OBJECTIVES: Previous studies suggest that the perimenopause is a period of increased risk for physical and emotional disturbances. The intense fluctuation in hormone levels during the perimenopause has been associated with the presence of depressive symptoms. The present study investigated the association between levels of estradiol (E2) and follicle-stimulating hormone (FSH) and the severity of depressive symptoms of women in the perimenopause. METHODS: Fifty perimenopausal women (age: 40-55 years, all meeting DSM-IV criteria for depressive disorders [major depressive disorder, dysthymia or depressive disorders NOS], with irregular periods and FSH levels > 20 IU/L) were selected from a larger sample of patients attending specialized gynecologic (n=101) and psychiatric (n=75) outpatient services. They were randomized to receive treatment with patches of placebo or 17 b-estradiol for 12 weeks. Serum levels of estradiol and FSH, and scores on the Montgomery-Åsberg Depression Scale (MADRS) were used as outcome measures. RESULTS: There was a significant correlation between changes in MADRS scores and changes in FSH (r de Pearson=0.554, p<0.001) and E2 levels (r=0.436, p=0.003) among patients treated with placebo or E2. CONCLUSIONS: These preliminary results show a significant association between hormone levels and changes in depression scores. They also suggest that changes in hormone levels play an important role in the pathogenesis and/or treatment of depression in the perimenopause. The results of large community-based cohort studies should clarify the importance of the association between hormonal fluctuation and depressive symptoms during the perimenopause.
Estrogen; Hormone replacement therapy; Estrogen replacement therapy; Depression; Depressive disorder; Women; Perimenopause; Climacteric; Treatment; MADRS; FSH; Estradiol
