PCOS-MEDICATION Messages for June, 2002: Re: Progesterone Increasing Depression?

Re: Progesterone Increasing Depression?

From: Victoria (anonymous@obgyn.net)
Fri, 21 Jun 2002 22:35:50 -0400

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Maybe in reply to: susan: "Progesterone Increasing Depression?"

> From: bj@biotronikusa.com (BJ)
>
> Just look up the birth control pills in the PDR. Depression is an
> adverse reaction linked to use of oral contraceptives. Oral
> contraceptives are composed of synthetic hormones. There is plenty of
> research that shows this and I don't need to start listing it all here.
> By the way, I don't much like your website.

Actually I was looking for newer clinical research studies on the pill and depression, and natural progesterone being a better solution than the synthetic hormones. Are the studies basing depression on older studies, with first generation contraceptives versus third generation? What about differences in depression: i.e. clinical depression versus hormonal depression. What about differences in progestational agents? What about women who have problems on one pill, but not on another: is that differentiated for studies? I've looked at Medline/Pubmed, and found the following

1) Endocrinol Metab Clin North Am 2002 Mar;31(1):63-78 The hypothalamic-pituitary-gonadal axis in mood disorders. Young EA, Korszun A.

Similarly, blockade of progesterone appears to be ineffective as a treatment for PMS [79]. No published studies have examined women with major depression to determine whether leuprolide will exacerbate or improve depressive symptoms. Some studies suggest beneficial effects of estrogen on mood in postmenopausal women, but no placebo controlled studies have explored estrogen augmentation in the treatment of major depression in either post- or premenopausal women, although estrogen is beneficial in women with perimenopause-related mood disorders [78].

2) Climacteric 1998 Sep;1(3):211-8 Menopausal symptom control and side-effects on continuous estrone sulfate and three doses of medroxyprogesterone acetate. Ogen/Provera Study Group. Nand SL, Webster MA, Baber R, Heller GZ.

Mood swings, lethargy and vaginal dryness improved rapidly in the initial 3 months of therapy. Headache, depression, nausea, bloating and irritability showed a similar pattern of decline.

3) Climacteric 1998 Mar;1(1):55-62 Hormonal treatment and psychological function during the menopausal transition: an evaluation of the effects of conjugated estrogens/cyclic medroxyprogesterone acetate. Khoo SK, Coglan M, Battistutta D, Tippett V, Raphael B.

CONCLUSIONS: The use of hormones, given as a continuous estrogen and cyclic progestogen formulation after a formal calibration/run-in period, may have a beneficial effect on psychosocial distress experienced by women towards the end of their reproductive function.

4) Encephale 2001 Nov-Dec;27(6):501-8 [Psychiatric and psychological aspects of premenstrual syndrome] [Article in French] Limosin F, Ades J.

Numerous, but heterogeneous studies have been performed about premenstrual syndrome, with finally a lack of credibility and interest among practitioners.

Among non-psychiatric treatments, progesterone was the most widely prescribed treatment, but relating to recent performed studies, it failed to prove its efficiency in such an indication. In the same way, the efficiency of the contraceptive pill was not demonstrated. Finally, intermittent prescription of serotonin re-uptake inhibitors appears to be the most effective treatment, the previously used hormonal treatments not having made proof of their efficiency in such an indication.

5) JAMA 2002 Feb 6;287(5):591-7 JAMA. 2002 Feb 6;287(5):641-2. JAMA. 2002 May 1;287(17):2210-1; discussion 2211. Quality-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy: results from the Heart and Estrogen/Progestin Replacement Study (HERS) trial. Hlatky MA, Boothroyd D, Vittinghoff E, Sharp P, Whooley MA; Heart and Estrogen/Progestin Replacement Study (HERS) Research Group.

CONTEXT: Postmenopausal hormone therapy is commonly used by women for disease prevention, but its effects on quality of life have not been well documented. OBJECTIVE: To determine the effect on quality of life of estrogen plus progestin therapy used as secondary prevention in women with coronary artery disease. DESIGN, SETTING, AND PARTICIPANTS: A total of 2763 postmenopausal women with documented coronary artery disease (mean age, 67 years) in the Heart and Estrogen/Progestin Replacement Study, a randomized, placebo-controlled, double-blind trial conducted from January 1993 to July 1998 at outpatient and community settings at 20 US clinical centers. INTERVENTION: Participants were randomly assigned to receive either 0.625 mg/d of conjugated equine estrogen plus 2.5 mg/d of medroxyprogesterone acetate (n = 1380) or placebo (n = 1383) for 36 months. MAIN OUTCOME MEASURES: Physical activity, measured by the Duke Activity Status Index; energy/fatigue and mental health, measured by RAND scales; and depressive symptoms, measured on the Burnam screening scale, at 3 years of follow-up. RESULTS: In all patients, scores declined significantly over 3 years for physical function (-3.8; P<.001), mental health (-0.6; P =.05), and energy/fatigue (-3.8; P<.001), **but depressive symptoms were not significantly changed** (P =.20). The effect of hormone therapy on these measures depended on the presence (n = 434) or absence (n = 2325) of flushing at study entry. Women with flushing who were assigned to hormone therapy had improved mental health (+2.6 vs - 0.5; P =.04) and fewer depressive symptoms (-0.5 vs + 0.007; P =.01) over follow-up compared with those assigned to placebo. Women without flushing who were assigned to hormone therapy had greater declines in physical function (-4.2 vs -3.3; P =.04) and energy/fatigue (-4.6 vs -3.1; P =.03) over follow-up. Quality-of-life scores were significantly lower among patients with older age, diabetes, hypertension, chest pain, or heart failure. These differences in quality of life among women classified by clinical characteristics were much greater than the effects of hormone therapy. CONCLUSION: Hormone therapy has mixed effects on quality of life among older women. The effects of hormone therapy depend on the presence of menopausal symptoms; women without flushing had greater declines in physical measures, while women with flushing had improvements in emotional measures of quality of life.

