A. Ahokas et al., Estrogen deficiency in severe postpartum depression: Successful treatment with sublingual physiologic 17 beta-estradiol: A preliminary study, J CLIN PSY, 62(5), 2001, pp. 332-336
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.