Gonadal steroids in the treatment of mood disorders

Increased interest in the complex interplay between gonadal steroids and ne urotransmitter systems involved in mood has led investigators to question t he role of gonadal steroids in the treatment of affective disorders, especi ally in women. Objectives: The purpose of this article is to provide a rati onale for using gonadal hormones in the treatment of depression in women. M ethods: The literature is reviewed regarding 1) sex-specific phenomenologic and epidemiologic differences in the manifestation of psychiatric illness, 2) sex-specific differences in the therapeutic and adverse effects of psyc hotropic medications, 3) the complex interplay between gonadal steroids and neurotransmitter systems implicated in psychiatric disorders, and 4) the g rowing literature regarding the use of estrogen and progesterone in the tre atment of mood disorders in women and androgens in the treatment of depress ion and sexual dysfunction in both men and women. Results: Findings from ph armacologic trials of estrogen and androgens are encouraging, albeit mixed, in the treatment of mood disorders and decreased libido in women, respecti vely. Controlled studies have failed to confirm early open-label reports of the effectiveness of progesterone in the treatment of premenstrual syndrom e. Conclusions: Pending replication, estrogen may become an important pharm acologic agent in the treatment of postnatal and perimenopausal depression, whereas androgens have been shown to improve libido in postmenopausal wome n and hypogonadal men. Progesterone cannot be recommended as a treatment fo r premenstrual sydrome or postnatal depression.