6) J Womens Health Gend Based Med 2001 Dec;10(10):991-7 Natural vaginal progesterone is associated with minimal psychological side effects: a preliminary study. Shantha S, Brooks-Gunn J, Locke RJ, Warren MP.

The objective of this study was to evaluate the psychological side effects of a transvaginal natural progesterone gel in hormone replacement therapy (HRT). This 3-month preliminary study was part of a multicenter study previously performed in our center. We enrolled 49 women (ages 18-45 years) with hypothalamic amenorrhea (HA) (n = 40) and premature ovarian failure (POF) (n = 9). Estrogenized patients applied vaginal progesterone gel (4% or 8%) every other day for six doses per month. The Hopkins Symptom Checklist (HSCL), a psychometric profile test, was administered at baseline, day 13 of cycle 2, day 24 of cycle 2, and day 24 of cycle 3. **Application of the progesterone gel caused no significant change in HSCL total scores or individual symptom scores for somatization, obsession-compulsion, interpersonal sensitivity, depression, and anxiety.** Natural vaginal progesterone gel can be an effective alternative to oral progesterone for women on HRT.

7) I also reviewed the women's health forums: http://forums.obgyn.net/womens-health/WHF.0112/1684.html http://forums.obgyn.net/womens-health/WHF.0007/0448.html http://forums.obgyn.net/womens-health/WHF.0204/0610.html http://forums.obgyn.net/womens-health/WHF.0110/1764.html

8) I reviewed: http://www.femalelife.com/default.asp?PageID=488 Myths about the pill It's a myth that the pill makes you fat and depressed Depression Very severe depression can be made worse by the pill, but this is a relatively rare side effect, which affects a tiny minority of women. Because women who are on the pill see their doctor more often, there is a good chance that women with depressive problems can be identified and helped earlier. (If you feel the pill is making you depressed, speak to you doctor right away.)

9) http://forums.obgyn.net/womens-health/WHF.0202/0424.html HRT can play a role in clinical depression, though the effect is almost always beneficial. There are exceptions to every rule however.

10) Also see: http://forums.obgyn.net/womens-health/WHF.9801/0405.html >depression is a listed side effect; i am wondering if anyone
>can tell me more about the relation between progesterone, estrogen, and
>depression- specifically, chemically, what is the relation between the
>two?

This has not been delineated yet. >also, are there other alternatives to treating my depression other
>than going on anti-depressants; for example; should i try taking other
>types of pills with different ratio of estrogen and progesterone, or use
>another type of contraceptive altogether.

That may or may not work. there is no such thing as a depression birth control pill. Individual reactions vary. >And,
>does this side effect, like others, go away with time?

Although I don't recall seeingit in the literature, my personal feeling is I doubt it.

11) And another: J Pediatr Adolesc Gynecol 2001 May;14(2):71-6 Related Articles, Books, LinkOut Mood changes in adolescents using depot-medroxyprogesterone acetate for contraception: a prospective study. Gupta N, O'Brien R, Jacobsen LJ, Davis A, Zuckerman A, Supran S, Kulig J. CONCLUSIONS: Adolescents using DMPA do not show depressive symptoms when using DMPA as a contraceptive agent over a period of 12 months as measured by the BDI and show no significant changes in negative or positive affect as measured by the MAACL-R.

The websites I reviewed for natural agents involved them selling a product (usually related to natural progesterones), sometimes books. Which one is best? Are there sites that don't promote or sell a product or ask for funds for a product in exchange for promotion?

http://www.natural-progesterone.com/ http://www.wellnessmd.com/progesterone.html http://webmd.lycos.com/content/dmk/dmk_article_5963103 http://progesterone-menopause.com/depression_test.html http://www.lifeplusvitamins.com/progest.html http://www.internetshoppingplace.com/herbal/renewedbalancea.htm

I reviewed Dr. Lee's site, and couldn't find specifics of what double blind placebo studies he did to reflect this work. I'd really be interested in seeing them. Since the ones I could find are different from what you post, I thought you would be a good source to point me in that direction, as what I find gives me a different impression.

On the women's health lists, my perception of your posts is that you are against anything that is not natural. Is this correct?

I'm sorry you don't like the website. Do you have one?

--
Victoria

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