Hormonal Therapy for the Treatment of Menopause-Related Depression

There is a need for new, efficient, and safe hormonal replacement therapy to improve mental health outcomes among women going through menopause.

Highlights:

Chances of woman developing depression and anxiety is high due to changing estrogen levels on the central nervous system (CNS) during menopausal transition and perimenopause
Antidepressants are the first-line treatment for menopausal depression, with limited or subpar results
Hormonal Replacement therapy (HRT) with estrogen may be useful in the management of menopausal depression due to the growing recognition of the beneficial effects of estrogen treatment on the CNS

The period between a woman’s reproductive stage and menopause is known as perimenopause. It is diagnosed clinically by the commencement of irregular menstrual cycles or varying cycle lengths, which often occur between the ages of 42 and 52. When a woman goes through the menopausal transition and perimenopause, her chance of developing depression and anxiety is enhanced. Compared to pre- and post-menopause, perimenopause depressive symptoms are frequently more severe. Some women may have these unfavorable psychological consequences due to fluctuating estrogen levels in the central nervous system (CNS) during the menopausal transition.

Perimenopausal depression is not classified or defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This omission highlights the lack of knowledge regarding the relationship between the menopausal transition process and the well-recognized increase in depression in middle-aged women.

‘There is a need for novel, effective and safe hormonal replacement therapies for treating depression in menopausal women.’

Are women at Risk of Depression During Menopause Transition Period

Two distinct categories of women are at an increased risk of depression during the perimenopause transition period. Women in the first category, who have never had depression, see a fourfold rise in their risk of depression after menopause, while women who have a history of depressive disorders are significantly more at risk of developing new depressive episodes during menopause. Women with pre-existing psychiatric problems make up most presentations in clinical populations. According to a cross-sectional study, menopausal depressive symptoms got worse for 57% of women who had previously been diagnosed with depression during the menopausal transition.

Transdermal Estradiol May Prevent Perimenopausal Depression
Transdermal estradiol could be the key to not only treating existing perimenopausal depression, but also possibly preventing it.

What Causes Menopause-Related Depression

According to the available data, menopause-related depression in women is not caused by a gonadal hormone imbalance per se but by a brain reaction to hormonal variations that results in menopausal transition depression. This brain hormone response is a significant etiological reason for perimenopausal depression in certain women, along with psychological and social factors.

Very First Recommendations to Assess and Treat Perimenopausal Depression
First ever guidelines to assess and treat perimenopausal depression have been issued to enable clinicians to recognize the condition and provide affected women much needed treatment and support.

Treatment of Menopausal Depression

Antidepressants are the first-line treatment for menopausal depression, with little success. Hormonal therapy with estrogen may be useful for managing menopausal depression due to the growing recognition of the beneficial effects of estrogen treatment on the CNS.

Newer therapies using gonadal hormone modulators show promise as prospective treatments in light of brain hormone response in perimenopausal depression, either on their own or in conjunction with antidepressant drugs.

Therefore, it is surprising that there are not many clinical studies looking at hormone replacement therapies for menopausal women who are either experiencing their first episode of depression or relapse. To ascertain the effectiveness of conventional hormone therapy in the treatment of menopausal depression, further large-scale clinical trials are necessary.

Source-Medindia