Chapter 8 218 1.2. Sex hormones in depression and sleep problems An important biological difference between the sexes, especially during the reproductive age, is the difference in the level of sex hormones: testosterone, estrogen and progesterone. The sex differences in prevalence of insomnia and depression appear from puberty onwards (Salk et al., 2017) and seems to coincide with the timing of girls’ first menstruation (Johnson et al., 2006). This suggests that female sex hormones might partly account for the gender difference in prevalence of depression and sleep problems. Another indication that female sex hormones may affect mood is found in women suffering from premenstrual syndrome (PMS). An estimated 48% of women suffer from PMS symptoms (Direkvand-Moghadam et al., 2014), reporting a depressed mood and fatigue in the week before onset of menstruation (Baker & Driver, 2007; Halbreich et al., 2003; Potter et al., 2009). In 13 to 18% of women, these symptoms include severe anhedonia, lability and/or anxiety in such severity that it fulfils the criteria of the DSM 5classified “premenstrual dysphoric disorder” or PMDD (American Psychiatric Association, 2013; Halbreich et al., 2003; Hantsoo & Epperson, 2015). Fatigue is a symptom of PMDD, which indicates that sleep quality might also be affected in PMDD. Moreover, some studies also reported associations between oral hormonal contraceptives (OC) and depressive mood (Gingnell et al., 2013), antidepressant use (Skovlund et al., 2016) and risk of suicide (Skovlund et al., 2018), although these findings are not always replicated (Hamstra et al., 2017; Scheuringer et al., 2020; Toffol et al., 2011). Hormonal contraceptives suppress endogenous hormones by administering exogenous hormones (Montoya & Bos, 2017), so whether these side effects are caused by exogenous or endogenous hormone changes is not yet clear. During the menopausal transition, when sex hormones strongly fluctuate and eventually diminish, sleeping problems, reported as “trouble sleeping” and “sleeping problems”, are a common complaint (Kravitz et al., 2003; Schnatz et al., 2005) and depressed mood often occurs (Cohen et al., 2006; Hay et al., 1994; Soares, 2010). Estrogen administration in some cases counteracts depressive symptoms and sleep complaints in women during menopause (Miller, 2003; Sarti et al., 2005). Altogether, we could say that relative changes in estrogen or progesterone levels often seem to co-incide with an increase in depressive symptoms and sleep problems.
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