Are oestrogens useful for the treatment of depression in women?

The relationship between mood changes and the menstrual cycle has been recognized for many years. Initial treatments involved removal of the ovaries to prevent fluctuation of oestradiol, but this was also associated with the long-term effects of hypo-oestrogenism such as osteoporosis or heart disease. More recently, the use of high-dose oestrogen has been explored with some success. A diagnosis of hormone-related depression is made on the history, where the problem is worse at a time of hormone fluctuation such as occurs in the premenstrual phase, in the postnatal period and in the years leading up to the menopause. Many women may only feel well for a minority of days in the month and the problem can become chronic. Antidepressant medication is not usually successful, although this is often the preferred treatment for general practitioners and psychiatrists, possibly because of the potential side-effects of high-dose oestrogen administration. This chapter covers the diagnosis and treatment of premenstrual depression, postnatal depression and depression occurring in the climacteric period to emphasize the chronic nature of the problem and the best ways of diagnosing and relieving this distressing condition.