Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17beta-estradiol: a preliminary study.

BACKGROUND: The postpartum period is a time when women are vulnerable to depressive disorders, which can be severe and have long-lasting adverse sequelae. In spite of multiple contacts with health care providers, women with postpartum depression often remain unrecognized and untreated. To evaluate the association between estradiol and postpartum depression, we measured serum estradiol concentration and performed an open-label study of physiologic 17beta-estradiol. METHOD: Twenty-three women fulfilling ICD-10 criteria for major depression with postpartum onset were consecutively recruited from a psychiatric emergency unit. Serum estradiol concentrations were measured at baseline and weekly during sublingual 17beta-estradiol treatment for 8 weeks. The treatment effect was assessed using a clinician-rated depression symptom scale, the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: At baseline, all patients were severely depressed (mean MADRS total score = 40.7; range, 35-45) and had a low serum estradiol concentration (mean = 79.8 pmol/L; range, 23-140 pmol/L); in 16/23 patients, the concentration was even lower than the threshold value for gonadal failure. During the first week of estradiol treatment, depressive symptoms diminished significantly, resulting in a mean MADRS score of 11.0 (Z = -4.20, p < .001), and serum estradiol concentrations approached those of the follicular phase (mean +/- SD = 342 +/- 141 pmol/L). At the end of the second week of treatment, the MADRS scores were compatible with clinical recovery in 19/23 patients. CONCLUSION: This preliminary study shows that depression symptoms may be rapidly reduced in patients with postpartum depression who have documented estradiol deficiency by treatment with 17beta-estradiol and suggests that estradiol can have significance in the pathophysiology of this condition and may be an option in the treatment of women vulnerable to postpartum depression.

Positive treatment effect of estradiol in postpartum psychosis: a pilot study.

BACKGROUND: Postpartum illnesses with psychiatric symptoms and serious adverse sequelae are highly prevalent during the childbearing years. Despite multiple medical contacts, these illnesses often remain unidentified and untreated. To study the association between estradiol and puerperal psychosis, we measured serum concentration of estradiol and performed an open-label trial of physiologic 17beta-estradiol in women with this disorder. METHOD: Ten women with ICD-10 psychosis with postpartum onset consecutively recruited from a psychiatric duty unit were studied. Serum estradiol concentration was measured at baseline and weekly during sublingual 17beta-estradiol treatment for 6 weeks. The treatment effect was evaluated by a clinician-rated psychiatric symptom scale (the Brief Psychiatric Rating Scale [BPRS]). RESULTS: The baseline serum estradiol levels (mean = 49.5 pmol/L; range, 13-90 pmol/L) were even lower than the threshold value of gonadal failure, and the patients exhibited high scores on the psychiatric symptom scale (mean BPRS total score = 78.3; range, 65-87). During the first week of 17beta-estradiol treatment, psychiatric symptoms diminished significantly (BPRS score decreased to a mean of 18.8, p < .001). Until the end of the second week of treatment, serum estradiol concentrations rose to near the values normally found during the follicular phase, and the patients became almost free of psychiatric symptoms. CONCLUSION: The reversal of psychiatric symptoms in all patients by treating documented estradiol deficiency suggests that estradiol plays a role in the pathophysiology and may have a role in the treatment of this condition. There was a rebound of psychotic symptoms in the 1 patient who discontinued estradiol treatment. Given the small number of patients, this area deserves further study.

Association between oestradiol and puerperal psychosis.

OBJECTIVE: Postpartum psychiatric disorders with long-lasting adverse sequelae are common during the childbearing years. These disorders can be severe and resistant to conventional psychiatric treatment methods. We present two consecutive cases with puerperal psychosis who were refractory to conventional treatment methods but responded successfully to oestrogen therapy. METHOD: Serum oestradiol concentration was measured by radioimmunoassay and the documented oestradiol deficiency replaced with physiological oestradiol sublingually. The treatment effect was evaluated by the Brief Psychiatric Rating Scale. RESULTS: In both cases the baseline oestradiol concentration was low (28 and 69 pmol/L). During the treatment with oestradiol, there was a concomitant elevation of the concentration of serum oestradiol, which coincided with the decline in psychotic symptoms. CONCLUSION: The observation of low serum oestradiol together with psychotic symptoms and successful treatment with oestradiol suggests that oestradiol may have a causal relevance to puerperal psychosis and significance in the treatment of this condition.

Role of estradiol in puerperal psychosis.

RATIONALE: Postpartum period has been considered a time of increased risk for the development of psychiatric disorders with long-lasting adverse consequences. Psychoses are the most severe of these illnesses and can be resistant to psychiatric medication. OBJECTIVE: We present two women with puerperal psychosis who had low serum estradiol, were refractory to neuroleptic medication but responded successfully to estradiol treatment. METHODS: Serum estradiol concentration was measured at baseline and during the treatment with sublingual 17-beta estradiol. Treatment effect was evaluated using Brief Psychiatric Rating Scale. RESULTS: Both patients had a low pretreatment estradiol concentration (28 and 54 pmol/l). During treatment with estradiol, the rise in serum estradiol coincided with a decline of psychotic symptoms. Discontinuation of estradiol treatment resulted in a rebound of florid psychotic symptoms in both cases. CONCLUSIONS: Estradiol may have a causal relation to postpartum psychosis and significance in the treatment of this illness.

Effect of oestradiol on postpartum depression.

RATIONALE: The months following childbirth are a time when women are susceptible to depressive disorders, which may be severe and have long-lasting serious adverse consequences. The illnesses remain often unrecognized and untreated, and can be resistant to conventional psychiatric treatment methods. OBJECTIVE: We report two patients with postpartum depression, who had low serum oestradiol together with psychiatric symptoms, and who responded successfully to treatment with oestradiol. METHODS: The serum oestradiol concentration was measured at baseline and weekly during treatment with sublingual 17-beta oestradiol for 8 weeks. The treatment effect was evaluated using the Montgomery-Asberg Depression Rating Scale. RESULTS: Both patients had a low pretreatment oestradiol concentration (36-120 and 31 pmol/l). During treatment with oestradiol, the decline of depressive symptoms coincided with a rise in serum oestradiol. CONCLUSIONS: Oestradiol may be causally related to postpartum depression and have significance in the treatment of this condition.

Changes in proteasome levels in spinach (Spinacia oleracea) seeds during imbibition and germination.

Proteasomes are the major cytosolic protease complexes responsible for energy-dependent and extra-lysosomal proteolysis. Ubiquitinated proteins are degraded by the 26S proteasome which is composed of a 20S proteasome and two regulatory complexes. Changes in the 20S and 26S proteasome activity levels and protein abundance in spinach seeds during imbibition and germination were examined by using glycerol density gradient centrifugation. The 26S proteasome activity level decreased transiently during imbibition, reached a minimum one day after starting imbibition, and then increased again. During the period of minimal accumulation, the protein being detected with an anti-26S proteasome antibody shifted to a lower sedimentation coefficient fraction. In contrast, the 20S proteasome activity level increased during imbibition, and remained high for two days. The change in the 20S proteasome level corresponded to the change in the 20S proteasome activity level.