Reproductive factors affecting the course of affective illness in women

Women are at higher risk than men to develop depressive episodes during the reproductive years. Furthermore, women are vulnerable to depressions associated with oral contraceptives, abortion, the premenstrual period, the puerperium, and menopause. The phenomenology and the biologic mechanisms involved in these illnesses perhaps should be viewed in the context of other manifestations of the link between depression and female reproductive functions. For example, women are especially vulnerable to a rapid cycling form of affective illness and to hypothyroidism, an associated factor for this form of affective disorder. The postpartum period is also associated with impaired thyroid function, and there are reports of the induction of rapid cycles of mood following the termination of pregnancy. Thus, alterations in thyroid hormones may be a feature of both postpartum and rapid cycling forms of affective disorder in women. A previous history of a postpartum depression places a woman at a high risk for the development of a subsequent puerperal episode. Also, difficulties during pregnancy may predispose a woman to the development of other reproductive-related depressions. The role reproductive hormones play in this possible sensitization phenomenon needs to be examined in order to understand the relationship of depression to the female reproductive cycle.