Why Many Women Have Anxiety Disorders


by  | via commonhealth |















MM: Right.

RZ: Ok, so if estrogen helps with fear extinction, and women typically have more estrogen than men, then why aren’t men gripped with fear and anxiety all the time?

MM: As our initial hypothesis, we thought that men would behave very much like women with low estrogen, but when we got the data, I was puzzled because men behaved very much like women with high estrogen, and only low-estrogen women showed deficits in the fear extinction. What we have learned is that testosterone in men, in the brain gets converted to estrogen by an enzyme called aromatase. So we think that a lot of the benefit that men get is due to this conversion of testosterone to estrogen.

RZ: It’s cool to think that a hormone often thought of as “female,” could be so crucial to a characteristic often thought of as “male”…But you also conducted some research involving women on birth control pills, which, of course, interfere with the body’s normal production of estrogen. How does that affect the fear response?

MM: We did an initial study that made us concerned — we recruited women on birth control, and what we found is that women on birth control pills act like women with low estrogen. In other words, birth control seemed to impair women’s ability to control or extinguish fear.

(Editor’s Note: Lots of caveats here; Milad says all of these findings need to be replicated and tested on a much larger scale and are in no way conclusive at this point.)

RZ: After childbirth, that post-partum period is a time when many women have dramatic mood swings, depression, anxiety. Might that be related to the extreme hormonal changes that occur after birth, specifically the drop in estrogen?

MM: Yes, we think it’s that drop that perhaps may make women more vulnerable to anxiety disorders.

RZ: And what about the anti-anxiety drugs we’re all prescribed now? You did a study on fear extinction and SSRI’s, specifically using the generic version of Prozac, fluoxetine. These drugs aren’t prescribed with any thought about how hormones come into play…

MM: Right, they are not tailored to the different genders, everyone is taking the same thing. We did a study in female rats with fluoxetine, and what we found is that it’s most effective in reducing fear in the female rat only when the rat was in the estrous phase, which is the low estrogen state…So it doesn’t always work. And that could provide some data into why aren’t all women responding, for example, to Prozac or other medications for anxiety, why there’s a huge difference in how people respond.

RZ: So what’s next on your research agenda?

MM: We have applied for funding for a study to recruit women with PTSD; we want to pair prolonged exposure therapy with an estrogen pill to see if that helps with fear extinction.

R: Fascinating, and great if that worked. But tell me: what ever happened to that camping trip with your kids?

MM: Yeah, I was thinking about the bear thing…I would be anxious if I was in that park alone with my kids.

R: So did you end up going camping?

MM: No, of course not. I’m highly anxious.

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