Escitalopram versus ethinyl estradiol and norethindrone acetate for symptomatic peri- and postmenopausal women

Soares, Cláudio N.; Arsenio, Helga; Joffe, Hadine; Bankier, Bettina; Cassano, Paolo; Petrillo, Laura; Cohen, Lee S.

doi:10.1097/01.gme.0000240633.46300.fa

Cited by 148 publications

(69 citation statements)

References 42 publications

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“…Studies evaluating the efficacy of oral preparations of E2 in treating D-MT have obtained mixed results [21][22][23]. In contrast, transdermal E2 may be a more promising treatment for D-MT.…”

Section: The Perimenopause and Early Postmenopausementioning

confidence: 91%

Hormone Replacement Therapy in the Treatment of Perimenopausal Depression

Gordon

Girdler

2014

Curr Psychiatry Rep

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The menopause transition is associated with a two to fourfold increased risk in major depressive disorder (MDD) and clinical elevations in depressive symptoms. While the pathophysiological mechanisms underlying this increased risk remain uncertain, ovarian hormone fluctuation is believed to play a role. To the extent that this is the case, hormone replacement therapy (HRT), through its hormone-stabilizing effects, represents a viable antidepressant treatment. The current review summarizes the most recent literature evaluating the efficacy of HRT in treating MDD in peri- and postmenopausal women. In addition, to provide a clinical context in which to interpret this research, the endocrinology and clinical phenomenology related to depression with onset in the menopause transition (D-MT) are discussed. The available evidence suggests that HRT, specifically involving estrogen delivered through a skin patch, is a promising intervention in the treatment of D-MT. However, HRT of any form is an ineffective antidepressant in women who are well into the postmenopausal period.

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Section: The Perimenopause and Early Postmenopausementioning

confidence: 91%

Hormone Replacement Therapy in the Treatment of Perimenopausal Depression

Gordon

Girdler

2014

Curr Psychiatry Rep

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“…3) Sem isso, pacientes com transtornos depressivos ou ansiosos moderados a graves serão submetidas a tratamentos de reposição hormonal, para os quais se mostrarão pouco eficazes 13 , retardando o uso de antidepressivos ou ansiolíticos.…”

Section: Discussionunclassified

Impacto dos transtornos depressivos e ansiosos sobre as manifestações da menopausa

Veras¹,

Rassi²,

Yukizaki³

et al. 2007

Rev. psiquiatr. Rio Gd. Sul

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ResumoObjetivo: Determinar, pela primeira vez, em uma amostra ambulatorial brasileira, o impacto dos diagnósticos psiquiátricos sobre os sintomas da menopausa presentes no índice de menopausa de Blatt-Kupperman (B-K). Métodos: Avaliamos consecutivamente, através do instrumento diagnóstico estruturado MINI 4.4 e da entrevista psiquiátrica tradicional, mulheres (n = 86) em atendimento no ambulatório de menopausa do Instituto de Ginecologia da Universidade Federal do Rio de Janeiro. As pacientes incluídas no estudo (n = 48) foram avaliadas pela escala B-K até 6 meses antes ou depois da entrevista pelo MINI e divididas em dois grupos: o grupo com algum transtorno depressivo-ansioso (GTDA) (n = 26) e o grupo-controle (GC) (n = 22). Resultados: O GTDA apresentou uma pontuação significativamente maior do que o GC na escala de B-K (22,6 versus 13,7). Entre os sintomas significativamente mais intensos no GTDA estão parestesia e melancolia. Além disso, observamos que as pacientes do GTDA queixavam-se de um maior número de sintomas do que as pacientes do GC (6,8 vs. 4,8). Entre os sintomas significativamente mais relatados no GTDA, estão parestesia, fraqueza e melancolia. Conclusão: Apesar da limitação da pequena amostra, pudemos observar o significativo viés dos transtornos depressivos e ansiosos sobre as pacientes em tratamento por queixas referentes à menopausa. Por esse motivo, o perfil sintomático de cada paciente deve ser sempre observado, evitando o ginecologista basear-se na intensidade global dos sintomas do B-K para decidir sobre o tratamento. Descritores: Depressão, ansiedade, menopausa, índice de Blatt-Kupperman. AbstractObjective: To establish for the first time in a Brazilian outpatient sample the impact of depressive and anxiety disorders over the symptoms of the Blatt-Kupperman menopausal index (B-K). Methods: Women (n = 86) receiving care in the menopause clinic at Instituto de Ginecologia da Universidade Federal do Rio de Janeiro were consecutively assessed using a structured diagnostic instrument (MINI 4.4) and a traditional psychiatric interview. Patients included in the study (n = 48) were assessed using the B-K scale within 6 months before or after the MINI. The total sample was divided into the anxiety and depressive disorder group (GTDA) (n = 26) and the control group (CG) (n = 22). Results: B-K total scores were greater in the GTDA comparing with the CG (22.6 vs. 13.7). Paresthesia and melancholia were significantly more severe in the GTDA. GTDA patients also complained of a greater number of symptoms (6.8 vs. 4.8) than the GC. Paresthesia, weakness and melancholia were significantly more present in the GTDA. Conclusion: Although the small sample limitation we could observe a great bias of depressive and anxiety disorders over menopause outpatients. For that reason, the symptomatic profile of each patient must always be observed by the gynecologist, avoiding exclusive observation of B-K total score to decide about the treatment.

