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Irritability

Natural Solutions to Improve Mood

By Nieske Zabriskie, ND

Irritability is a common complaint and accompanies several medical disorders. It is a symptom of an underlying imbalance, and is defined as the state of being abnormally or excessively responsive to slight stimuli, or unduly sensitive. There are numerous potential causes of irritability that must be addressed in order to diagnose the underlying causative factor.

Lack of Sleep

It is estimated that 50-70 million people in the United States have chronic sleep and wakefulness disorders that may adversely affect health.1 Insomnia is the most commonly reported sleep disorder and it is estimated that 10 to 15 percent of the adult population has chronic insomnia with an additional 25 to 35 percent having transient insomnia.2 Symptoms of insomnia include difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and non-restorative or poor quality of sleep. Insomnia results in irritability, fatigue, decreased concentration, and often mood disorders.3

Endocrine Disorders

Mood disorders often accompany endocrine diseases. In fact, one study showed that irritable mood was found to occur in 46 percent of patients treated for endocrine conditions.4 Common endocrine disorders include thyroid, adrenal, and estrogen/progesterone imbalance.

Irritability is a common symptom of female hormone imbalance that often presents as premenstrual syndrome (PMS) or during menopause. The most common PMS complaints are irritability, depression, weight gain, bloating, loss of sex drive, fatigue, breast swelling or tenderness, cravings for sweets, and headaches. Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome diagnosed in 5 to 10 percent of all fertile women. PMDD is characterized by depressed mood, tension, affect lability (excessive emotional reactivity), and irritability, with irritability the most prominent of these symptoms.5

Thyroid hormone imbalances are common endocrine problems. Thyroid hormone imbalance may present with irritability, lack of energy, aches and pains, poor memory, dry skin, cold intolerance, and/or depression.6 Hypothyroid patients, even with adequate thyroid hormone replacement therapy, have significant psychological impairment and hypothyroid symptoms when compared to individuals with normal thyroid function.

In addition, it is estimated that 50-80 percent of physical disorders are stress-related.7 The stress response is a complex set of physiological processes triggered by a stressor. Over time, chronic activation can lead to adverse physiological effects, which may lead to or exacerbate existing disease. The adrenal gland secretes cortisol, the primary stress response hormone. Mood disorders, such as depression and anxiety, are associated with malfunction of the hypothalamus-pituitary-adrenal (HPA) axis. Research has correlated environmental stress with increased levels of cortisol, increased irritability, and fatigue.8 Dysregulation of the HPA axis is found in anxiety and panic disorder as well.9 Research also indicates that late-in-life depression is associated with both below and above normal levels of cortisol, suggesting a sensitivity to any variation in the HPA axis.10

Natural Approaches for Irritability Improving Sleep

Melatonin is a hormone produced by the pineal gland and acts as a circadian rhythm and sleep-anticipating signal. In addition, melatonin has antioxidant and immune modulating activity. Melatonin production declines with age and the prevalence of sleep disorders, such as insomnia, increases. Several signs of impaired function of the circadian clock have been identified including various types of sleep disorders, memory and concentration impairment, and irritability.11 Melatonin plays a major role in normal function of the circadian clock. Levels of plasma melatonin have been shown to be significantly decreased in patients with primary insomnia compared to control groups.12 In an analysis of studies investigating the efficacy of melatonin for insomnia, melatonin treatment was shown to significantly reduce sleep onset latency, increase sleep efficiency, and increase total sleep duration.13 According to researchers, melatonin also significantly heightened freshness on awakening, improved mood, and improved daytime functioning.14 Studies have also shown that melatonin supplementation can moderate negative mood symptoms. In fact, melatonin has been shown to decrease irritability, anxiety, depression, restlessness, and cigarette cravings during nicotine withdrawal.15

Individuals who snore should also have a sleep apnea test performed to rule out this common cause of non-restorative sleep.

