Occurrence and treatment of depression by sex hormones

Abstract

It has been demonstrated that aging has a significant impact on sex hormones production. It is now accepted that these hormones (including estrogens, progestogens, testosterone, and dehydroepiandrosterone [DHEA]) may play a pivotal role in the modulation of brain functioning, especially on mood and cognition. Changes in these modulatory effects due to abrupt sex hormonal fluctuations - as seen in the menopausal transition - contribute to the occurrence of mood disturbances. Hormonal interventions seem to improve depressive symptoms, as already demonstrated in studies of perimenopausal women treated with estradiol, and postmenopausal women treated with testosterone. This article reviews the potential role of sex hormones in the occurrence and treatment of depressive symptoms. Clinical studies on the antidepressant benefit of estrogens, testosterone, and DHEA are critically discussed. In essence, there are preliminary but promising data on the use of estradiol and testosterone for the treatment of depression in some specific sub-populations. Further studies would help to better delineate their therapeutic use (as monotherapy or adjunctive treatment), and to identify their limitations due to clinical contra-indications or risk of serious adverse events.