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 .
Influence of a continuous combined HRT (2 mg estradiol valerate and 2 mg dienogest) on postmenopausal depression
Objective This r and omized , double-blind , placebo-controlled study was planned to investigate the effects of continuous combined hormone replacement therapy ( HRT ) with 2 mg estradiol valerate and 2 mg dienogest ( Climodien ® /Lafamme ® ) over 24 weeks on postmenopausal depression . Method A total of 129 patients with a mild to moderate depressive episode according to ICD-10 : F32.0 , F32.1 in the context of a postmenopausal syndrome ( ICD-10 : N95.1 ) and a baseline score in the Hamilton depression scale ( HAMD ) ⩾ 16 were included in the study . The primary target variable was depression severity as measured by the HAMD after 24 weeks of treatment . A four-point difference between HRT and placebo at the end of the study and , in addition , a final score ⩽ 8 ( corresponding to an improvement of ⩾ 50 % as compared to baseline ) for the individual patient ( responders analysis ) were considered clinical ly relevant . Clinical global impression ( CGI ) of investigators ( therapeutic and side-effects ) at the end of the study was investigated . Secondary effects of HRT  on depression severity caused by its effect on vasomotor symptoms or sleep disturbances ( domino hypothesis ) were taken into consideration . Also , the study addressed the question of whether the effect of HRT on depression severity depends on a history of premenstrual syndrome ( PMS ) or postnatal depression ( PND ) . Results The results showed a clear and clinical ly relevant reduction of depression severity  under HRT after 24 weeks of treatment and superiority over placebo ( p < 0.0005 ) in spite of a strong placebo effect . The effects of the estrogen – progestin combination thereby seemed only partially to be dependent on the improvement of vasomotor symptoms and sleep disturbances . Also , the effects of HRT could not be shown to be dependent on a history of PMS and /or PND , even though women with and without this history clearly differed in baseline depression scores ( p < 0.0001 ) . The assessment of CGI was positive : whereas HRT was clearly superior to placebo with regard to therapeutic effects ( p = 0.0014 ) , there were no differences with regard to side-effects ( p = 0.35 ) . Conclusion The combination of 2 mg estradiol valerate and 2 mg dienogest can be regarded as an effective and safe treatment option for women with mild to moderate depression in the context of postmenopausal syndrome
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 .