1st Revision: Isobel Lester 
3rd Revision: Conor Hodges Based on a paper titled “Sex hormone levels in females of different ages suffering from depression” originally written by Lei et al. 2021.
Lei et al. BMC Women’s Health (2021) 21:215
By: Murielle Nsiela
Depression is a mental disorder affecting individuals of all ages, causing reduced interest in daily activities, poor concentration, feeling down, changes in sleep pattern, along with multiple other symptoms.1 By 2030, globally, the main cause of disease burden will be depression.2 The onset of depression can be due to many factors, including psychological, biological, and social onwa. However, two sex hormones, progesterone and oestrogen, are considered to play a role in developing depression.3 Sex hormones generally affect the lives of people assigned female at birth (AFAB) drastically, and multiple factors can affect sex hormone levels. However, an individual’s overall health and age are pivotal factors. In addition, studies have found that stress-related disorders such as trauma and anxiety are regulated by sex hormones.4
Hormonal fluctuations linked to pregnancy, menstruation, menopause, and extreme premenstrual syndrome (PMS) or perimenopausal/postpartum depression is experienced by almost all people AFAB.5 Most of these people AFAB go through typical changes that occur with reproductive hormones and reduced central nervous system responses, which leads to changed behaviours and mixed emotions.6 It is suggested that people AFAB are more likely to become depressed at the beginning or after menopause due to the constant low levels of the ovarian steroid hormones oestradiol and progesterone.
Furthermore, the severity of the depression is associated with fluctuations in oestrogen, an ovarian hormone.7 However, studies have indicated that oestrogen does have a positive effect on the mood of middle-aged people AFAB.8 Treatment with hormone therapy has been conducive for many years in improving mood in people AFAB in early post-menopause by improving symptoms such as depression and anxiety.9 Oestrogen is said to enhance the effectiveness of a chemical messenger that acts as a mood stabiliser by reducing the activity of a specific catalyst.10
In addition, prolactin is a hormone that regulates lactation after birth; it is used as an indicator to approximate the relationship between mood and the changes in hormone levels in postpartum people AFAB.11 The severity of depression amongst people AFAB depends upon the changing hormone levels; as this occurs throughout the female’s life cycle, it can affect the body’s response to antidepressant medications and increase adverse event incidences. Therefore, postmenopausal people AFAB with reduced oestradiol and progesterone levels and increased luteinising hormone, which controls the menstrual cycle, are suggested to have different antidepressant dosages or treatments than premenopausal people AFAB.
In conclusion, the paper highlights the role sex hormones play in depression and how this can drastically affect the lives of people AFAB. After extensive research, the results showed a negative relationship between the severity of depression and age. In addition, there is also a negative correlation between oestrogen levels in people AFAB with depression and their age.
References:
- Lei et al., 2021 - Lei et al. BMC Women’s Health (2021) 21:215 https://doi.org/10.1186/s12905-021-01350-0
- Holden C. Mental health. Global survey examines impact of depression. Science. 2000;288(5463):39–40.
- Skovlund et al., 2016 - Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of hormonal contraception with depression. JAMA Psychiatry. 2016;73(11):1154–62
- Li SH, Graham BM. Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? The potential role of sex hormones. Lancet Psychiatry. 2017;4(1):73–82.
- Epperson CN, Steiner M, Hartlage SA, Eriksson E, Schmidt PJ, Jones I, Yonkers KA. Premenstrual dysphoric disorder: evidence for a new category for DSM-5. Am J Psychiatry. 2012;169(5):465–75
- Altemus et al, 2014 - Altemus M, Sarvaiya N, Neill Epperson C. Sex diferences in anxiety and depression clinical perspectives. Front Neuroendocrinol. 2014;35(3):320–30.
- Gordon JL, Girdler SS, Meltzer-Brody SE, Stika CS, Thurston RC, Clark CT, Prairie BA, Moses-Kolko E, Jofe H, Wisner KL. Ovarian hormone fuctuation, neurosteroids, and HPA axis dysregulation in perimenopausal depression: a novel heuristic model. Am J Psychiatry. 2015;172(3):227–36
- Cohen LS, Soares CN, Poitras JR, Prouty J, Alexander AB, Shifren JL. Short-term use of estradiol for depression in perimenopausal and postmenopausal women: a preliminary report. Am J Psychiatry. 2003;160(8):1519–22.
- de Villiers TJ, Hall JE, Pinkerton JV, Perez SC, Rees M, Yang C, Pierroz DD. Revised global consensus statement on menopausal hormone therapy. Maturitas. 2016;91:153–5.
- Sassarini DJ. Depression in midlife women. Maturitas. 2016;94:149–54.
- Szpunar MJ, Parry BL. A systematic review of cortisol, thyroid-stimulating hormone, and prolactin in peripartum women with major depression. Arch Womens Ment Health. 2018;21(2):149–61.
