||Depression in the Peri-Menopausal
Depression is more common in women
than men with the excess beginning at puberty and being no longer
apparent five years after the menopause. There remains controversy
whether this excess is due to environmental factors or hormonal
factors but it is significant that depression occurs at times of
hormonal flux such as adolescence, the post-natal period, the
pre-menstrual days and the years around the time of the menopause.
This climacteric depression is usually at its worst in the two or
three years before the periods stop and is also affected by the
cyclical depression of severe PMS.
This combination of post-natal depression, PMS and climacteric
depression is known as the triad of hormone related mood disorders (HRMD)
and often occur in the same vulnerable women. There is good evidence
from randomised placebo-controlled trials that this depression is
improved using moderately high dose oestrogens transdermally either
by patches or hormone implant. This improvement occurs even in women
who are not responsive to anti-depressants and in my view should be
These patients respond well to oestrogens but are often progestogen-intolerant
responding badly to the necessary cyclical oral progestogens needed
if they still have a uterus. Such patients benefit from the
insertion of a progestogen releasing (Mirena) intra-uterine system.
Thus long-term therapy may be continuous oestradiol patches plus a
Mirena coil producing the mental tonic effect of moderately high
dose oestrogens without the bleeding or the cyclical changes that
occur with progestogen tablets.
. Panay, N., Studd, JWW., The psychotherapeutic effect of oestrogens.
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. Gregoire, AJP., Henderson, AF., Kumar, R., Everitt, B., Studd, JW.
(1996). Transdermal oestrogen for treatment of severe postnatal
depression. Lancet 347, 930-33
. Watson, NR., Studd, JWW., Savvas, M., Garnett, T., Baber, RJ.
(1989) Treatment of severe pre-menstrual syndrome with oestradiol
patches and cyclical oral norethisterone. Lancet ii, 730-34
Hormones and Depression
in Women. Why are estrogens rarely used for the treatment of
depression in women?
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