Citalopram is an effective alternative treatment option for patients who do not want to take HT for the alleviation of climacteric symptoms. Adjuvant treatment with a selective serotonin reuptake inhibitor increases the effectiveness of HT for the treatment of climacteric symptoms in women who had responded inadequately to HT.

I wish to respond to the article by Woods et al 1 suggesting that there should be reasons other than hormones for menopausal dysphoric disorder (MDD). The apparent association between attention deficit hyperactivity disorder (ADHD) and MDD suggests that new biological treatment options for ADHD might also be beneficial in treating patients with MDD.Of interest, not only the DAT-1, DRD-4, and DRD-5 genes have been shown to be responsible for ADHD but the serotonergic system (as a modulating system) also seems to be involved. Eight polymorphisms that encode the 5hydroxytryptamine transporter (LPR, VNTR-2, and 3-UTR) have been investigated for both ADHD and MDD. 1,2 Although results were inconsistent, the similarity of both disorders suggests that there may be an association between them and also that treatments with some benefit for one disorder might also have some benefit for the other disorder.There also seems to be a higher prevalence of MDD (20%/40%) among patients with ADHD than in healthy control individuals with no psychiatric disorders. We observed six female patients with ADHD and found that four of them also had MDD, which corresponds to a prevalence rate of 65%.To our knowledge, no systematic studies of the treatment of MDD with methylphenidate (MPH) have been conducted. MPH is a proven and well-tolerated medication for ADHD, which has also been reported to show some benefit in treating severe major depression. 3 Our 41-year-old female patient had ADHD and MDD. Therapy with MPH, 20 mg daily, was initiated and was associated with a significant improvement in ADHD symptomatology (Wender Utah Scale) and also with a significant reduction of MDD symptoms.We assume that MPH may also show some benefit in the treatment of MDD. Polymorphisms in the estrogen synthesis and metabolism pathways and symptoms during the menopausal transition: observations from the Seattle Midlife Women`s Health Study. Menopause 2006;13:902<910. 2. Heiser P, Dempfle A, Friedel S. Family-based association study of serotonergic candidate genes and attention-deficit/hyperactivity disorder in a German sample. In reply:Thank you for your interest in our research relating polymorphisms in the estrogen synthesis, metabolism, and receptors pathways to vasomotor symptoms. Although the association of attention deficit hyperactivity disorder and dysphoric mood during the menopausal transition was not a component of our study, it is likely that other investigators who have completed a comprehensive mental health assessment during the menopausal transition may have data regarding these comorbidities. Our research efforts have not yet included genotyping for polymorphisms other than those addressed in our article.The hypothesized relationship between the polymorphisms encoding the 5-hydroxytryptamine transporter and depression during the menopausal transition is of great interest. Because serotonin is also implicated in the etiology of hot flashes, the relationship to both depressed mood and hot flashes should be considered in future work.Such pro...