Estrogen therapy: Interface between gynecology and psychiatry

Abstract

One of the most widely documented findings in psychiatric epidemiology is that women have higher rates of major depressive episodes than men. This has been found all around the world using a variety of diagnostic schemes and interview methods (Bland et al. 1988; Cheng 1989; Weissman and Myers 1978; Nolen-Hoeksema 1987; Weissman and Klerman 1992). The prevalence of depression among women in these studies has been reported to be between one and a half and three times that of men. It can be argued that societal norms and sex role socialization experiences make it easier for women than for men to admit depression in epidemiological surveys (Phillips and Segal 1969; Young et al. 1990). However, a number of methodological studies have been carried out on this type of response bias in community surveys of nonspecific psychological distress using standard psychometric methods to assess potential biasing factors (Clancy and Gove 1972; Gove and Geerken 1977; Gove 1978). No evidence was found in any of these studies that the significantly higher levels of self-reported distress found among women than among men was due to these biasing factors. Female sex steroids profoundly influence the brain. Apart from the symptoms characterizing female-specific mood disorders such as irritability, dysphoria, affect lability, and changes in appetite, other aspects of brain function, such as sexual activity (Sanders et al. 1983), cognitive capabilities, sensorimotor function, and seizure susceptibility (Bäckström 1976) are also related to serum levels of estrogens, progesterone, and various progesterone metabolites. Moreover, sex steroids play a major role in the etiology and treatment of premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postnatal depression (PND), and menopausal related complaints. These roles will be discussed in more details later in this chapter. © 2005 Springer-Verlag/Wien.