The Effects of Estrogen Withdrawal on Mood Symptoms in Women
Condition: Perimenopausal Depression; Post Menopausal; Healthy; Depression
MeSH terms: Depression; Depressive Disorder
Study type: Observational

Summary: 
      This study evaluates the effects on mood when stopping estrogen replacement therapy.

      The purpose of this study is to investigate the effects of estrogen levels on perimenopausal
      depression. This study will examine short-term withdrawal of estrogen in women whose mood had
      improved with estrogen therapy.

      Perimenopause-related mood disorders cause significant distress in a large number of women.
      Evidence suggests that estradiol may have beneficial effects in women with perimenopausal
      depression. However, the effect of declining estradiol secretion during perimenopause has not
      been fully examined.

      Peri- and post-menopausal women who experience a remission of perimenopause-related
      depression symptoms while on estrogen therapy and a control group of healthy volunteers on
      hormone replacement therapy (HRT) will be switched from their current form of HRT to
      estradiol for a 3-week period; volunteers will also complete symptom ratings to confirm the
      absence of mood symptoms. Participants will then be randomly assigned to either continue
      estradiol or take a placebo (an inactive pill) for an additional 3 weeks. Mood ratings will
      be used to determine response to estradiol withdrawal.

      ...
    

Detailed description: 
      Perimenopause-related mood disorders cause significant distress to a large number of women.
      Recent studies have reported the therapeutic benefits of estradiol in women with these mood
      disorders; however, a relevant pathophysiologic role of declining estradiol secretion during
      the perimenopause has not been demonstrated. In this protocol we wish to investigate the
      effects of acute withdrawal of estradiol on mood under placebo controlled conditions. Thus,
      mood and behavior symptoms may be precipitated by the experimental conditions of this
      protocol. This protocol will address the following hypothesis: women with a past history of
      perimenopause-related depression but not women without such a history will experience a
      recurrence of mood and behavioral symptoms during acute estradiol withdrawal but not during
      continued estradiol administration. The nature of the relationship between the declining
      secretion of estradiol and mood in perimenopausal depressed women will be examined as
      follows: Peri- and postmenopausal women reporting the onset of depression during the
      perimenopause and who report remission of depressive symptoms on estrogen therapy (ET) will
      be withdrawn from ET under blinded and placebo-controlled conditions. We will recruit as a
      comparison group asymptomatic women on hormone replacement and without a history of
      perimenopause-related depression. During a three week baseline phase, all women will be
      switched from their current form of hormone replacement therapy to estradiol and will
      complete symptom ratings to confirm the absence of mood symptoms prior to entry into the
      study. After the screening, all women will be randomized to receive either estradiol or
      placebo for an additional three weeks. Comparison of mood ratings during these contrasting
      treatment conditions will allow us to examine the specific role of estrogen withdrawal in
      depression that is responsive to ET.
    

Keywords: Hormone Replacement; Gonadal Steroids; Estrogen; Major Depression; Minor Depression; Perimenopause; Estradiol; Depression; Perimenopausal Depression