I have reviewed this paper carefully and found it credible and encouraging. I have been convinced for some time that estrogen replacement can help the mood changes in the perimenopause. This study shows that it can definitely help depression and the effect seems to last beyond the weeks of treatment. The dose of 0.10mg of transdermal was however higher than our usual replacement starting dose. Other studies have suggested that lower doses also work.
Estradiol can be effective as an antidepressant treatment for peri-menopausal women.
"Transdermal estradiol has a clinically significant antidepressant effect in peri-menopausal women," say members of an international team of researchers.
"This finding may support a potential role of estrogen replacement therapy for the treatment of peri-menopausal mood disturbance, complementing other established benefits of this compound."
Investigators from the University of Sao Paulo in Brazil, the University of Western Australia in Perth, Australia, and Harvard Medical School in Boston, Massachusetts, United States, point out that depressive symptoms are common during the transition to menopause.
"Cross-sectional surveys describe high rates of depressive symptoms among women treated in menopause clinics."
At the same time, estrogen replacement used to treat menopausal symptoms has been shown to increase women's psychological well-being.
Their study enrolled 50 women aged 40 to 45 years. All had irregular menstrual periods and serum concentrations of follicle-stimulating hormone greater than 25 IU/L.
Participants met criteria for major depressive disorder (26 patients), dysthymic disorder (11 patients) or minor depressive disorder (13 patients).
Participants were randomized to receive transdermal patches with 17 beta-estradiol or placebo. Twelve weeks of treatment were followed with a four-week washout period.
Researchers used Montgomery-Asberg Depression Rating Scale and Blatt-Kupperman Menopausal Index scores as outcome measures.
"Remission of depression was observed in 17 women treated with 17 beta-estradiol (68 percent), compared with five in the placebo group (20 percent)," the researchers report.
"Subjects responded similarly to estradiol treatment regardless of Diagnostic and Statistical Manual of Mental Disorders IV diagnosis.
"Patients treated with estradiol sustained antidepressant benefit of treatment after the four-week washout period, although somatic complaints increased in frequency and intensity."
Investigators note that treatment was well tolerated in both groups. Adverse events were rare.
They suggest larger clinical trials are needed. New studies should include a longer treatment follow-up and evaluate the potential alteration of antidepressant benefit with concomitant progesterone, they add.
(published by Doctor's Guide Publishing Limited)