Journal
HARVARD REVIEW OF PSYCHIATRY
Volume 17, Issue 2, Pages 72-86Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1080/10673220902899706
Keywords
estrogen; major depression; neurosteroids; perimenopause; postpartum; premenstrual; reproductive; serotonin
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Funding
- NATIONAL INSTITUTE OF MENTAL HEALTH [K23MH074799] Funding Source: NIH RePORTER
- NIMH NIH HHS [K23 MH074799-01A2, K23 MH074799] Funding Source: Medline
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The lifetime risk for major depression in women is well known to be twice the risk in men and is especially high during the reproductive years between menarche and menopause. A subset of reproductive-age women experience depressive episodes that are triggered by hormonal fluctuations. Such reproductive depressions involve episodes of depression that occur specifically during the premenstrual, postpartum, and perimenopausal phases in women. These reproductive subtypes of depression can be conceptualized as a specific biological response to the effects of hormonal fluctuations in the brain. The different types of reproductive depressions are associated with each other, have unique risk factors that are distinct from nonreproductive depression episodes, and respond to both hormonal and nonhormonal interventions. This review uses a PubMed search of relevant literature to discuss clinical, animal, and genetic evidence for reproductive depression as a specific subtype of major depression. Unique treatment options, such as hormonal interventions, are also discussed, and hypotheses regarding the underlying biology of reproductive depressionincluding interactions between the serotonergic system and estrogen, as well as specific effects on neurosteroidsare explored. This review will provide evidence supporting reproductive depression as a distinct clinical entity with specific treatment approaches and a unique biology that is separate from nonreproductive depression.
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