In women with a previous episode of depression, times of rapidly changing gonadal steroid concentrations, such as those occurring premenstrually or postpartum, mark particularly vulnerable times for the occurrence of depressive symptoms. Several studies have shown that in women, a history of depression increases the risk of both postpartum "blues" and postpartum major depression (O'Hara 1986; O'Hara et al. 1991; Reich and Winokur 1970) and that hormonal changes occurring premenstrually may affect mood (Halbreich et al. 1984, 1986). When they were euthymic, 62% of women with a history of major depressive episodes reported the occurrence of premenstrual mood changes and biological symptoms typical of major depressive disorder. Other studies found a relationship between the rise in estrogen and testosterone levels and the rising incidence of depression in girls during adolescence (Angold et al. 1999). More recently in two epidemiological cohorts (Cohen et al. 2006; Freeman et al. 2006), there was an increased incidence of depressive symptoms and major depression during the menopausal transition. Both high and low estrogen were associated with depression (Freeman et al. 2004, 2006), and the variability in estrogen levels may drive depression—that is, those women who show rapid changes from high to low estrogen and vice versa are those who develop depressive symptoms during the perimenopause transition. This suggests that examining the reproductive axis in depression may be a fruitful area of psychoneuroendocrine research.
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