Menopause May Worsen Antidepressant Treatment Response

Summary and Comment |
September 1, 2006

Menopause May Worsen Antidepressant Treatment Response

  1. Deborah Cowley, MD

Results from a naturalistic study in Spain

  1. Deborah Cowley, MD

Some study results suggest that depressed women respond better to SSRIs than to tricyclic antidepressants and that women younger than 44 respond better to SSRIs than do older women. These researchers examined SSRI response in 59 men, 147 premenopausal women, and 95 postmenopausal women (age range, 18–75) who were beginning pharmacologic treatment for depression at any of 16 primary care centers in Spain.

All patients met DSM-IV criteria for major depression, dysthymic disorder, or depression not otherwise specified. Menopause was determined by self-reports of absence of menses for 1 year. Only six postmenopausal women were receiving hormone replacement therapy. Participants were treated naturalistically by primary care providers with citalopram, fluoxetine, paroxetine, or sertraline and underwent telephone assessments by a psychologist at baseline, 3 months, and 6 months. Dropout rates were 34% at 3 months and 44% at 6 months.

Among completers, overall antidepressant response rates (≥50% decrease in scores on a nine-item depression module) were 61% at 3 months and 69% at 6 months. Men and women had similar response rates. However, postmenopausal women were significantly less likely than premenopausal women to respond to an SSRI. This association was independent of age, education level, employment, diagnosis, or the SSRI prescribed.

Comment

Interesting features of this study include a definition of menopausal status based on cessation of menses (rather than age) and the very low rate of hormone replacement therapy in postmenopausal women. Both of these factors suggest that the observed differences in response rates might be due to menopausal status and, perhaps, resulting hormonal changes — not simply to age. These findings add to concerns regarding poorer antidepressant response rates in postmenopausal women and their need for other treatments or adjunctive approaches.

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