We previously reported on studies suggesting estrogen may be helpful for the treatment of depression in peri- and post-menopausal women, either alone or in combination with an antidepressant.  In addition, other studies have suggested that older, postmenopausal women may respond more poorly to antidepressants than premenopausal women. Two recent studies attempt to better understand the impact of reproductive hormones on clinical presentation and treatment response of depression in women.

In the first study, Kornstein and colleagues used data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study to explore the clinical characteristics of women with major depression, assessing women not taking hormone therapy who were either premenopausal (N=950), perimenopausal (N=380), or postmenopausal (N=562). Similar comparisons were also made between postmenopausal women (n=768) taking (N=171) or not taking (N=562) hormone therapy.

  • Premenopausal women were more likely to present with irritability than either peri- or postmenopausal women.
  • Premenopausal women were more likely to have decreased appetite and less likely to have early morning insomnia than perimenopausal women.
  • Postmenopausal women were more likely to have suicidal ideation and poorer physical health than either of the other groups.
  • Postmenopausal women taking hormone therapy had better physical functioning, fewer melancholic features, and less sympathetic arousal than women not taking hormone therapy.

Using the same data, Kornstein and colleagues were also able to examine whether menopausal status and use of hormonal contraceptives or hormone therapy (HT) had any impact on treatment response in a group of women taking antidepressants.  The analysis included premenopausal (n = 896) and postmenopausal (n = 544) women treated with citalopram for 12 to 14 weeks.

  • Premenopausal and postmenopausal women differed in multiple clinical and demographic baseline variables but did not differ with regard to response or remission rates.
  • Response and remission rates did not differ between premenopausal women taking hormonal contraceptives versus those not taking contraceptives.
  • Response and remission rates did not differ between postmenopausal women taking versus those not taking hormone therapy.

These studies suggest that while premenopausal women may present with slightly different symptoms than peri- or postmenopausal women, it appears that they do not differ substantially with regard to treatment response.  In addition, exogenous hormones (contraceptives or hormone replacement therapy) don not appear to have a significant impact on treatment response.

Ruta Nonacs, MD PhD

Kornstein SG, Young EA, Harvey AT, et al. The Influence of Menopausal Status and Postmenopausal Use of Hormone Therapy on Presentation of Major Depression in Women.  Menopause. 2010; 17(4): 828–839.

Kornstein SG, Toups M, Rush J, et al. Do menopausal status and use of hormone therapy affect antidepressant treatment response? Findings from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. J Womens Health. 2013; 22(2): 121-131.