Effect of estrogen replacement therapy on symptoms of depression and anxiety in non-depressive menopausal women

Abstract

The efficacy of estrogen replacement therapy (ERT) for mood disturbances associated with menopause has yet to be firmly established. The objective of this study was to investigate the efficacy of ERT for improving mood and anxiety of non-depressive postmenopausal women. This double-blind, randomized, placebo-controlled study involved two treatment groups: one receiving conjugated equine estrogens (CEEs; 0.625 mg/day) and the other placebo, for six cycles of 28 days each. Subjects were hysterectomized, healthy, non-depressive (according to Schedule for Affective Disorders and Schizophrenia, Life Time Version [SADS-L]) women. Depressive and anxiety symptoms were assessed with the Beck Depression Inventory (BDI), and the Hamilton Anxiety Scale (HAMA), respectively. The Profile of Mood States (POMS) and other scales were used to characterize symptoms. In both groups, BDI scores were significantly lower at cycles 1, 2, 3, and 6, compared with baseline assessments (p<0.01). Anxiety scores for both groups significantly improved from cycle 3 to study endpoint. The only significant difference favoring the active group occurred at cycle 1. POMS scores were significantly improved at the end of cycles 1, 2, 3 and 6 among treated subjects and at the end of cycles 2, 3, and 6 among placebo subjects. ERT is not associated with improvements in mood or anxiety symptoms in non-depressive, hysterectomized, postmenopausal women.

Hormone therapy and mood in perimenopausal and postmenopausal women

“…On the contrary, the efficacy of oral ET in mood improvement is more questionable, as suggested by previous small trials 18,31<35 and further confirmed by more recent randomized controlled trials specifically focused on depressive symptoms in postmenopausal women. 42,43 Taken together, these results confirm the hypothesis that women's sensitivity to estrogens and changes in estrogen levels may be heightened during the menopausal transition but reduced in postmenopause. This may limit the optimal timing for ET to a temporal window during the perimenopausal period when women are also more vulnerable to depressive symptoms and disorders related to hormonal fluctuations.…”

Hormone Replacement Therapy in the Treatment of Perimenopausal Depression

“…HRT was not found to significantly impact the percentage of women endorsing clinically significant elevations in depressive symptoms. Similarly, an RCT of 76 hysterectomized euthymic postmenopausal women did not find an effect of treatment on mood or anxiety after randomization to six 28-day cycles of either conjugated equine estrogen (0.625 mg/day) or placebo [31].…”

New knockout model confirms a role for androgen receptors in regulating anxiety-like behaviors and HPA response in mice

“…Similarly, androgen blockade therapy for prostate cancer treatment has been reported to increase anxiety, which was alleviated when treatment ended (Almeida et al, 2004). Although the nature of the relationship between these steroid hormones and anxiety level is not always consistent (Demetrio et al, 2011; Kiesner, 2011; Thomson and Oswald, 1977), they appear to exert anxiolytic effects in a number of different circumstances.…”