After delivery there is a one hundred fold (sometimes a thousand fold) decrease in plasma oestradiol levels and there is little doubt that in many cases of depression the essential cause is fluctuation of oestrogen levels. It is very logical that post natal depression would respond to oestrogen therapy and indeed it does. In the paper of mine published in the Lancet in 1996 it was shown to be more effective than placebo even in those patients who had failed to respond to antidepressants.
If antidepressants are used with postnatal depression they sometimes work but often the response is poor which results in an increase in dose with another poor response which then results in the addition of another antidepressant often in combination with the first. After six months of ineffective therapy they are often on a cocktail of powerful antidepressants and even mood stabilising drugs. By this time the periods return and the depression becomes cyclical they can often be misdiagnosed as bipolar disorder and then will be offered mood stabilising drugs and even ECT without apparent benefits. All this can be avoided by the use of transdermal oestrogens in a dose that elevates the plasma oestradiol levels.
There is another reason why it is important to treat post natal depression correctly. There is a large group of patients with what we should call, “Reproductive Depression”, who have depressive episodes when their oestrogen levels change. This is obviously premenstrual depression, post natal depression and perimenopausal depression. It is common to see 45 year old women in the menopausal transition with profound depression having had 10 or 20 years of ineffective antidepressants. The critical point in their history seems to be the recurrence of post natal depression. These women will state that they last felt well with no depression when they were pregnant and then developed post natal depression which became cyclical and worse with age.
It is a failure to treat post natal depression with effective transdermal oestrogens which leads these women into a decade of depression and the use of multiple antidepressants without benefit.
31 August 2011