I get my current cream through, is lovely, but pricey and her saliva tests are $400 a pop. Can you recommend how I can do this testing on my own? I see that ZRT only sells to qualified practitioners. Is there any company that I can purchase from as a lay person and get my own results without having to spend a fortune to go through a naturopath?
Many thanks, Tuline

Apr 10, 2012
Home Saliva test kits
by: Wray

Hi Tuline So pleased the info helped, the nutrients should too, but please give them time. It's not a quick fix, as there are so many things we are not aware of that need help. We're only aware of the things which are obvious to us. 13ng/ml is very low! I'm pleased it's increased, no wonder your immune system was struggling. The 6000iu's you're currently taking is good, and should continue to get your level up, but if you want it to rise quickly, you will need to increase it for a month or two. And then have another test. I do recommend ZRT, but Birmingham Hospital in the UK do them now, and for only £25 (±$32) will send you a test kit. They'll send the results back by email, but ignore their 'adequate' level, far too low! They follow the NHS of 20ng/ml, even the FDA sets it at 30ng/ml. I gave you their link in my first reply above. But they don't do saliva tests. ZRT are the best and they do send out test kits, see ZRT Labs. I can't see anywhere on their site you have to go through a doctor. I would really recommend taking the NAC now, it's such an important antioxidant, and you have/had EBV and now they say the CMV. Your glutathione will be very low. And don't worry about the TSH, we do have levels for that too on the Hormone test page I gave you, they range from 0.4 - 4.0 mIU/L. TSH is produced by the pituitary, I liken it to the whip on the donkeys back, beating the thyroid to make it work! Well it seems it's done it's job as your levels are low, in other words the thyroid is making sufficient T3 and T4. Let me know how you get on. Take care Wray

Apr 17, 2012
Thank you
by: Tuline

Thank you for helping me understand the Tyhroid levels- I'm delighted to know that in the past year it seems to be whipping it into shape ;)
For now, I'm going to take 10,000 iu of Vit D. per day to get my immune system back to a better place- it's been struggling the past couple of months. I've started the formulas you suggested at the dosages recommended however, I'm only taking 2000 of the glutamine/day. Do you suggest I go higher- closer to 8000 a day?
I also received your cream last Thursday..yay!! and was able to use 1/1/3 tsp daily until I started bleeding yesterday. So, Friday, Sat and Sun I used 1 1/3 tsp that I spread out to three applications a day. I'm guessing at that frequency of dose, I will probably use 2 tubes or more per month. Does that sound about right to you? Also, should I definitely not use the cream while I'm bleeding and wait until Day 14 to start up use again? I'm encouraged and excited to see and feel the results of your cream.
Best, Tuline

Apr 18, 2012
Thank you
by: Wray

Hi Tuline Yes the TSH does seem to have done it's job! Pleased you are increasing the vitamin D too, that should help enormously. Please have another test done in about 3 months. Very happy you've started the supplements. See how you get on with the 2000mg/day glutamine, it's so easy to increase it if you feel you need to. Tiredness is the main symptom which should be helped, but do remember it does take time. I'm glad the cream has arrived, we have a stock out at the moment, which is causing me a great deal of anguish! There was a complete mess up with the delivery of one of the raw materials which set back production. Yes the 1 1/3tsp will be giving you ±216mg/day progesterone. There's 2000mg in each tube, so one tube will last ±9 days. See how you get on with stopping the progesterone, if adverse symptoms occur, it might be best to ignore any bleeding and use it daily for 2-3 months. This will at least ensure progesterone becomes dominant. It not harmful to use it during bleeding, I suggest this to many women, as often they have very painful cramps. Progesterone inhibits the prostaglandins which cause them. Please let me know how you get on. Take care Wray

May 21, 2012
it's been 2 cycles now
by: Tuline

Dear Wray-
I wanted to check in and let you know how I'm getting along. I've been using the cream for 2 cycles now and I find that while I'm on the cream, I really notice a difference: better mood, less anxious, less depressed, more energy etc...but once I stop using it when I start my cycle, within days I'm feeling sluggish and blue again.
I'm just not sure what to do as I'm also working on getting pregnant and fear using the cream daily will act as a contraceptive. Considering that my Reproductive Endo wants me to use Femara to help me get pregnant, I'm scared to do anything that may interfere with using fertility meds.
It's all very overwhelming and I'm trying to weigh the pros and cons.
Any suggestions?
Best, Tuline

PS. I live in California and ZRT labs can only process a salvia kit for me with a practitioner's note. Apparently this is a state law. Any suggestions or ideas?

