The benefit of oestrogens and progestogens in postnatal depression

Postnatal depression, with a prevalence of at least 10%, is a common complication of the puerperium. The aetiology is unclear, specific diagnostic criteria cannot be drawn and the treatment options are limited. As hormones are thought to contribute to its pathophysiology, the supplementation with either progesterone or oestrogen might be of prophylactic and/or therapeutic value in postnatal depression. Research into hormonal prophylaxis and treatment of postnatal depression (PND) is limited. This review article is aimed at exploring the evidence available regarding the use of oestrogen and progesterone in postnatal depression. A search of electronic databases Medline, Psychinfo, Embase and published books from 1970 to 2002 was carried out. The search strategy was limited to the English language. Of 193 articles, 30 were chosen and all 30 copies were identified and analysed critically. Prophylactic and treatment value were separately analysed for both oestrogen and progesterone. Some uncontrolled studies by Dalton (1982, 1985) report the benefit of progesterone in preventing postnatal depression. The value of oestrogen in preventing and treating this disorder is suggested by some articles but the methodological shortcomings in these studies make the study results unreliable. In addition, the use of oestrogen in the postnatal period may have significant side effects. Use of synthetic progesterone is associated with depression in the postnatal period and should be used with caution. Oestrogen therapy may be of modest value in severe postnatal depression.