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Depression: Emotion or Illness?

In the treatment of puerperal depression the dose of progesterone may need to be higher during the first month or two following childbirth, and up to 200 mg by daily injections may be needed for the first few days. That may seem a high dose, but during pregnancy the level of progesterone production in the placenta exceeds 300 mg daily. If treatment of puerperal depression has been delayed for a few months, then it is usual to find an exacerbation of the depression during the premenstruum, and in these cases it is as well to give continuous progesterone for the first month or two and when symptoms are relieved to give progesterone cyclically in the second half of the menstrual cycle. These are two depressions that need no reference to the consultant psychiatrist. Their diagnosis and treatment lie completely within the province of the family doctor. Those doctors familiar with the treatment of premenstrual syndrome should have no difficulty in mastering the technique of progesterone therapy in puerperal depression. Thus, practice of good medicine will avoid wasting the valuable time of our psychiatric colleagues.