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eLetters: Electronic letters published:
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Marital bliss - maybe not...
- Dr Adil Y. Kadri (13 December 2006)
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Role of Hormonal changes in mental disorders in Women
- Dhruvashree Somasundara (18 December 2006)
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Dr Adil Y. Kadri, Psychiatrist Cefn Coed Hospital, Swansea NHS Trust, Wales, UK
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adilkadri{at}hotmail.com Dr Adil Y. Kadri
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The authors have come up with some interesting findings in their study, with one of them being that 'being married as compared with being single' is independently associated with the risk for common mental disorder. In my opinion this finding could well be just a confounder as traditionally most women in India (if not almost all) between the ages of 18 to 50 years would be married anyway. To not be married (unless already widowed) and be within this age group would be considered almost a social taboo. I would therefore question the validity of this finding. The more likely explanation for this I suspect is related to the quality of the marital relationship rather than the marital status. |
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Dhruvashree Somasundara, Ex- PRHO, Bangalore Medical College, Bangalore-560001, India
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dhruvashree{at}gmail.com Dhruvashree Somasundara
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Depression(1) is the most common cause of disability in the world among individuals aged 5 years and above. It is the most common psychiatric illness in the world and is almost twice as common in women as in men. Women are particularly vulnerable to depression after childbirth. Hormonal and physiological changes with the responsibility of a new life can lead to such changes. While transient baby “blues” are common, more prolonged symptoms require intervention. Therefore, in addition to screening for the risk factors that the author has mentioned, in my opinion, postpartum screening of mothers would help to further reduce the burden of disease. According to a large Danish Study(2), within the first three months of child birth, 1 in 1000 women in the United States suffer from various mental illnesses such as schizophrenia, bipolar disorder, depression or some other psychotic condition severe enough to be hospitalized. Hormones are believed to play a major role in postpartum illness. During pregnancy, when the levels of oestrogen and progesterone are high, there is a decline in mental illnesses. However, there are exceptions of cases of schizophrenia whose symptoms increase both in pregnancy and postpartum period(3). With a precipitous fall in the level of these hormones after childbirth, symptoms of mental illnesses are increased. States such as New Jersey in the United States have recognised the importance of postpartum screening and have already passed a law making postpartum screening mandatory. Hormonal factors play a major role in mental illness even in non- pregnant women. The menstrual cycle, especially the premenstrual phase, perimenopausal period, menopause are the most common periods of important hormonal changes during which women show signs of irritability and depression. A recent NIMH study(3) showed that in the case of severe premenstrual syndrome (PMS), women with a pre-existing vulnerability to PMS experienced relief from mood and physical symptoms when their sex hormones were suppressed. Shortly after the hormones were re-introduced, they again developed symptoms of PMS. However, women without a history of PMS reported no effects of the hormonal manipulation. To support the effect of hormonal changes on mental symptoms, treatment of menopausal symptoms including depression and hot flushes has traditionally been Estrogen. Infact, a NIMH study found its effects to be comparable to the efficacy of antidepressants. Thus, whether high (as in PMS) or low (as in postpartum period), hormones do have a significant role in mental illnesses in women, and periods of significant hormonal stress leading to vulnerability to mental changes such as the postpartum period should be given due consideration in screening for mental disorders in women to reduce the burden of disease. References: 1. www.who.int/mediacentre/factsheets/fs265/en/ 2. Mental illness hits 1 in 1,000 new mothers, www.baltimoresun.com/news/health 3. National Institute of mental health, Women Hold Up Half the Sky: Women and Mental Health Research www.nimh.gov.uk |
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