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