PROPHYLACTIC ESTROGEN IN RECURRENT POSTPARTUM AFFECTIVE-DISORDER

Seven women with histories of puerperal psychosis and four with histor ies of puerperal major depression were consecutively treated with high -dose oral estrogen immediately following delivery. None of the women had histories of nonpuerperal affective disorder, and all women were a ffectively well throughout the current pregnancy and at delivery, Desp ite the high risk for recurrent illness in this population, only one w oman developed relapse of postpartum affective disorder, All others re mained entirely well and required no treatment with psychotropic medic ations during the 1 year follow-up period, This low rate of relapse, 9 % compared to an expected 35-60% without prophylaxis, suggests that or al estrogen may stem the rapid rate of change in estrogen following de livery, thereby preventing the potential impact on dopaminergic and se rotonergic neuroreceptors. It is hypothesized that the rapid rate of c hange of estrogen after delivery creates an ''estrogen withdrawal stat e.'' This may be a critical factor in driving acute puerperal affectiv e psychosis and early-onset puerperal major depression.