May 23, 2012
it's been 2 cycles now
by: Wray

Hi Tuline I would really recommend using the progesterone daily, for about 2-3 months. This will ensure it becomes dominant and suppresses any extra oestrogen. Each time you stop it allows oestrogen to rise again. I've found it usually only takes 2-3 months before things settle down, and you can follow your cycle again. When you do I recommend you get a mini microscope to check for ovulation. I would suggest you time the progesterone by starting it within the 50 hour pre-ovulatory surge. It begins rising then, but round about 12 hours prior to ovulation it rises exponentially, and continues to do so after ovulation. The microscope will take the guessing out of it. I can't get my head around why he wants you to use Femara, it's an aromatase inhibitor which stops all oestrogen production. Oestrogen is needed if your aim is to fall pregnant, see here and here. The more usual fertility drugs also have a cancer risk, see here, here and here. California has the most daft laws, another thing I can't get my head around! I can only suggest you email Birmingham Hospital and get one of their kits, they are cheaper too. Take care Wray

May 23, 2012
Thank you
by: Tuline

As always, Wray, you've been so very helpful!! Thank you. I will order the microscope. Just to clarify, should I be using the full dose (for me that's 1 1/3 tsp) daily for 2-3 months? and then taper back to using 50 hours pre-ovulation until day 1 of cycle?
In regards to the Femara- wow...that's so interesting!! Somehow it induces ovulation and increasing chance of pregnancy. At least that's what I'm told. They wanted me to try Clomid, but I refuse b/c of the horrible emotional/hormonal side affects.
I'm not totally sold on using fertility meds, but the reason I'm considering it is because my partner lives in NYC and I need him to fly out at "just the right time" to catch ovulation. Which, as I've shared, I've been terribly unsuccessful with using ovulation predictor kits. So, using the Femara would give me a clear idea of when exactly I will ovulate. Honestly, I'm not even sure that I'm ovulating at all. However, I had a uterine sonogram and I have 6-7 follicles on each ovary, so that was good news. I bleed on a 28 day cycle, but yet, the pee stick ovu predictor have consistently been inconclusive which is why I was sent to a specialist. Also because my progesterone levels were so low in the second half of my cycle.
I'm learning so much, I feel empowered, yet confused as well.
I just want to get pregnant- who knew it would be so much work. At 37 I guess this is what it's like. I've cut way down on alcohol consumption and I'm in the process of a smoking cessation class. I eat well, fresh and organic. Take supplements etc...
I will email Birmingham Hosp- thank you.
Ok, again, my thanks for all your support.
Best, Tuline

May 24, 2012
Thank you
by: Wray

Hi Tuline I would suggest using it daily, you might not need the full 2-3 months. It's easy enough to see if you are topped up enough, just by stopping the progesterone when you start bleeding, and see if the symptoms return. If not you could continue using it taking the customary break. I would suggest staying on the amount you're using now, as it seems to suit you. Femara has been used off-label for ovulation stimulation. By stopping oestrogen production, the hypothalamus/pituitary senses this, so increases the gondotrophins FSH to stimulate follicle development, and LH to stimulate ovulation. But as you saw from those papers I gave you, progesterone is responsible for the LH surge and therefore ovulation. To my mind a very twisted way of forcing the body to produce a follicle and ovulate. The ovulation induction drugs are for me a last resort, after all natural means have failed. You do have your work cut out, a partner living in NYC and you in California! I think you might find the microscope helps you, as it picks up the very early stages of ovulation. Do keep in touch. Take care Wray

Nov 20, 2012
follow up Q about Vit D
by: Tuline

Greetings Wray-
It's been months since I've checked in and wanted to touch base.
I've been using the creak daily for the past several months and I definitely feel a difference when I'm using it vs. when I slack for a couple of days.
WOW!
As the cold season approaches, I wanted to get my Vit D levels tested and I'm so glad I did.
I've dropped from about 33 to 20.
I don't understand why b/c I've been supplementing with 10,000 of Vit D per day. 5,000 in am and 5,000 in pm.
Is there anything that may be blocking my body's ability to absorb this amount and actually use it as needed?
Could it be the Epstein Barr virus that just depletes the Vit D stores so very fast.
I'm at a loss as to how to handle this and to get to a place where I'm closer to 100 in my blood, rather than a mere 20.
Suggestions and feedback welcome.
many thanks, Tuline

Nov 24, 2012
follow up Q about Vit D
by: Wray

Hi Tuline Bless you for this feedback, it's always so helpful. I'm so pleased you've found a difference. Your vitamin D has dropped! And yes there are factors preventing absorption, do you have any gut problems? See here. The EB would deplete the vitamin D, any bacterial or viral disease would. I'm going to suggest you take 100,000iu's for 6 days only, then drop down to 20,000iu's per day for the rest of the month. Then have another test done. I do this frequently if I feel the need for more. Toxicity is only reached when vitamin D levels get to 200ng/ml, 10 times more than you currently have. I feel using such a high dose, it might overcome the EB, and then the lower doses would give you enough to bring your level up. But it would be necessary to have a test done after about a month. If still not high enough, repeat the month. This is an excellent article to read about toxicity, when really huge levels of vitamin D were taken, see here. Take care Wray

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