Premenstrual tension and depression - is there a relationship?

A biological basis for vulnerability to post-partum depression has been hypothesised. Women who experience difficulty in physiologically compensating for the relatively minor changes of the menstrual cycle or who are biologically hypersensitive to subtle endocrinological stimuli are claimed to have even greater difficulty adjusting to the dramatic decrease in steroid output during parturition. A review of the literature found that most studies of parous patients reported an association between the occurrence of post-partum depression and a remembered history of premenstrual tension, menstrual problems and dysmenorrhoea. The aim of the present study was to investigate whether women who clearly suffer from premenstrual syndrome would have a history of mood disorders at other times of hormonal change, whether endogenous (post partum) or exogenous (oral contraceptive pill). Sample for the study were 75 women who were found after 2 months of prospective evaluation on strict criteria to suffer from premenstrual syndrome. The control group comprised 34 women volunteers who did not regard themselves as suffering from PMS. Median age of patients was 35 years and that of volunteers was 38 years. Median number of children in each group was 2. Self-esteem was significantly lower amongst patients than volunteers. Of the parous PMS sufferers 62.6% had experienced a post-partum depression compared with 41.4% of the volunteers. Of post-partum depression sufferers 69.8% of PMS patients and 38.9% of volunteers remembered experiencing side effects on the oral contraceptive pill (P < 0.05). Amongst those with a post-partum depression history, more PMS sufferers than controls reported obstetric difficulties, gynaecological problems and family psychiatric history. These findings provide further evidence for the role of biological vulnerability in both post-partum depression and premenstrual syndrome.