Elsevier

The Lancet

Volume 347, Issue 9006, 6 April 1996, Pages 930-933
The Lancet

Articles
Transdermal oestrogen for treatment of severe postnatal depression

https://doi.org/10.1016/S0140-6736(96)91414-2Get rights and content

Abstract

Summary

Background Postnatal depression can have long-term adverse consequences for the mother, for the marital relationship, and for the infant's psychological development. Such depressions can be severe and resistant to both support and counselling and to therapy with antidepressant drugs. We investigated the antidepressant efficacy of oestrogen given transdermally.

Methods In a double-blind, placebo-controlled study, 61 women with major depression, which began within 3 months of childbirth and persisted for up to 18 months postnatally, were allocated randomly active treatment (n=34; 3 months of transdermal 17β-oestradiol 200 μg daily alone, then 3 months with added cyclical dydrogesterone 10 mg daily for 12 days each month) or placebo (n=27; placebo patches and tablets according to the same regimen). The women were assessed monthly by self-ratings of depressive symptoms on the Edinburgh postnatal depression scale (EPDS) and by clinical psychiatric interview (schedule for affective disorders and schizophrenia [SADS]—change scale).

Findings On pretreatment assessments the women in both groups were severely depressed (mean EPDS score 21·8 [SD 3·0] active group, 21·3 [2·9] placebo group; SADS scores, 66·3 [11·4] and 64·3 [10·7]). During the first month of therapy the women receiving oestrogen improved rapidly, and to a significantly greater extent than controls (mean EPDS scores 13·3 [SD 5·7] vs 16·5 [5·3]). Patients receiving placebo also improved over time but, on average, their scores did not fall below the screening threshold for major depression for at least 4 months. The estimated overall treatment effect of oestrogen on the EPDS was 4·38 points (95% Cl 1·89-6·87). None of a range of other factors (age, psychiatric, obstetric and gynaecological history, severity and duration of current episode of depression, and concurrent antidepressant medication), influenced the response to oestrogen.

Interpretation This study has shown that transdermal oestrogen is an effective treatment for postnatal depression. Further studies are required to establish the minimum effective dose and shortest necessary duration of treatment as well as the mechanism of antidepressant action of oestrogen.

References (37)

  • Jl Cox et al.

    A controlled study of the onset, duration and prevalence of postnatal depression

    Br J Psychiatry

    (1993)
  • Jl Cox et al.

    Prospective study of the psychiatric disorders of childbirth

    Br J Psychiatry

    (1982)
  • R. Kumar et al.

    A prospective study of emotional disorders in childbearing women

    Br J Psychiatry

    (1984)
  • Jp Watson et al.

    Psychiatric disorder in pregnancy and the first postnatal year

    Br J Psychiatry

    (1984)
  • Hl Caplan et al.

    Maternal depression and the emotional development of the child

    Br J Psychiatry

    (1989)
  • S. Cogill et al.

    Impact of maternal postnatal depression on cognitive development of young children

    BMJ

    (1986)
  • L. Murray

    The impact of postnatal depression on infant development

    J Child Psychol Psychiatry

    (1992)
  • Em Cummings et al.

    Maternal depression and child development

    J Child Psychol Psychiatry

    (1994)
  • Cited by (0)

    View full text