NAMS/Solvay Resident Essay Award. Relationship between estrogen, serotonin, and depression.

OBJECTIVE: A limited review of the medical literature was performed to determine whether there is an increase in the prevalence of depressive symptomatology in women undergoing menopause and whether this increase can be related to fluctuating levels of estrogen. In addition, we evaluate the possible effect that estrogen has on the concentrations of neurotransmitters, specifically serotonin, in the central nervous system and the subsequent impact on mood in peri- and postmenopausal women. Finally, we examine whether estrogen replacement therapy is efficacious in the treatment of depression during the climacteric.
DESIGN: Limited MEDLINE review of the medical literature on depression in women, the evidence for a serotonergic role in depression, evidence linking estrogen to changes in serotonergic activity and evidence that estrogen therapy can improve depression.
RESULTS: Depression is more common in women than in men and seems to be increased at times of changing hormone levels in women. The serotonergic system seems to play a major role in depression, although other neurotransmitters are also involved. Estrogen can alter not just serotonergic activity but also has an impact on the activity of several other neurotransmitters that might result in an antidepressant effect. At this time, estrogen therapy for the treatment of depression in peri- and postmenopausal women may be useful, but confirmatory studies are still lacking.
CONCLUSIONS: There is suggestive evidence that estrogen therapy is appropriate treatment for mid-to-moderate depression in peri- and postmenopausal women.