Efficacy of 17β-Estradiol on Depression: Is Estrogen Deficiency Really Necessary?

Letter to the Editor

Sir: Ahokas and colleagues1 recently published the results of an open-label study in which 23 women who suffered from severe postpartum depression (mean ± SD Montgomery-Asberg Depression Rating Scale [MADRS] total score = 40.7 ± 2.8; range, 35-45) received micronized 17β-estradiol (E₂) sublingually for 8 weeks. The results were impressive: 39% of subjects experienced full remission of depression (MADRS total score ≤ 7) after 1 week of treatment, and almost 83% experienced full remission after 2 weeks. Two patients sustained antidepressant benefit at 4 weeks following treatment discontinuation. At baseline, 16 of 23 subjects were hypogonadal (serum E₂ level < 110 pmol/L), and all subjects had a serum E₂ level < 200 pmol/L.