Treatment of menopause-related mood disturbances.

More than 1.7 million American women are expected to reach menopause each year. Recent Canadian statistics show that a 50-year-old woman can now expect to live until her mid-80s, which implies living at least one-third of her life after menopause. The menopausal transition is typically marked by intense hormonal fluctuations, accompanied by vasomotor symptoms (eg, hot flashes, night sweats), sleeps disturbance, and changes in sexual function, as well as increased risk for osteoporosis, cardiovascular disease, and cognitive decline. More importantly, recent studies have demonstrated a significant association between menopausal transition and a higher risk for developing depression. In the post-Women's Health Initiative Study era, physicians and patients are questioning the safety and efficacy of long-term hormone therapy use. This article reviews the current literature on the benefits and risks of using hormone therapy for the treatment of menopause-related mood disturbances and alternate strategies currently available for the management of menopause-related problems, including antidepressants, complementary and alternative medicine, and selective estrogen receptor modulators.

Short-term use of estradiol for depression in perimenopausal and postmenopausal women: a preliminary report.

OBJECTIVE: The authors examined the effect of a 4-week course of estrogen therapy on depression in perimenopausal and postmenopausal women. METHOD: Twenty-two depressed women who were either perimenopausal (N=10) or postmenopausal (N=12) received open-label treatment with transdermal 17beta-estradiol (100 micro g/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

Efficacy of citalopram as a monotherapy or as an adjunctive treatment to estrogen therapy for perimenopausal and postmenopausal women with depression and vasomotor symptoms.

BACKGROUND: Women frequently report depressive and vasomotor symptoms during the menopausal transition. Hormone therapy has been shown to improve some of these symptoms, although its safety as a long-term treatment has been questioned. It is still unclear whether the use of antidepressants alone may alleviate menopause-related mood and vasomotor symptoms or enhance the response observed with short-term use of estrogen therapy. METHOD: Perimenopausal and postmenopausal women with depressive disorders (DSM-IV criteria) and menopause-related symptoms received treatment with 20 to 60 mg/day of citalopram alone (N = 22) or adjunctive to estrogen therapy (N = 13). Adjunctive treatment was offered to subjects who had failed to show remission of depression after 4 weeks with estrogen therapy (estradiol [E(2)]) alone. Depressive symptoms, menopause-related symptoms, and global clinical improvement were assessed at baseline and at endpoint of adjunctive treatment (8 weeks) or citalopram monotherapy (12 weeks). Remission of depression was defined as a score of < 10 on the Montgomery-Asberg Depression Rating Scale and a score of < or = 2 on the Clinical Global Impressions scale at endpoint. Data were collected from November 2000 to February 2002. RESULTS: Twelve women (92.3%) concluded the 8-week adjunctive treatment; 11 subjects (91.6%) achieved full remission of depression. Symptoms that had persisted after an initial 4-week treatment with E(2) alone (e.g., tension, anxiousness, tiredness, and difficulty in concentrating) improved significantly (p <.05). Fifteen subjects concluded the treatment with citalopram monotherapy; 13 subjects (86.6%) showed full remission of depression. Anxiety and other somatic complaints had significant improvement (p <.05), while there was a trend toward improvement in vasomotor symptoms in those receiving monotherapy (p =.06). CONCLUSION: Citalopram alone is an efficacious treatment for perimenopausal and postmenopausal women with depression. Citalopram also appears to be efficacious as an adjunctive treatment for depressed subjects who remain symptomatic after treatment with E(2) (i.e., E(2) nonremitters). The role of citalopram monotherapy for the management of vasomotor symptoms warrants further investigation.

Effect of reproductive hormones and selective estrogen receptor modulators on mood during menopause.

