This moderate to large effect size , showing lower ratings of depressed mood in treated patients compared with controls , implicated HRT as a potential treatment of or prophylactic for depression in menopausal women .
One can generalize from the studies review ed here only with great caution , but there is little evidence to support the use of estradiol to improve mood in nondepressed patients ( not surprisingly ) and some evidence to support the antidepressant efficacy of estradiol in perimenopausal but not postmenopausal women
BACKGROUND Controversy regarding the antidepressant efficacy of hormone replacement therapy ( HRT ) stems almost from its inception and reflects the same method ological inconsistencies that have compromised efforts to determine whether the perimenopause is accompanied by an increase in mood symptoms or depression .
Since this publication , multiple studies have aim ed to discern the relationship between HRT and menopausal mood .
METHODS The purpose of this systematic review is to examine the findings and quality of the evidence amassed since Zweifel and O'Brien 's meta- analysis .
Increased estradiol and improved sleep, but not hot flashes, predict enhanced mood during the menopausal transition.
BACKGROUND The antidepressant effect of estrogen in women undergoing the menopause transition is hypothesized to be mediated by central nervous system effects of increasing estradiol on mood or through a pathway involving suppression of hot flashes and associated sleep disturbance . Estrogen therapy ( ET ) and the hypnotic agent zolpidem were selected as interventions in a three-arm , double-blind , placebo-controlled trial to distinguish the effects of estradiol , sleep , and hot flashes on depression . METHODS Women with depressive disorders , hot flashes , and sleep disturbance were r and omly assigned to transdermal 17β-estradiol 0.05 mg/d , zolpidem 10 mg/d , or placebo for 8 wk . Changes in serum estradiol , perceived sleep quality , objective ly measured sleep , and hot flashes were examined as predictors of depression improvement [ Montgomery-Åsberg Depression Rating Scale ( MADRS ) ] using multivariate linear regression . RESULTS Seventy-two peri/postmenopausal women with depression disorders were r and omized to 17β-estradiol ( n = 27 ) , zolpidem ( n = 31 ) , or placebo ( n = 14 ) . There was no significant difference between groups in depression improvement ( overall MADRS decrease 11.8 ± 8.6 ) . Increasing estradiol ( P = 0.009 ) and improved sleep quality ( P < 0.001 ) predicted improved mood in adjusted models but reduced hot flashes ( P = 0.99 ) did not . Post hoc subgroup analyses revealed that the therapeutic effect of increasing estradiol levels on mood was seen in perimenopausal ( P = 0.009 ) , but not postmenopausal , women . CONCLUSIONS For women with menopause-associated depression , improvement in depression is predicted by improved sleep , and among perimenopausal women , by increasing estradiol levels . These results suggest that changes in estradiol and sleep quality , rather than hot flashes , mediate depression during the menopause transition . Therapies targeting insomnia may be valuable in treating menopause-associated depression
This moderate to large effect size , showing lower ratings of depressed mood in treated patients compared with controls , implicated HRT as a potential treatment of or prophylactic for depression in menopausal women .
One can generalize from the studies review ed here only with great caution , but there is little evidence to support the use of estradiol to improve mood in nondepressed patients ( not surprisingly ) and some evidence to support the antidepressant efficacy of estradiol in perimenopausal but not postmenopausal women
BACKGROUND Controversy regarding the antidepressant efficacy of hormone replacement therapy ( HRT ) stems almost from its inception and reflects the same method ological inconsistencies that have compromised efforts to determine whether the perimenopause is accompanied by an increase in mood symptoms or depression .
Since this publication , multiple studies have aim ed to discern the relationship between HRT and menopausal mood .
METHODS The purpose of this systematic review is to examine the findings and quality of the evidence amassed since Zweifel and O'Brien 's meta- analysis .