Women's Depression Often Linked to Hormonal Changes

There are three times in a woman's life when she is at higher risk for depression.

"The greatest risk for depression occurs a week to 10 days before the period starts, after the birth of a child, and one to two years before menopause. In general, women's depression falls between the ages of 22 and 45," says Dr. Lucy Puryear, director of The Women's Clinic at Baylor College of Medicine's department of psychiatry.

Premenstrual dysphoric disorder (PMDD) can occur each month before a woman's menstrual period. It affects 6 percent to 8 percent of women and can be severely disabling.

"PMDD shouldn't be confused with the common PMS symptoms of slight tearfulness and irritability," she says. "Women with PMDD cannot function during the week to 10 days before their period."

Symptoms include an inability to work or go to school, excessive crying, and relationship problems. Once the period begins, the woman's functioning returns to normal.

Treatment with antidepressants provides immediate relief of the symptoms. "Other types of depression need three to six weeks for the medication to take effect. It is not clear why PMDD responds differently," Dr. Puryear says.

Women with PMDD have the same hormone levels as other women, but women with PMDD may be more vulnerable to hormonal changes before their period.

Postpartum depression occurs in one out of 10 women and can last for six months to a year if left untreated. Not to be confused with the "baby blues" which can last for a couple of weeks, women with postpartum depression feel extreme sadness and guilt and are unable to function and to enjoy caring for their baby.

"Postpartum depression interrupts the bonding between a mother and child," Dr. Puryear says. "The newer anti-depressants allow mothers to continue breastfeeding while being treated."

Researchers believe the rapid drop in estrogen that occurs immediately after birth triggers the depression. Prevention tactics being studied include using oral estrogen or estrogen patches to taper the estrogen decline.

"Women who have been sensitive to hormonal changes in the past should be watchful for signs of major depression one to two years before menopause," Dr. Puryear says.

Estrogen replacement therapy will treat the mild tearfulness and moodiness that women often experience before menopause, but anti-depressants are needed to treat severe depression.

"Not getting out of bed, not functioning, and wishing you were dead is not a normal part of menopause," Dr. Puryear says.

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©2006 Texas Medical Center

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