Female Hormone Balancing

Progesterone deficiency, or a decreased progesterone-to-estrogen ratio, can result in mood disorders. Therefore, taking a salivary hormone test (comprehensive hormone panel) to confirm hormone levels can offer valuable insight into possible causes behind irritability. If results indicate an unbalanced progesterone-to-estrogen ratio or progesterone deficiency, natural progesterone cream can help balance progesterone levels without the side effects of synthetic hormones. A double-blind, placebo controlled trial was performed to evaluate the efficacy of using progesterone in subjects diagnosed with moderate to severe PMS. The results showed a significant improvement in symptoms such as irritability, anxiety, tension, and mood swings. The authors of the study concluded that progesterone and the metabolites of progesterone such as pregnenolone may play a role as anxiety-reducing and mood-modifying agents.16

Thyroid Support

Iodine is a trace element required by the body and must be ingested in the diet. Iodine deficiency is associated with several medical conditions such as hypothyroidism, goiter (enlarged thyroid), cretinism, cognitive disorders, neurological disorders, and breast disease. Iodine is important for normal thyroid function as it is incorporated into thyroid hormones.

Although some studies indicate that the iodine intake in the U.S. is adequate, numerous other researchers suggest that sub-clinical iodine deficiency may be present and difficult to detect. Iodine deficiency can be caused by several factors such as salt restrictive diets, low levels of iodine in the soil, and intake of large amounts of goitrogens. Goitrogens are substances that suppress the function of the thyroid gland by interfering with iodine uptake and include cruciferous vegetables, cassava, millet, and soya flour. Intake of particular elements that compete with iodine for uptake and utilization such as chlorine and bromine may also be a factor. The National Health and Nutrition Examination Surveys (NHANES) have shown that between NHANES I (1971-1974) and NHANES III (1988-1994), the median urinary iodine concentration decreased by 50 percent in the U.S. Also, during this same time period, “low excretion” of iodine in the population (less than 5 mcg/dL) increased 4.5 fold.17

Iodine sufficiency can be detected by oral loading tests. These tests measure the amount of iodine excreted in the urine after a loading dose of iodine (Iodoral®) is ingested. If the body has sufficient iodine, at least 90 percent of the loading dose of iodine will be excreted in the urine. Less iodine is excreted if the body is deficient. The results confirm if supplementation with iodine is required, thus helping to determine whether low iodine levels may be responsible for irritability or moodiness.

Stress and Adrenal Support

To determine whether irritability is caused by adrenal dysfunction, taking a salivary hormone test (the adrenal function panel) can provide diagnostic guidance. Or, to test adrenal function and levels of other important hormones, the comprehensive hormone panel, as mentioned above, is a good option. If high cortisol levels are indicated, supplementing with Cortisol Control can help support adrenal gland health. Cortisol Control contains Withania somnifera (ashwagandha), a plant often used in Ayurvedic medicine to promote mental and physical health. Historically, this adaptogenic herb has been used to modulate the stress response as well as for immune modulation, anti-inflammatory, and antioxidant activity.18 Studies indicate that ashwagandha moderates the stress response when exposed to chronic environmental stressors, including modulation of symptoms such as depression, increased cortisol, and cognitive deficits.19 Research has shown that ashwagandha exhibits anti-anxiety and antidepressant activity comparable to pharmaceutical agents.20 Additional studies have supported the use of ashwaganha as a mood stabilizer.21

Magnolia officinalis and Phellodendron amurense (two other plant-derived compounds found in Cortisol Control) are botanicals also used for modulating the stress response. Research has shown that supplementation with Relora®, a proprietary blend of Magnolia officinalis and Phellodendron amurense, effectively reduces symptoms associated with increased stress such as irritability, anxiety, restlessness, depression, and concentration difficulties. This study also demonstrated that 78 percent of subjects reported increased relaxation and 74 percent had more restful sleep. Additional research has shown that Relora® can decrease cortisol levels in stressed subjects as well as decrease stress-induced overeating.22 In an additional randomized placebo-controlled clinical trial, pre-menopausal female adults with increased anxiety were supplemented with Magnolia officinalis and Phellodendron amurense. The results showed that these botanicals were effective in reducing transitory anxiety.23

Conclusion

Irritability is a common complaint and may be caused from a number of medical conditions. Common causes such as lack of sleep, endocrine imbalances and adrenal dysfunction must be addressed in an attempt to alleviate the underlying pathology causing the irritability. Testing for iodine sufficiency, hormone levels, and adrenal function and then supplementing with nutrients that support proper sleep, healthy iodine and hormone levels, and adrenal health, can be an important step toward banishing irritability and improving mood.

References

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2. Doghramji K. The epidemiology and diagnosis of insomnia. Am J Manag Care. 2006 May;12:S214-220.

