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 .
Modulation of cognition-specific cortical activity by gonadal steroids: a positron-emission tomography study in women.
There is considerable evidence from animal studies that gonadal steroid hormones modulate neuronal activity and affect behavior . To study this in humans directly , we used H215O positron-emission tomography to measure regional cerebral blood flow ( rCBF ) in young women during three pharmacologically controlled hormonal conditions spanning 4 - 5 months : ovarian suppression induced by the gonadotropin-releasing hormone agonist leuprolide acetate ( Lupron ) , Lupron plus estradiol replacement , and Lupron plus progesterone replacement . Estradiol and progesterone were administered in a double-blind cross-over design . On each occasion positron-emission tomography scans were performed during ( i ) the Wisconsin Card Sorting Test , a neuropsychological test that physiologically activates prefrontal cortex ( PFC ) and an associated cortical network including inferior parietal lobule and posterior inferolateral temporal gyrus , and ( ii ) a no-delay matching-to- sample sensorimotor control task . During treatment with Lupron alone ( i.e. , with virtual absence of gonadal steroid hormones ) , there was marked attenuation of the typical Wisconsin Card Sorting Test activation pattern even though task performance did not change . Most strikingly , there was no rCBF increase in PFC . When either progesterone or estrogen was added to the Lupron regimen , there was normalization of the rCBF activation pattern with augmentation of the parietal and temporal foci and return of the dorsolateral PFC activation . These data directly demonstrate that the hormonal milieu modulates cognition-related neural activity in humans
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 .