Jury Is Still out on Use of HRT for Perimenopausal Depression. (Few Older Women Participate in Trials)

By Demott, Kathryn | Clinical Psychiatry News, December 2001 | Go to article overview

Jury Is Still out on Use of HRT for Perimenopausal Depression. (Few Older Women Participate in Trials)


Demott, Kathryn, Clinical Psychiatry News


NEW ORLEANS -- Data on the role of hormone replacement therapy for menopause-associated mood disorders look promising, but only well-documented treatments such as selective serotonin reuptake inhibitors are appropriate first-line approaches at this time, Dr. Lee Cohen said at the annual meeting of the North American Menopause Society.

Nevertheless, he and his colleagues remain "very excited" about where estradiol may fit into the treatment of mood disorders associated with menopause, said Dr. Cohen of the department of psychiatry at Harvard Medical School, Boston.

He is involved in studies at the Massachusetts General Hospital Center for Women's Health, Boston, exploring gender-based determinants of mood disorders. In a recent study involving 50 perimenopausal women with depressive disorders, Dr. Cohen and his associates found that 68% of women who were randomized to treatment with 17[beta]-estradiol transdermal patches experienced symptom remission, compared with 20% of patients in a placebo group (Arch. Gen. Psychiatry 58[6]:537-38, 2001).

But Dr. Cohen warned that it's still too soon to start prescribing HRT for menopause-related depression. Many questions still remain. Researchers have not yet identified whether a specific population of women benefit from the combination of estradiol and an SSRI. The data on adding estradiol to regimens for women who don't respond to SSRIs are still preliminary.

The study of gender-based differences in depression and anxiety disorders has come on the radar screen only recently. And so far, most of the data deal with postpartum depression. Fewer data look at the effect of the menstrual cycle or menopausal status on the course of mood disorders, treatment response, and the interaction between hormone therapies and antidepressants. Part of the problem is that as women get older, their participation in trials dwindles, so the estimates of risk for mood disturbances among them are not entirely reliable, Dr. Cohen said.

The data don't suggest that the perimenopausal period is associated with a frank increased risk for major depression; however, it is associated with an increased risk of more depressive symptoms.

While it's "intuitively compelling" to look at the increases in FSH and irregular menstrual cycles during perimenopause and assume that such fluctuations are driving depressive symptoms, "we really don't have enough data yet to link what we see hormonally to what is going on in terms of risk for mood disturbance. …

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