Hormones and Depression
Professor John Studd, Consultant Gynaecologist
There are a large number of depressed women whose problems relate to
menstruation and pregnancy. The episodes are influenced by hormonal changes that occur during this time. These conditions include:
- premenstrual depression
- postnatal depression
- climacteric depression
Best treatment evidence
There is good evidence from randomised placebo controlled trials that these three common types of depression can be effectively treated with transdermal oestrogens. In the case of premenstrual depression, this treatment suppresses ovulation and the cyclical hormonal changes which produce the symptoms. In the case of postnatal depression it increases oestrogen levels from the low postnatal levels. In the case of perimenopausal depression they have the obvious effect of suppressing night sweats, stopping insomnia and increasing energy and mood.
"Reproductive Depression" has not been picked up by psychiatrists
This group of conditions should be called "Reproductive Depression" and although this is well known in gynaecological/endocrinological circles this seems not to have been picked up by psychiatrists. Also, general practitioners would prefer to treat hormonal responsive depression with antidepressants rather than transdermal oestrogens. This is a tragedy for many women for many years.
There is a further problem in that women with cyclical depression due to severe premenstrual depression or premenstrual dysphoric disorder (PMDD) do not respond to antidepressants and are therefore labelled with bipolar disorder. This can result in mood stabilising drugs, hospitalisation and electroconvulsive therapy (ECT) when the logical treatment for this endocrine condition is hormones. These hormones are best given by the transdermal route, which is theoretically safer than the oral route and we can be reassured that there is no evidence whatsoever that such therapy in this age group is related to strokes, heart attacks or breast cancer.
Some doctors are still confused
Unfortunately the legacy of the much criticised 2002 Women's Health Initiative study is with us, although the series of complications reported have been revoked even by the original investigators. The ‘fact’ that Hormone Replacement Therapy (HRT) causes strokes, breast cancer and heart attacks is now in the undergraduate text books and it will take a generation to get rid of this falsehood.
We do need to encourage general practitioners and psychiatrists to treat this trio of hormone responsive depressive disorders with hormones. Apart from the transdermal Oestradiol it is often worthwhile adding transdermal testosterone for the improvement of energy, mood and also libido.
Relevant publications are:
Nappi RE, Studd J. Reproductive Depression. Gynecological Endocrinology 2012:28;42–45
Studd JW. A guide to the treatment of depression in women by estrogens. Climacteric 2011:14(6);637–642
Studd J. Severe premenstrual syndrome and bipolar disoder: A tragic confusion. Menopause International 2012:18(2);82–86
