Gynecology
Estrogen replacement in perimenopause-related depression: A preliminary report

https://doi.org/10.1067/mob.2000.106004Get rights and content

Abstract

Objectives: We examined the efficacy of estrogen in the treatment of depression in perimenopausal women with and without hot flushes. Study Design: Women with perimenopause-related depression were randomized in a double-blind parallel design to receive either 17β-estradiol or placebo for 3 weeks. Subsequently, women receiving estradiol during the first 3 weeks continued receiving estradiol for an additional 3 weeks, whereas women who had received placebo crossed over to estradiol for 3 weeks. Outcome measures included standardized mood rating scales and a visual analog scale self-report instrument. Results: Of 34 female subjects, 16 received estradiol first and 18 received placebo first. After 3 weeks of estradiol, standardized mood rating scale scores and visual analog scale symptom scores (eg, sadness, anhedonia, and social isolation) were significantly decreased compared with baseline scores (P <.01) and were significantly lower than scores in women receiving placebo (P <.01), who showed no significant improvement. Neither the presence of hot flushes nor the duration of treatment (3 weeks vs 6 weeks) influenced outcome. A full or partial therapeutic response was seen in 80% of subjects receiving estradiol and 22% of those receiving placebo. Conclusion: In this preliminary study estradiol replacement effectively treats perimenopausal depression independent of its salutary effects on vasomotor symptoms. (Am J Obstet Gynecol 2000;183:414-20.)

Section snippets

Methods

Subjects were women between the ages of 44 and 55 years who met the diagnostic criteria for perimenopause-related depression. The women were referred by their personal physicians or responded to advertisements in local newspapers. The study was conducted at an outpatient clinic within the National Institutes of Health Clinical Center. The protocol was approved by the National Institute of Mental Health Intramural Research Review Subpanel, and written informed consent was obtained from all

Results

Thirty-four women were admitted into this trial; 16 received estradiol first and 18 received placebo first. Eight women had a current diagnosis of a major depressive episode, and the remainder met criteria for current minor depression. Women receiving estradiol were similar to those receiving placebo in terms of baseline characteristics (Table II).

. Characteristics of subjects entering study

Empty Cell17β-estradiol (n = 16)Placebo (n = 18)
Age (y)
 Mean ± SD48.3 ± 2.7050.1 ± 3.1
 Range44-5244-55
Parity (mean ± SD)

Comment

This study demonstrates that a dose of estradiol 0.05 mg/d administered by skin patch is associated with a significant improvement in mood in depressed perimenopausal women with or without hot flushes. Our data are consistent with studies by Montgomery et al6 and Saletu et al,7 who observed the beneficial effects of estrogen on mood in perimenopausal women reporting depressive symptoms. We extend prior findings by demonstrating that estradiol has salutary effects on mood in women who meet

Acknowledgements

We thank Ciba-Geigy, Raritan, NJ, for the provision of estradiol skin patches; Dr John Bartko for statistical consultation; Ms Candace Davis for expert assistance with figure preparation; and Ms Nazli Haq for clinical assistance.

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