Associations between sex hormones, sleep problems and depression 241 testosterone levels in men is associated with an increase in depressive symptoms, although in the same participants absolute testosterone levels do not seem to correlate with reported depressive symptoms (Kische et al., 2018). Another explanation is that there may be individual differences in the sensitivity for sex hormone changes causing some individuals to be more susceptible to hormonal mood complaints. Mechanisms involving differences in neurosteroids (Rapkin, 1999; Sundström Poromaa et al., 2003), MAO-receptors (Sacher et al., 2010) and GABA-A receptors (Bäckström et al., 2011; Klatzkin et al., 2006) have been proposed to explain individual vulnerability for the effects of sex hormones. The hypothesis that hormone-related depressive symptoms have a different etiology than MDD has also been suggested in previous studies in menopausal women and women with PMDD (Klatzkin et al., 2006; Kornstein et al., 2010). These studies suggest that hormonal depressive complaints may have a different underlying mechanism. One finding supporting this hypothesis is that these “hormonal depression phases” respond to different treatments which seem to target sex hormones and their metabolites. For example, intermittent use of the antidepressant fluoxetine (Prozac) relieves PMDD symptoms in a matter of days, whereas the effect is usually noticeable after 6 to 8 weeks in MDD (Steinberg et al., 2012; Steiner et al., 2003), which may be related to the much faster effect of fluoxetine on progesterone metabolites (Devall et al., 2015; Steiner et al., 2003). Additionally, depressive symptoms during menopause can be relieved through sex hormone replacement therapy (Gordon & Girdler, 2014). 4.4. Conclusion This systematic review shows that studies on endogenous sex hormone levels, sleep and depression have mainly been conducted in women, and that studies on exogenous sex hormone administration are rare. Based on the current literature there seems to be more evidence for an association between absolute sex hormone levels and sleep problems, than a relation between absolute sex hormone levels and depressive symptoms or a diagnosis of depression.
RkJQdWJsaXNoZXIy MTk4NDMw