Review of the role of progesterone in the management of postnatal mood disorders

Postnatal mood disorders (maternity blues, postnatal depression and puerperal psychosis) are cross-cultural symptoms that are commonly seen in primary care by general practitioners and midwives, by gynecologists and obstetricians, and within the psychiatric services. One of several hypotheses for their causation is falling progesterone levels in the postpartum period. Progesterone supplements are therefore currently used in the treatment of postnatal mood disorders, both in primary and secondary health care settings. The evidence for this is reviewed. The MEDLINE and PSYCHLIT databases from 1966 to 1999 were searched. References reporting observational data on progesterone levels around delivery or therapeutic studies using progesterone were retrieved. Additional references were identified by citation tracking from these and direct contact with available authors. Eight papers were identified. Although there is some weak evidence for its role in maternity blues and some theoretical justification for its use, there is no robust primary research to support the use of progesterone in the treatment of postnatal mood disorders. Progesterone is being used to prevent recurrence of postnatal depression but the evidence supporting its efficacy is lacking. Its use in the treatment of postnatal mood disorders cannot be recommended on the basis of current evidence. Randomized controlled trials are needed to decide if it has a role in the treatment and prevention of postnatal mood disorders.