Estrogen replacement therapy for depression in perimenopausal women

ABSTRACT

To determine the effect of a four-week course of oral estrogen therapy on depression in aging women. Quasi experimental. The OPD, Bahawal Victoria Hospital, Bahawalpur, from September 2000 to January 2004. Forty-two depressed women [aged 42-57] who were either perimenopausal [n=20] or postmenopausal [n=22] received open label treatment with oral estrogen tablets[1.25mg/day] for 4 weeks. The Montgomery-Asberg Depression Rating Scale and the Beck Depression Inventory were used to assess depressive symptoms, the Greene Climacteric Scale was used to assess menopause-related symptoms, and the Clinical Global Impression[CGI] was used to assess global clinical improvement in these women at baseline and after treatment. Remission of depression was defined as a score <10 on the Montgomery-Asberg Depression Rating Scale and a score < 2 on the CGI at week 4. The women who completed the study had a median Montgomery-Asberg Depression Rating Scale score of 20 [range= 15-32] at study entry and 11.50 [range= 10-31.0] at week 4 [z = -3.43, p<0.01]. This improvement was consistent with that reported by the women themselves on the Beck Depression Inventory [rs=0.86, n=20, p<0.01]. The improvement measured by CGI scores was also significant [p<0.01]. Remission of depression was noted in 5 of the 40 women [after 1 year] who completed the study. Anti-depressant response was not associated with severity or subtypes of depression at study entry or with concomitant improvement in menopause-related symptoms. Perimenopausal and postmenopausal women benefit from short-term use of estrogen therapy. Antidepressant effect of estrogen therapy is independent of improvement in menopause-related symptoms