Investigating the Role of 17β-Estradiol on the Serotonergic System, Targeting Soy Isoflavones as a Strategy to Reduce Menopausal Depression: A Mechanistic Review

AbstractLow serotonin is one factor implicated in the development of depression. 17β-estradiol (E2) has been shown to modulate gene expression regulating the neurotransmission of serotonin. Sex hormone levels fluctuate dramatically during the menopausal transition, coinciding with a 14-fold increased risk of depression. This review aimed to examine the effect of soy isoflavones to support decreased and variable E2 levels before and after menopause, linked to an investigation of the pathophysiological mechanisms underlying the protective influence of E2 on the serotonin pathway. The overall aim of this review is to assess the potential of soy isoflavones to reduce depression in middle-aged women. A systematic literature search was performed in three stages. 1,421 papers were screened for relevance to the research aims and objectives. 63 papers were selected based on pre-defined inclusion/exclusion criteria (13 reviews, 24 mechanistic and 26 intervention studies) and critically appraised. Available research supported the hypotheses that E2 increases serotonin synthesis and availability through stimulation of tryptophan hydroxylase-2 (TPH-2) and decreased degradation by monoamine oxidase-A (MAO-A). There was less scientific agreement on the effects of E2 on serotonin transporter (SERT) and serotonin receptors 1 A and 2 A. Studies varied widely on the effectiveness of soy isoflavones in reducing depressive symptoms in (peri)menopausal women. Animal and human studies acknowledge women's increased risk of depression linked to fluctuating E2 rather than absolute levels. However, mechanisms linking E2 variability with depression remain an underrepresented area of research. Study limitations and heterogeneity may contribute to varying results for soy isoflavones and some effects of E2 on the serotonin pathway.KEY TEACHING POINTS17β-estradiol increases serotonin synthesis and availability through its effects on tryptophan hydroxylase-2, monoamine oxidase-A, serotonin transporter and serotonin receptors 1A and 2A.Soy isoflavones may ameliorate depressive symptoms around the menopausal transition by replicating the effect of 17β-estradiol on serotonin.Combining research on the mechanistic pathway of soy isoflavones with the effectiveness of outcomes can enhance clinical decision-making.Keywords: EstrogenSerotoninSoy isoflavonesMenopauseDepression Disclosure statementThe authors report there are no competing interests to declare.Author contributionsScotti McLaren: Conceptualization, Investigation, Roles/Writing – Original draft. Dr Karin Seidler: Supervision, Writing – Review & Editing. Dr James Neil: Review & Editing.