3. Hidalgo JL, Gras CB, García YD, et al. Functional status in the elderly with insomnia. Qual Life Res. 2007 Mar;16:279-286.

4. Sonino N, Tomba E, Fava GA. Psychosocial approach to endocrine disease. Adv Psychosom Med. 2007;28:21-33.

5. Eriksson E, Andersch B, Ho HP, et al. Diagnosis and treatment of premenstrual dysphoria. J Clin Psychiatry. 2002;63 Suppl 7:16-23.

6. Lazarus JH. Clinical manifestations of postpartum thyroid disease. Thyroid. 1999 Jul;9(7):685-689.

7. Randolfi EA. Developing A Stress Management And Relaxation Center For The Worksite. Worksite Health. 1997 Summer; Vol.4, No. 3, 40-44.

8 Melamed S, Bruhis S. The effects of chronic industrial noise exposure on urinary cortisol, fatigue and irritability: a controlled field experiment. J Occup Environ Med. 1996 Mar;38(3):252-256.

9. Erhardt A, Ising M, Unschuld PG, et al. Regulation of the hypothalamic-pituitary-adrenocortical system in patients with panic disorder. Neuropsychopharmacology. 2006 Nov;31(11):2515-2522.

10. Penninx BW, Beekman AT, Bandinelli S, et al. Late-life depressive symptoms are associated with both hyperactivity and hypoactivity of the hypothalamo-pituitary-adrenal axis. Am J Geriatr Psychiatry. 2007 Jun;15(6):522-529.

11. Mahé V, Chevalier JF. Role of biological clock in human pathology. Presse Med. 1995 Jun 17;24(22):1041-1046.

12. Riemann D, Klein T, Rodenbeck A, et al. Nocturnal cortisol and melatonin secretion in primary insomnia. Psychiatry Res. 2002 Dec 15;113(1-2):17-27.

13. Brzezinski A, Vangel MG, Wurtman RJ, et al. Effects of exogenous melatonin on sleep: a meta-analysis. Sleep Med Rev. 2005 Feb;9:41-50.

14. Suresh Kumar PN, Andrade C, Bhakta SG, et al. Melatonin in schizophrenic outpatients with insomnia: a double-blind, placebo-controlled study. J Clin Psychiatry. 2007 Feb;68:237-241.

15. Zhdanova IV, Piotrovskaya VR. Melatonin treatment attenuates symptoms of acute nicotine withdrawal in humans. Pharmacol Biochem Behav. 2000 Sep;67(1):131-135.

16. Baker ER, Best RG, Manfredi RL, et al. Efficacy of progesterone vaginal suppositories in alleviation of nervous symptoms in patients with premenstrual syndrome. J Assist Reprod Genet. 1995 Mar;12(3):205-209.

17. Hollowell JG, Staehling NW, Hannon WH, et al. Iodine nutrition in the United States. Trends and public health implications: iodine excretion data from National Health and Nutrition Examination Surveys I and III (1971-1974 and 1988-1994) J Clin Endocrinol Metab. 1998 Oct;83(10):3401-3408.

18. Mishra LC, Singh BB, Dagenais S. Scientific basis for the therapeutic use of Withania somnifera (ashwagandha): a review. Altern Med Rev. 2000 Aug;5(4):334-346.

19. Bhattacharya SK, Muruganandam AV. Adaptogenic activity of Withania somnifera: an experimental study using a rat model of chronic stress. Pharmacol Biochem Behav. 2003 Jun;75(3):547-555.

20. Bhattacharya SK, Bhattacharya A, Sairam K, et al. Anxiolytic-antidepressant activity of Withania somnifera glycowithanolides: an experimental study. Phytomedicine. 2000 Dec;7(6):463-469.

21. Gupta GL, Rana AC. Protective effect of Withania somnifera dunal root extract against protracted social isolation induced behavior in rats. Indian J Physiol Pharmacol. 2007 Oct-Dec;51(4):345-353.

22. LaValle J, Hawkins E. Relora—The Natural Breakthrough to Losing Stress-Related Fat and Wrinkles. North Bergen, NJ: Basic Health Publications; 2003:16.

23. Kalman DS, Feldman S, Feldman R, et al. Effect of a proprietary Magnolia and Phellodendron extract on stress levels in healthy women: a pilot, double-blind, placebo-controlled clinical trial. Nutr J. 2008 Apr 21;7:11.

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