Oestrogens and Post-natal Depression
Psychiatrists have little understanding of the importance of hormones in the treatment of depression in women
Professor Studd’s reply to an article in ‘The Obstetrician & Gynaecologist:
I was shocked to read your articles on perinatal depression in that all sorts of psychiatric and psychological help was discussed without a mention of oestrogen therapy. We are used to psychiatrists being utterly ignorant of the effects of oestrogens on Reproductive Depression, ie premenstrual, post natal and perimenopausal depression, no doubt because they cannot cope with the minor complications of oestrogen therapy such as sore breasts, occasional vaginal bleeding and progestogen side effects. Although these complications can be dealt with by any competent general practitioner they are clearly beyond the ability of psychiatrists.
There is good evidence that oestrogens are effective in the treatment of post natal depression even with women who have not been helped by antidepressants (1). Regrettably, this original Lancet study has not been repeated after 10 years either because it was perfect (which I doubt) or because psychiatrists are not interested in this form of therapy and the pharmaceutical companies not interested in testing their profitable SSRI’s against non-profitable out of patent oestrogens. There are even experimental studies where women with a previous history of post natal depression are given hormonal pseudo pregnancy and then the hormones discontinued. Those with a history of post natal depression become depressed, those with no history do not become depressed (2).
There seems to be little doubt that this excess of depression in women in the premenstrual and post natal period are due to changes in oestradiol levels which can be so easily treated with replacement transdermal oestrogens in moderately high doses. For further information on this, readers are referred to the review articles by Studd and Panay (3).
- Gregoire A J, Kumar R, Everitt B, Henderson A F, Studd, J W – Transdermal oestrogen for the treatment of severe post natal depression. Lancet 1996, 347, 930-933.
- Bloch M, Schmidt B J, Danaceau M et al – Affects of gonadol steroids in women with a history of post partum depression. MJ Psychiatry, 2000, 157, 124-230.
- Studd, J, Panay N – Hormones and depression in women. Climacteric 206, 7338-7346