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After delivery there is a dramatic drop in levels of estrogens and progesterone. Many have hypothesized that this decline in estrogen levels may precipitate postpartum depression (PPD) in susceptible individuals, and several studies have explored the use of estrogen for the treatment of depression after delivery. Gregoire and colleagues have shown a beneficial effect of estrogen therapy in a double blind, placebo-controlled study of women with PPD. Although this study was small and was confounded by the inclusion of patients who were simultaneously treated with antidepressant medications, it is the first to demonstrate that estrogen alone or when used in conjunction with an antidepressant may be useful in women with PPD.
More recently, Ahokas and colleagues have shown that estrogen alone was effective in women with PPD.
Although these studies suggest a role for estrogen in the treatment of women with postpartum depression, these treatments remain experimental. Estrogen delivered in the acute postpartum period is not without risk and has been associated with changes in breast milk production, as well as more significant thrombo-embolic events, including stroke and deep vein thrombosis.
Antidepressants are safe, well tolerated and highly effective and remain the first choice for women with PPD. Estrogen augmentation is typically reserved for cases where there is evidence of estrogen deficiency or when the depression appears particularly refractory to treatment.
