Worsening Depression in a Patient with a Granulosa Cell Tumor

Abstract

Increased estrogen levels are likely to play a role in depression. The steroid hormone estrogen can modulate turnover of neurotransmitters by enhancing serotonin and noradrenaline levels. Estrogen is also involved in the regulation of serotonin receptor number and function. 1 Oscillating estrogen levels during the postmenopausal period or caused by an estrogen-producing tumor may herald a recurrence or a worsening of the depressive episode in a woman with a previous diagnosis of depression. Both high and low levels of estrogen have been associated with the occurrence of depressive symptoms, and the variability in estrogen may cause depression. 2,3 This suggests that exploring the hypothalamicpituitary-gonadal axis in depression may yield areas of research in psychosomatic medicine and psychooncology. At present, evidence-based pharmacologic options are being studied for treating estrogen-sensitive depression. This article offers information on the pharmacological treatment and characteristics of depression in a woman with a previous diagnosis of major depression who is experiencing extreme fluctuations of estrogen levels.