CMAJ • August 2, 2005; 173 (3). doi:10.1503/cmaj.1050022.
© 2005 CMA Media Inc. or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters
Correspondance

HRT and antidepressants

Wendy L. Wolfman

Director, Menopause Unit, Mount Sinai Hospital, Toronto, Ont.

Roger McIntyre and associates1 discuss reciprocal relationships between hormone replacement therapy (HRT) and antidepressant treatment. Although some women experience significant mood changes related to changes in estrogen levels at menopause, I believe there is another obvious explanation for the increase in prescriptions for selective serotonin reuptake inhibitors (SSRIs) after publication of the Women's Health Initiative (WHI) trial.2

Hot flashes occur in 65%–75% of women during natural or induced menopause.3 Many women discontinued their hormone therapy because of the WHI results but continued to experience significant symptoms and sought medicinal help from their physicians. The only medications with scientific proof of efficacy, other than estrogen and progestins, are SSRIs, clonidine and, more recently, gabapentin.3,4,5,6,7

As demonstrated by Loprinzi and colleagues,7 breast cancer patients with depression reported a reduction in hot flashes when taking SSRIs. Subsequently, other SSRIs were shown to have similar beneficial effects. However, SSRIs are much less effective in this regard than HRT (which is more than 85% effective).3

Footnotes

Competing interests: Dr. Wolfman has received an honorarium from Wyeth for speaking to physicians about issues to do with menopause.


References

  1. McIntyre RS, Konarski JZ, Grigoriadis S, Fan NC, Mancini DA, Fulton KA, et al. Hormone replacement therapy and antidepressant prescription patterns: a reciprocal relationship [editorial]. CMAJ 2005;172(1):57-9.[Free Full Text]
  2. Rossouw JAE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288:321-33.[Abstract/Free Full Text]
  3. North American Menopause Society. Treatment of menopause-associated vasomotor symptoms: position statement of the North American Menopause Society. Menopause 2004;11:11-33.[CrossRef][Medline]
  4. Evans M, Pritts E, Vittinghoff E, McClish K, Morgan KS, Jaffe RB. Management of postmenopausal hot flushes with venlafaxine hydrochloride: a randomized, controlled trial. Obstet Gynecol 2005;105(1):161-6.[Medline]
  5. Loprinzi CL, Sloan JS, Perez EA, Quella SK, Stella PJ, Mailliard JA, et al. Phase III evaluation of fluoxetine for treatment of hot flashes. J Clin Oncol 2002;20:1578-83.[Abstract/Free Full Text]
  6. Stearns V, Beebe KL, Iyengar M, Dube E. Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. JAMA 2003;289:2827-34.[Abstract/Free Full Text]
  7. Loprinzi CL, Kugler JW, Sloan JA, Mailliard JA, LaVasseur BI, Barton DL, et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomized controlled trial. Lancet 2000;356:2059-63.[CrossRef][Medline]




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Right arrow Menopause (including HRT)
Right arrow Mood disorders (including depression)