Determine whether postpartum depression is triggered by the abrupt withdrawal of estrogen and
progesterone.
The appearance of mood and behavioral symptoms during pregnancy and the postpartum period has
been extensively reported. While there has been much speculation about possible biologically
based etiologies for postpartum disorders (PPD), none has ever been confirmed. Preliminary
results from two related studies (protocols 90-M-0088, 92-M-0174) provide evidence that women
with menstrual cycle related mood disorder, but not controls, experience mood disturbances
during exogenous replacement of physiologic levels of gonadal steroids. The present protocol
is designed to create a "scaled-down" hormonal milieu of pregnancy and the puerperium in
order to determine whether women who have had a previous episode of postpartum major
effective episode will experience differential mood and behavioral effects compared with
controls and to determine whether it is the abrupt withdrawal of gonadal steroids or the
prolonged exposure to gonadal steroids that is associated with mood symptoms.
Supraphysiologic plasma levels of gonadal steroids will be established, maintained, and then
rapidly reduced, simulating the hormonal events that occur during pregnancy and parturition.
This will be accomplished by administering estradiol and progesterone to women who are
pretreated with a gonadotropin releasing hormone (GnRH) agonist (Lupron). After eight weeks,
administration of gonadal steroids will be stopped in one group of patients and controls, and
a sudden decline in the plasma hormone levels will be precipitated. Another group will be
maintained on supraphysiologic levels of estrogen and progesterone for an additional month.
Outcome measures will include mood, behavioral and hormonal parameters (a separate protocol
done in collaboration with NICHD).