Dracula Depression

This article below appeared on Dr John Studd’s web site recently. (www.studd.co.uk). A look at Dr Studd’s CV would show that he is one of the worlds foremost experts on womens health and hormones’. He discusses a recent artilcle in a medical journal by a psychiatrist writing about the treatment of Depression in women, and their hormones.

Here is his Biography:

Biography

Professor John Studd, DSc,MD,FRCOG was Consultant Gynaecologist at the Chelsea & Westminster Hospital, London and also Professor of Gynaecology at Imperial College. He qualified in 1962 and has worked and trained in Birmingham. Zimbabwe and London. He was Consultant Gynaecologist in Salisbury, Rhodesia and Consultant and Senior Lecturer at the University of Nottingham and moved to London in 1974 as Consultant Obstetrician and Gynaecologist at King’s College Hospital. Six years ago he was invited to join the staff at the new Chelsea & Westminster Hospital, London.

His early research was on chronic renal disease and high blood pressure in pregnancy (MD thesis) but later started the first menopause clinic in the county in Birmingham in 1969. This hormone treatment for the menopause was so controversial at that time that the clinic was closed down for three months following protests from the BMA. However, the optimism placed in HRT has been confirmed and John Studd has continued to work on specific treatments for menopausal symptoms. He pioneered the sequential oestrogen/progestogen treatment and also the continuous combined oestrogen/progestogen non-bleeding treatment. He has championed the use of hormone implants for women with osteoporosis or with severe depressive or sexual problems after the menopause and as an almost routine route of HRT after hysterectomy.

He first described the use of oestrogen patches and oestrogen implants for the treatment of severe PMS and runs a PMS/Menopause clinic at the Chelsea & Westminster Hospital, the Lister Hospital and the Wellington Hospital.

He is also shows the efficacy of moderately high dose transdermal oestrogens for the treatment of hormone responsive depression in women, particularly post-natal depression, pre-menstrual depression, menopausal depression and post-hysterectomy depression. He has a D.Sc. for 25 years of published work on oestrogen therapy in women. He has written more than 500 scientific articles and written or edited more than 25 post-graduate books on gynaecology and realises the he needs to write one for the public. This is much more challenging.

He is Founder and Vice-President of the National Osteoporosis Society and has been a Council Member of the Royal College of Obstetricians and Gynaecologists for 12 years and a Past-President of the Section of Obstetrics and Gynaecology at the Royal Society of Medicine. In 2005-2007 Professor Studd was Chairman of the British Menopause Society.

Article:

Dr O has two items in The Obstetrician & Gynaecologist, which confirm my belief that oestrogen to psychiatrists is like garlic to Dracula. It is equally illogical. It is unbelievable that for an article on Postnatal Depression, oestrogen has a brief last paragraph footnote informing that oestrogen can act like an antidepressant by the effect upon the dopaminergic and serontonergic receptors. Indeed it does and for this and other logical reasons as well as scientific and clinical evidence that should be used in those conditions of depression in women related to changes in oestrogen levels. These will include premenstrual depression, postnatal depression and peri-menopausal depression. These have all been shown in double blind trials to be responsive, greater than placebo to transdermal oestrogens, yet the original Lancet paper showing the beneficial effect of this on postnatal depression is not featured in the text or references although the co-authors were psychiatrists, Dr Alan Gregoire and the distinguished expert on postnatal depression the late professor Chani Kumar .It is bad enough that these studies have not been repeated by those responsible for the care of depression i.e. psychiatrists but the refusal to reference and discuss such a paper is intolerable.

There is good evidence that postnatal depression, premenstrual depression and peri-menopausal depression confirm the same vulnerable women and it is a commonplace experience that depressed 45-year-old women will say that they were last well when they were last pregnant 10+ years ago. They then developed postnatal depression and were put on antidepressants. When the periods returned they developed a cyclical depression and towards the menopause the depression became less cyclical so they no longer even have 7 good days a week but every day as the depression is now continuous.

The tragedy is that these women were given antidepressants of doubtful value and certain side effects at the time of their postnatal depression. Over the years they then suffer ineffective multi-drug therapy frequently with ECT (particularly in the private sector). At this stage it is difficult for women to come off these powerful drugs, which they probably shouldn’t have had in the first place. It is true that women with postnatal depression and other types of hormone responsive depression do not have different hormone levels than those without depression. Nobody ever said that they did. It is simply a response to changes of oestrogen and no doubt progesterone in women, who, for some reason, are biochemically vulnerable to these hormonal changes.

The diagnosis of reproductive depression is not based upon blood tests but on the history relating the current depression to the history of being in good mood during pregnancy followed by postnatal depression. There is also a history of previous premenstrual depression and perhaps the history of menstrual headaches is a further clue to the cyclical and endocrinological basis for this condition.

I am very pleased that Dr. O reports that the article most read by psychiatrists last month was ‘Oestrogen relieves psychotic symptoms in women with schizophrenia’. This has of course been known for more than ten years. I am not reassured that psychiatrists have an interest in this but I would be more impressed if they actually used oestrogens for such an indication. But they do not. Similarly psychiatrists must learn how to use oestrogens for certain sorts of depression in women as an effective safe alternative to their usual armamentarium. It would surprise them to discover how frequently “bipolar depression” disappears once the cyclical mood changes of PMS are ablated by transdermal estrogens. In reality the psychiatrist’s dismissal of the evidence and refusal to study the issue further is merely a turf war resulting from their inadequate knowledge of the basic practicalities of hormone therapy.