Every year more than 1.7 million women in the United States enter into menopause. During this time of hormonal fluctuations it is typical for women to experience hot flashes, night sweats and sleep disturbance. More recently, studies have identified an association between menopausal transition and an increased risk for developing depressive symptoms (Harlow et al., 2003; Freeman et al., 2004). It is not clear how physicians and patients should deal with menopause-related physical and emotional symptoms. While hormone therapy effectively treats insomnia and hot flashes, the results have been mixed in treating mood and anxiety symptoms. Moreover, the safety of long-term use of hormone therapy is not known.
In a recent study from Dr. Claudio Soares at the Center for Women’s Mental Health, preliminary data suggest that antidepressants may effectively treat menopause-related depressive symptoms as well as vasomotor symptoms (Soares et al., 2005). In this study, 38 women between the ages of 40 and 60 (15 peri-menopausal and 23 post-menopausal) with depressive disorders were randomized to receive open treatment with either escitalopram (flexible dosing of 10-20mg) or hormone therapy (norethindrone acetate and ethinyl estradiol). The Montgomery-Asberg Depression Rating Scale (MADRS) was used to assess the severity of depressive symptoms. Improvement in quality of life was also measured in both treatment groups.
After 8 weeks, full remission of depression (defined as MADRS score < 10) was observed in 75%(12/16) of subjects treated with escitalopram versus 25% (4/16) treated with hormone therapy. Both treatment groups showed significant improvement of vasomotor symptoms, sleep and quality of life. Ten of the 12 non-responders to hormone therapy received a trial of hormone therapy plus escitalopram. After this 8-week extension phase, 60% (6/10) of the women achieved remission of depression with the addition of escitalopram.
As significant improvements in depressive symptoms, quality of life and vasomotor symptoms were noted in both treatment groups, escitalopram may constitute an interesting treatment option for symptomatic menopausal women who are unable or unwilling to receive treatment with hormone therapy. Further research will examine the characteristics of symptomatic menopausal women who could better benefit from hormonal or non-hormonal interventions.
Maria Houghton, BA
Claudio Soares, MD, PhD
These data were presented as a poster at the 2004 Annual Meeting of the American Psychiatric Association.
Click here to view the Poster presented by Dr. Claudio Soares.
Freeman EW, Sammel MD, Liu L, Gracia CR, Nelson DB, Hollander L. (2004). Hormones and menopausal status as predictors of depression in women in transition to menopause. Arch Gen Psychiatry 61(1): 62-70.
Harlow BL, Wise LA, Otto MW, Soares CN, Cohen LS. (2003). Depression and its influence on reproductive endocrine and menstrual cycle markers associated with perimenopause: the Harvard Study of Moods and Cycles. Arch Gen Psychiatry 60(1): 29-36.
Soares CN, Poitras JR, Prouty J, Alexander AB, Shifren JL, Cohen LS. (2003). Efficacy of citalopram as a monotherapy or as an adjunctive treatment to estrogen therapy for perimenopausal and postmenopausal women with depression and vasomotor symptoms. J Clin Psychiatry 64(4): 473-9.
*This post was originally published as an article in our December 2005 Newsletter.