A substantial proportion of women transitioning into menopause experience a new onset or recurrence of depressive symptoms.  A new study from the Center for Women’s Mental Health indicates that duloxetine (Cymbalta) is effective for the treatment of depression and may also have a beneficial effect on vasomotor symptoms (hot flashes and night sweats).

In this study, 19 peri- and postmenopausal women with major depressive disorder (MDD) were treated in an open trial with duloxetine (60mg/day) for 8 weeks. Depressive symptoms were measured using the Hamilton Rating Scale for Depression (HAM-D). Anxiety was measured with the Generalized Anxiety Disorder scale (GAD-7). Hot flashes were monitored using daily diaries, the Greene Climacteric Scale (GCS), and the Hot Flash-Related Daily Interference Scale (HFRDIS).

16 of the 19 participants (84.2%) were evaluable (returned for ?1 follow up), and 13 (68.4%) completed the 8-week study. Three discontinued due to side effects. The pre-treatment and final median HAM-D scores were 15 and 6.5, respectively, reflecting a significant decrease in depressive symptoms (p=.0006). The response and remission rates were 56.3% (all responders were also remitters, having ?50% decrease in HAM-D scores and final scores of ?7). Anxiety symptoms also improved with treatment (p=.012).

Among women who reported hot flashes at baseline, the number and severity of hot flashes improved significantly overall (p=.009 and p=.008, respectively). Daytime, but not nighttime hot flashes improved significantly.

This study parallels the findings of previous studies indicating that serotonergic antidepressants are effective not only for the treatment of depression and anxiety, but also may be effective for treating the vasomotor symptoms that accompany the transition to menopause.

Ruta Nonacs, MD PhD

Freeman MP, Hirschberg AM, Wang B, et al.  Duloxetine for major depressive disorder and daytime and nighttime hot flashes associated with the menopausal transition.Maturitas.2013 Apr 17.

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