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“…The Greene Climacteric Scale is a standardized instrument widely used for the evaluation of menopausal symptoms in epidemiologic (14 -16) and clinical studies (17)(18)(19)(20)(21)(22). It comprises 21 questions that measure physical and psychological symptoms associated with menopause, further grouped in 3 independent subscales called factors: psychological, somatic, and vasomotor.…”

Section: Protocolmentioning

confidence: 99%

Efficacy of estrogen plus progestin on menopausal symptoms in women with systemic lupus erythematosus: A randomized, double‐blind, controlled trial

Cravioto¹,

Durand-Carbajal²,

Jiménez-Santana³

et al. 2011

Arthritis Care & Research

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Objective. To define the effects of continuous sequential estrogen plus progestin therapy on menopausal symptoms in women with systemic lupus erythematosus (SLE).Methods. We performed a randomized, double-blind, 24-month clinical trial involving 106 women with SLE who were in the menopausal transition or early or late postmenopause. Patients received continuous sequential estrogen plus progestin (n ‫؍‬ 52) or placebo (n ‫؍‬ 54). Menopausal symptoms were assessed using the Greene Climacteric Scale at 0, 1, 2, 3, 6, 9, 12, 15, 18, 21, and 24 months. A new factor analysis of the scale reduced 21 items to 5 factors. The primary outcome was improvement of menopausal symptoms throughout the followup period. Results were analyzed by the intent-to-treat principle. Results. At baseline, demographic and disease characteristics were similar in both groups. Fifteen of 21 menopausal symptoms had a prevalence of >50%, with a similar distribution between groups. Vasomotor factor scores decreased over time in both groups (P ‫؍‬ 0.002), but in the estrogen plus progestin group the reduction was more pronounced than in the placebo group (1.5-2.0 versus 0.35-0.8 points on a scale of 0 -6; P ‫؍‬ 0.03). Maximum effects were observed among the most symptomatic women. Psychological, subjective-somatic, and organic-somatic factors scores also improved along time (P < 0.001), but the treatment and placebo arms improved to a similar degree. Thromboses occurred in 3 patients receiving estrogen plus progestin and in 1 patient receiving placebo. Conclusion. Menopausal symptoms are highly prevalent in peri-and postmenopausal lupus patients. Estrogen plus progestin improved vasomotor symptoms at a clinically significant level, but not other menopausal symptoms. Given the thrombotic risks of menopausal hormone therapy, this should be used only in women with significant vasomotor symptoms.

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Escitalopram versus ethinyl estradiol and norethindrone acetate for symptomatic peri- and postmenopausal women

Abstract: ESCIT is more efficacious than EPT for the treatment of depression and has a positive impact on other menopause-related symptoms. ESCIT may constitute a treatment option for symptomatic menopausal women who are unable or unwilling to use hormone therapy.

Cited by 148 publications

References 42 publications

Hormone Replacement Therapy in the Treatment of Perimenopausal Depression

Hormone Replacement Therapy in the Treatment of Perimenopausal Depression

Impacto dos transtornos depressivos e ansiosos sobre as manifestações da menopausa

Efficacy of estrogen plus progestin on menopausal symptoms in women with systemic lupus erythematosus: A randomized, double‐blind, controlled trial

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