Estrogen Deficiency in Severe Postpartum Depression: Successful Treatment With Sublingual Physiologic 17β-Estradiol: A Preliminary Study
J Clin Psychiatry 2001;62(5):332-336
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: The postpartum period is a time when
women are vulnerable to depressive disorders, which can be severe
and have long-lasting adverse sequelae. In spite of multiple
contacts with health care providers, women with postpartum
depression often remain unrecognized and untreated. To evaluate
the association between estradiol and postpartum depression, we
measured serum estradiol concentration and performed an
open-label study of physiologic 17beta-estradiol.
Method: Twenty-three women fulfilling
ICD-10 criteria for major depression with postpartum onset were
consecutively recruited from a psychiatric emergency unit. Serum
estradiol concentrations were measured at baseline and weekly
during sublingual 17beta-estradiol treatment for 8 weeks. The
treatment effect was assessed using a clinician-rated depression
symptom scale, the Montgomery-Asberg Depression Rating Scale
Results: At baseline, all patients were
severely depressed (mean MADRS total score = 40.7; range, 35-45)
and had a low serum estradiol concentration (mean = 79.8 pmol/L;
range, 23-140 pmol/L); in 16/23 patients, the concentration was
even lower than the threshold value for gonadal failure. During
the first week of estradiol treatment, depressive symptoms
diminished significantly, resulting in a mean MADRS score of 11.0
(Z = -4.20, p < .001), and serum estradiol concentrations
approached those of the follicular phase (mean ± SD = 342 ± 141
pmol/L). At the end of the second week of treatment, the MADRS
scores were compatible with clinical recovery in 19/23 patients.
Conclusion: This preliminary study shows
that depression symptoms may be rapidly reduced in patients with
postpartum depression who have documented estradiol deficiency by
treatment with 17beta-estradiol and suggests that estradiol can
have significance in the pathophysiology of this condition and
may be an option in the treatment of women vulnerable to