Depression is more common in women, occurring at times of hormonal fluctuations as premenstrual
depression, postnatal depression and perimenopausal depression. These are all related to changes in
hormone levels and constitute the diagnosis of reproductive depression. There is a risk that severe premenstrual depression can be misdiagnosed as
bipolar disorder and that women will be started on inappropriate
antidepressants or mood-stabilizing
therapy. The most effective treatment for severe
premenstrual syndrome is by suppression of ovulation and suppression of the cyclical hormonal changes by transdermal
estrogens or by
GnRH analogs.
Postnatal depression is more common in women with a history of premenstrual depression and also responds to transdermal
estrogens. Transdermal
testosterone gel can be also used in women who suffer loss of energy and loss of libido which may be due to the
inappropriate prescription of
antidepressants. There is also a role for the
Mirena IUS and laparoscopic
hysterectomy and
oophorectomy in women who are
progestogen-intolerant. The hormonal causation of certain common types of depression in women and the successful treatment by
estrogens should be understood by psychiatrists and gynecologists.