Estrogen Replacement Therapy in the Treatment of Major Depressive Disorder in Perimenopausal Women

Background: Increased vulnerability to mood disorders has been reported during perimenopause. Fluctuating estrogen levels accompany the perimenopausal transition. Thus, estrogen replacement therapy (ERT) has been proposed as a potentially effective treatment for mood disorders occurring during perimenopause. Method: We examined the efficacy of ERT in the treatment of depression in 16 perimenopausal women with DSM-IV-defined major depressive disorder who were participating in the Mood Disorders Research Program at the Department of Psychiatry of the University of California, Los Angeles. Ten antidepressant- and ERT-naive women received ERT alone. Six women who were nonresponders or partial responders to an antidepressantreceived ERT in addition to existing treatment with fluoxetine. The Hamilton Rating Scale forDepression (HAM-D) was administered to all patients at baseline and weekly thereafter during the 8-weekopen-protocol trial. Partial response was operationalized as a final HAM-D score ≤ 50% of the baselinescore. Remission was defined as a final HAM-D score ≤ 7. Results: All patients exhibited clinical improvement as measured by HAM-D scores after the first week of treatment. Of the 10 perimenopausal depressed women receiving ERT alone, 6 remitted, 3 partially responded to treatment, and 1 did not respond by the end of the trial. Of the 6 women receiving antidepressant treatment with ERT, 1 patient remitted and 5 had apartial response by the end of the trial. Conclusion: This small study suggests that for some antidepressantnaive perimenopausal women with clinical depression, ERT may have antidepressant efficacy. In depressed women who have minimal response to a selective serotonin reuptake inhibitor, ERT may augment response.Further controlled trials are needed.