HRT for menopausal depression shows promise. (SSRIs Should Still be First Line of Defense).

NEW ORLEANS -- Although data on the role of hormone replacement therapy for mood disorders associated with menopause look promising, only well-documented, proven treatments such as selective serotonin reuptake inhibitors are appropriate first-line approaches at this time, according to Dr. Lee Cohen.

Nevertheless, he and his colleagues remain "very excited" about where estradiol may fit into the treatment of mood disorders associated with menopause, Dr. Cohen said at the annual meeting of the North American Menopause Society.

He is involved in studies at the Massachusetts General Hospital Center for Women's Health, Boston, exploring gender-based determinants of mood disorders. In a recent study involving 50 perimenopausal women with depressive disorders, Dr. Cohen and his associates found that 68% of women who were randomized to treatment with 1 7[beta]-estradiol transdermal patches experienced symptom remission, compared with 20% of patients in a placebo group (Arch. Gen. Psychiatry 58[6]:537-38, 2001).

But Dr. Cohen of the department of psychiatry at Harvard Medical School, Boston, warned that it's still too soon to start prescribing HRT for menopausal-related depression. Many questions still remain. For example, researchers have not yet identified whether a specific population of women benefit from the combination of estradiol and an SSRI. The data on adding estradiol to regimens for women who don't respond to SSRIs are still preliminary.

The study of gender-based differences in depression and anxiety disorders has come on the radar screen only recently And so far, most of the data deal with postpartum depression. Fewer data look at the effect of the menstrual cycle or menopausal status on the course of mood disorders, treatment response, and the interaction between hormone therapies and antidepressants. Part of the problem is that as women get older, their participation in trials dwindles, so the estimates of risk for mood disturbances among them are not entirely reliable, Dr. Cohen said.

The data don't suggest that the perimenopausal period is associated with a frank increased risk for major depression; however, it is associated with an increased risk of more depressive symptoms.