Depression, menopause and estrogens: is there a correlation?

Women have a higher incidence of depression than men. The lifetime incidence of endogenous depression in women is twice the incidence in males. Because depression in the elderly is an important public health concern, an eventual correlation between menopause and depression is of practical importance. The relevant literature is reviewed. There are suggestive data that estrogen deficiency may increase the susceptibility for depression. Furthermore, here is suggestive evidence from observational studies and a limited number of randomized, controlled trials that estrogen therapy after menopause improves mood and cognition. However, the clinical relevance of estrogen administration is unproved. There are weak data that estrogens might be considered for mild depressive symptoms attributed to hot flushes, sleep disturbances, or other climacteric symptoms. No hard data exist to indicate whether estrogen could be used as adjunct therapy for other depressive disorders during the menopausal transition or postmenopausal period, but newer findings suggest that estrogens may improve the effect of serotonin reuptake inhibitors.