Sex Hormones and Mood

Prof. Dr. Uriel Halbreich:

Sex Hormones and Mood

Worldwide, the prevalence of depression in women is significantly greater than in men. Available data suggest that estrogen, or its absence, is strongly implicated in the regulation of mood and behavior, as well as in the pathobiology of mood disorders.

The multiple effects and complex interactions of estrogens have been well documented, although specific, multifaceted role of estrogen in each dysphoric state has yet to be distinguished. Several facts suggest that estrogen exerts a vital role in the precipitation and course of mood disorders in women. Gender differences in the prevalence of depression first appear after menarche, continue through reproductive age, and dissipate after perimenopause. Periods of hormonal fluctuations or estrogen instability (i.e., premenstruai, postpartum, perimenopause) have been associated with increased vulnerability to depression among susceptible women. lt is plausible that the phenotype of these depressions is distinguishable.

Based on current knowledge, estrogen treatment for affective disorders may be efficacious in two situations:

1 To stabilize and restore disrupted homeostasis — as with premenstrual, postpartum, or perimenopausal conditions;

2. To act as a psychomodulator during periods of decreased estrogen levels and increased vulnerability to dysphoric mood, as with postmenopausal women. lt remains unclear whether estrogen may be efficacious as a sole antidepressant, but there is growin~ evidence suggesting that it may be an efficacious adjunct to SSRI's.