Dr. John Studd
clinical gynaecologist

print this pageHormones & Depression
in women

Oestrogen Treatment for Depression in Women - Are Psychiatrists Missing Something?

Abstract. 5th February 2010

There are certain types of depression in women that are effectively treatable with oestrogens, although psychiatrists seem to have closed their minds to this possibility to an extent which becomes dangerous for women. Depression is twice as common in women than men, and occurs at times of hormonal fluctuation. This particularly occurs with premenstrual depression, post natal depression and latterly perimenopausal depression in the menopausal transition. These women are typically very well with a good mood during pregnancy before the post natal depression occurs many weeks after delivery. There are now many randomised controlled trials showing that transdermal oestrogens in a dose of 200 mcgs twice weekly is an effective way of treating this sort of depression that which is best called “reproductive depression”. In patients with a uterus they should have cyclical progestogen for seven days a month or a Mirena coil in order to prevent endometrial pathology and irregular bleeding.

It should be noted that oestrogen responsive depression cannot be diagnosed by measuring hormone levels because they will always be normal for the particular age group but this type of depression should be diagnosed by a careful history taking into account the relationship to the menstrual cycle, to the postnatal period as well as perimenopausal depression as these all tend to occur in the same vulnerable woman. Thus the depressed perimenopausal woman will have a history of recurrent PMS from an early age after the menarche, being in good mood during pregnancy but with post natal depression and later cyclical depression as in PMDD when the periods recur. Unfortunately psychiatrists rarely use oestrogens and will use SSRIs or TCAs which are not only of doubtful long term value, having to be frequently changed, but are associated with serious health problems.

Smoller and colleagues (2009) have shown a 45% increase in stroke, a 32% increase in all cause mortality, a 210% increase in fatal stroke and a 212% increase in haemorrhagic stroke in women taking antidepressants.

Psychiatrists are so misinformed about the details of hormone related depression that it is not rare for young women who have been diagnosed as having bipolar depression by a psychiatrist to be cured completely by the use of transdermal oestrogens. If the same women develop some depression with the cyclical progestogen a hysterectomy with BSO with oestrogen and testosterone replacement will remove the hormonal component of any depression. It is significant that 93% of people with a diagnosis of bipolar depression are women. Many of these have a hormonal component in the causation and need hormonal manipulation of their cycles for a cure.