Depression is common in postmenopausal women suffering from menopausal vasomotor symptoms (hot flushes, night sweats) and insomnia. While estrogen replacement therapy may alleviate these symptoms and may also have a positive impact on mood, the use of estrogen has declined over recent years. There has been great interest in finding alternative strategies for the management of menopausal symptoms, and recent data suggest that selective serotonin reuptake inhibitor antidepressants (SSRIs) and the serotonin norepinephrine reuptake inhibitor (SNRI), venlafaxine, may be effective for the treatment of depression and vasomotor symptoms in peri- and postmenopausal women. In a study presented at the annual meeting of the American Psychiatric Association, Dr. Hadine Joffe and her colleagues at the Center of Women’s Mental Health presented data on the use of duloxetine (Cymbalta), a new SNRI, for the treatment of mood, vasomotor symptoms, and insomnia in postmenopausal women.
Postmenopausal women (age 40-60) were recruited for this study. Women receiving hormonal therapy or antidepressants were excluded. Preliminary analysis of the data included 26 post-menopausal women (mean age: 51.5 + 4.3 years) diagnosed with depression (Montgomery-Asberg Depression Rating Scale [MADRS] scores > 20). Subjects had significant menopausal symptoms, with a Green Climacteric Scale (GCS) total score of > 20 and a GCS vasomotor subscale score of > 3. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality.
Following a 2-week single-blind placebo run-in phase, subjects were treated for 8 weeks with open-label duloxetine with flexible dosing (60-120 mg/day), For the 11 women who had completed the study at the time this work was presented, MADRS scores declined from a mean of 22.6 + 2.9 to 6.0 + 4.9 (p < 0.001). 82% of the women had a full remission of their symptoms (MADRS < 10). GCS vasomotor scores declined from a mean of 4.8 +1.4 to 2.5 +1.1(p < 0.001), reflecting improvement of hot flushes. Sleep quality also improved significantly, with PQSI scores declining from 11.8 + 3.7 to 7.1 + 3.3 (p < 0.001). The final mean dosage of duloxetine used was 79.1 + 20.2 mg/day.
These preliminary data suggest that duloxetine is effective for the treatment of depressive symptoms in postmenopausal women with prominent vasomotor symptoms. Duloxetine also appears to alleviate hot flushes and improve sleep quality in this population and thus may be an attractive alternative to hormonal therapy for women with significant menopausal symptoms.
Ruta Nonacs, MD PhD
*This post was originally published as an article in our July 2006 Newsletter.