Female-specific mood disorders

The lifetime prevalence of mood disorders in women is approximately twice that of men. The underlying causality of this gender difference is not yet understood. There is increasing scientific attention to the modulation of the neuroendocrine system by fluctuating gonadal hormones. Here, we highlight the role and potential relevance of oestrogen and other sex steroids to psychiatric disorders specific to women from menarche to menopause in addition to the relationship between sex hormones, neurotransmitter function and mood disorders related to the reproductive lifecycle in women. The sudden appearance of higher levels of oestrogen in puberty alters the sensitivity of the neurotransmitter systems. Moreover, the constant flux of oestrogen and progesterone levels throughout the reproductive years portends constant modification of the neurotransmitter systems. Premenstrual syndromes may be the result of an altered activity or sensitivity of certain neurotransmitter systems. Pregnancy and delivery produce dramatic changes in oestrogen and progesterone levels, and significant suppression along the hypothalamic-pituitary-adrenal axis, possibly increasing vulnerability to depression. At menopause, oestrogen levels decline while pituitary luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels increase. The loss of modulating effects of oestrogen and progesterone may underlie the development of perimenopausal mood disorders in vulnerable women. The pattern of neuroendocrine events related to female reproduction is vulnerable to change and is sensitive to psychosocial, environmental and physiological factors. Further research is needed to identify specific genetic markers that might help us better understand how the balance between oestrogen, progesterone, testosterone and other steroid hormones affect neurotransmitter function.