The effect of estrogens on depression

Although much is known about the multiple actions and interactions of estrogens, less is known about its specific role in each dysphoric state. Several compelling facts suggest that estrogen or its absence play a major role in the onset and course of depressions in women. (1) From menarche through perimenopause, a significant gender difference exists in the prevalence of depressions. This distinction does not exist among prepubescent children, nor between postmenopausal women and older men. (2) The gender difference in prevalence of depressions is especially apparent during periods when estrogen levels are high but unstable. This is caused by cyclicity during the menstrual cycle and increases in estrogen levels during pregnancy, and sharp withdrawals in the postpartum period. (3) During periods of estrogen change (premenstrual, postpartum, and perimenopause), depressive symptoms are also more prevalent - although the direct effects of estrogen cannot be clearly distinguished from other factors, such as environmental influences, etc. (4) During menopause, when estrogen is almost absent, there is no increase in the prevalence of first-episode depression. It is plausible that hormonal fluctuations or lack of estrogen increase the risk of depression among vulnerable women. Based on current knowledge, treatment of depression with estrogen may: (1) stabilize and restore disrupted homeostasis - as during postpartum, premenstrual, or perimenopausal conditions; (2) act as a psychomodulator to offset vulnerability to dysphoric mood when estrogen levels are significantly decreased, as in the case of postmenopausal women. Although much is known about the multiple actions and interactions of estrogens, less is known about its specific role in each dysphoric state. Several compelling facts suggest that estrogen or its absence play a major role in the onset and course of depressions in women. (1) From menarche through perimenopause, a significant gender difference exists in the prevalence of depressions. This distinction does not exist among prepubescent children, nor between postmenopausal women and older men. (2) The gender difference in prevalence of depressions is especially apparent during periods when estrogen levels are high but unstable. This is caused by cyclicity during the menstrual cycle and increases in estrogen levels during pregnancy, and sharp withdrawals in the postpartum period. (3) During periods of estrogen change (premenstrual, postpartum, and perimenopause), depressive symptoms are also more prevalent - although the direct effects of estrogen cannot be clearly distinguished from other factors, such as environmental influences, etc. (4) During menopause, when estrogen is almost absent, there is no increase in the prevalence of first-episode depression. It is plausible that hormonal fluctuations or lack of estrogen increase the risk of depression among vulnerable women. Based on current knowledge, treatment of depression with estrogen may: (1) stabilize and restore disrupted homeostasis - as during postpartum, premenstrual, or perimenopausal conditions; (2) act as a psychomodulator to offset vulnerability to dysphoric mood when estrogen levels are significantly decreased, as in the case of postmenopausal women.