Estradiol may relieve perimenopausal depression. (Small Study of Patch Users).

PHILADELPHIA -- Short-term transdermal estradiol rapidly and substantially ameliorated depressive symptoms in perimenopausal but not postmenopausal women in a small open trial.

The antidepressant activity was independent of effects on vasomotor symptoms of menopause, Dr. Lee Cohen said at the annual meeting of the American Psychiatric Association.

While a role for estrogen in depression treatment of perimenopausal and postmenopausal women often is discussed, there are little data to substantiate it. The use of hormones "is more guided by clinical lore than science," said Dr. Cohen of Massachusetts General Hospital, Boston.

Dr. Cohen reported an open-label study that compared the effects of short-term transdermal estradiol in 9 perimenopausal and 11 perimenopausal women. Eleven women met criteria for major depressive disorder, six for minor depression, and three for dysthymia. All were given 100 mg of 17-[beta]-estradiol-2, administered via transdermal patch.

The women were moderately ill, with mean scores on the Montgomery-Asberg Depression Rating Scale of 21; 4 on the Clinical Global Impression scale; and 22.5 on the Beck Depression Inventory. Sixty-five percent had moderate to severe vasomotor menopausal symptoms. There were no significant differences between perimenstrual and postmenstrual women on any mood or vasomotor symptom measure, he said.

After 4 weeks of treatment, 10 women reported substantial improvement in depression (a reduction of more than 50% in MADRS), with 7% having full remission. Ten women reported improvement in menopausal symptoms, indicated by at least a 50% reduction in measures rated on a formal symptom scale.

The improvement in depression was significantly greater among the perimenopausal ...