Fluoxetine efficacy in menopausal women with and without estrogen replacement

A gradual decline in estrogen levels after the age of 40 may contribute to a higher rate of depression in women over 45 years of age. Estrogen replacement therapy (ERT) has been shown to produce cognitive and mood-enhancing effects in women and may facilitate antidepressant activity. Methods: We examined the efficacy rates in women on ERT greater than or equal to 45 years (n = 40) compared to women greater than or equal to 45 years not on ERT (n = 132) and to women < 45 years (n = 396) and to men (n = 262) with major depression during fluoxetine 20 mg daily up to 8 weeks. Remitters with a HAM-D-17 score less than or equal to 7 from week 9 to 12 were then treated up to 1-year in a placebo-controlled, relapse-prevention trial. Results: Efficacy rates were similar in women greater than or equal to 45 years on ERT when compared to women greater than or equal to 45 years taking fluoxetine alone, and when compared to women < 45 years and men taking fluoxetine. A Kaplan-Meier survival analysis in fluoxetine responders treated up to 26 weeks showed a somewhat greater relapse rate in women greater than or equal to 45 years taking ERT compared to other treatment groups (P < 0.06). Limitations: This study was retrospective nature and ERT was given in an uncontrolled fashion: 63% of women received estrogen alone while 37% also took intermittent progesterone. Other variables include the absence of hormonal documentation of menopausal status, no direct assessment of ERT compliance and the use of fixed-dose fluoxetine 20 mg daily. Conclusion: In contrast to prior reports suggesting that ERT may facilitate antidepressant activity, we observed similar efficacy in depressed women greater than or equal to 45 years taking fluoxetine plus ERT compared to those taking fluoxetine alone. (C) 1999 Elsevier Science B.V. All rights reserved.