Periods of intense hormonal fluctuations have been associated with heightened prevalence and exacerbation of underlying psychiatric illness, particularly the occurrence of premenstrual dysphoria, puerperal depression and depressive symptoms during perimenopause. It has been speculated that sex steroids such as estrogens, progestogens, testosterone and dehydroepiandrosterone (DHEA) exert a significant modulation of brain functioning, possibly through interactions with various neurotransmitter systems. It is therefore intuitive that abrupt alterations of these hormones would interfere with mood and behaviour. On the other hand, accumulating data suggest that hormonal interventions may also promote relief or even remission of depressive symptoms, as already demonstrated in studies with patients experiencing postpartum depression and perimenopausal depressive disorders. The extent to which perimenopause, alone, may increase the risk for depression is unclear. However, existing data strongly suggest that some women are particularly vulnerable to developing significant physical and psychological disturbances when entering perimenopause. This article reviews the effect of sex hormones and selective estrogen receptor modulators (SERMs) on mood among peri- and postmenopausal women. There are preliminary, though promising, data on the use of estradiol (particularly transdermal estradiol) to alleviate depression during perimenopause, use of a combination of estrogens and selective serotonin reuptake inhibitors for depression during the postmenopausal period, and the use of testosterone to improve psychological well-being and increase libido among women with induced menopause. Further studies would help to better delineate the usage of hormones as an antidepressant strategy (monotherapy or augmenting treatment) for peri- and postmenopausal women. A brief review of some nonhormonal interventions for the treatment of menopause-related symptoms that may significantly affect a woman's quality of life is also presented. There are some preliminary data suggesting the efficacy of antidepressants for the treatment of hot flushes; existing data on diet supplements and herbal products have shown more mixed results.

Ocorrência e tratamento de quadros depressivos por hormônios sexuais / Occurrence and treatment of depression by sex hormones

O processo de envelhecimento promove alterações significativas na produçäo e no equilíbrio dos níveis circulantes de diversos hormônios sexuais em homens e mulheres. Acredita-se que esses hormônios (estrógenos, progestógenos, testosterona, dehidroepiandrosterona [DHEA]) exercem papel modulador sobre diversas funções psíquicas, particularmente sobre o humor e a cogniçäo. Alterações nesse papel modulador causadas por variações abruptas dos hormônios sexuais circulantes -- como as que ocorrem, por exemplo, durante a transiçäo menopausal -- favorecem o surgimento de queixas depressivas. No entanto, a utilizaçäo terapêutica de hormônios sexuais pode promover alívio ou mesmo remissäo de sintomas depressivos, como já foi caracterizado com o uso de estradiol em mulheres em perimenopausa e com a administraçäo de testosterona após a menopausa. Este artigo aborda, por revisäo da literatura, os diversos papéis atribuídos aos hormônios sexuais no desenvolvimento e tratamento das queixas depressivas. Estudos sobre a eficácia terapêutica de estrógenos, testosterona e DHEA nos quadros depressivos säo discutidos de forma crítica. Em essência, existem resultados preliminares bastante promissores, particularmente quanto ao uso de estradiol e testosterona em subpopulações específicas para alívio de sintomas depressivos. Futuras investigações devem melhor definir a utilizaçäo de hormônios como agente depressivo monoterápico ou adjuntivo, bem como delinear os riscos e as contra-indicações associados a seu uso

Hormone treatment for mood disorders in women.

Periods of intense hormonal fluctuations have been associated with heightened prevalence and exacerbation of underlying psychiatric illness, particularly the occurrence of premenstrual dysphoria, puerperal depression and depressive symptoms during the menopausal transition. It has been speculated that sex steroids, such as estrogens, progestogens, testosterone and dehydroepiandrosterone, exert a significant modulation of brain functioning, possibly through interactions with various neurotransmitter systems. It is therefore intuitive that abrupt alterations of these hormones would interfere with mood and behavior. On the other hand, accumulating data suggest that hormonal interventions may also promote relief or even remission of depressive symptoms, as already demonstrated in studies on perimenopausal women treated with transdermal estradiol. This article reviews the potential role of sex hormones for the treatment of depressive disorders in women. There are preliminary, but promising data on the use of estradiol and testosterone for specific subpopulations. Further studies would help to better delineate the usage of these compounds as an antidepressant strategy (monotherapy or augmenting treatment).