What is the role of HRT in the treatment of perimenopausal depression?

Updated: Jan 30, 2019
  • Author: Nita V Bhatt, MD, MPH; Chief Editor: Ana Hategan, MD, FRCPC  more...
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For mild depression, hormone replacement therapy alone may be appropriate. Estrogen may be used when traditional antidepressants failed, when patients refuse psychotropic medications, or when patients experience other clinically significant vasomotor symptoms. [21, 37] Women who have surgically induced menopause have an increased risk of depression, [38] and they may be especially likely to benefit from hormone replacement therapy.

Results from studies of hormone treatments for depression have been inconsistent. Data from several studies suggested that estrogen replacement therapy had antidepressant effects or that it enhanced the effects of antidepressant treatment in perimenopausal women. [37, 39, 40, 41, 42, 43] Other studies did not show that estrogen adds to the effects of SSRIs. [42, 44] In general, such treatments appear to be helpful for managing depressive symptoms in perimenopause but not in postmenopause. [4, 21, 45]

Debate exists regarding whether the antidepressant effect is attributable to the effect of estrogen on vasomotor symptoms. Some studies reveal an antidepressant benefit only in women with vasomotor symptoms. Results of other studies suggest an independent antidepressant effect. [46, 47]

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