Estrogen deficiency in severe postpartum depression: Successful treatment with sublingual physiologic 17 beta-estradiol: A preliminary study

Background: The postpartum period is a time when women are vulnerable to de pressive disorders, which can be severe and have long-lasting adverse seque lae. In spite of multiple contacts with health care providers, women with p ostpartum depression often remain unrecognized and untreated. To evaluate t he association between estradiol and postpartum depression, we measured ser um estradiol concentration and performed an open-label study of physiologic 17 beta -estradiol. Method: Twenty-three women fulfilling ICD-10 criteria for major depression with postpartum onset were consecutively recruited from a psychiatric emerg ency unit. Serum estradiol concentrations were measured at baseline and wee kly during sublingual 17 beta -estradiol treatment for 8-weeks. The treatme nt was assessed using a clinician-rated depression symptom scale, the Montg omery-Asberg Depression Rating Scale (MADRS). Results: At baseline, all patients were severely depressed (mean MADRS tota l 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 concentra tion was even lower than the threshold value for gonadal failure. During th e first week of estradiol treatment, depressive symptoms diminished signifi cantly, resulting in a mean MADRS score of 11.0 (Z = -4.20, p < .001), and serum estradiol concentrations approached those of the follicular phase (me an +/- 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 ra pidly reduced in patients with postpartum depression who have documented es tradiol deficiency by treatment with 17 beta -estradiol and suggests that e stradiol can have significance in the pathophysiology of this condition and may be an option in the treatment of women vulnerable to postpartum depres sion.