Reproductive Depression and the Response to Hormone Therapy

Abstract

Many cases of depression in women are due to endocrine factors and inappropriate treatment by antidepressants or mood-stabilizing drugs such as lithium. The syndrome reproductive depression includes premenstrual depression (PMDD), postnatal depression (PND) and climacteric depression which is more severe in the transitional phase 2 or 3 years before the periods cease rather than in the years after the menopause. Such patients are usually free of depression during pregnancy. The diagnosis cannot be made by measuring hormone levels but by a careful history relating depression to monthly cycles and the postnatal state. The range and aetiology of depression in women is different than in men and cannot be understood without knowledge of the effect that oestrogen, progesterone and androgens have upon mood. These frequent problems are usually treated badly by psychiatrists who have little knowledge and less interest in the effect of hormones on mood. Treatment should be by oestrogens preferably by the transdermal route possibly with the addition of testosterone and if necessary the addition of progesterone to protect the endometrium.