Abstract
Background
We sought to obtain preliminary data regarding the efficacy of duloxetine for major
depressive disorder (MDD) during the menopausal transition. The secondary outcomes
were vasomotor symptoms (VMS, or hot flashes), specifically assessed as daytime or
nighttime, and anxiety.
Methods
After a single-blind placebo lead-in, peri- and postmenopausal women with MDD (n = 19) received eight weeks of open-label treatment with duloxetine (60 mg/day). The Hamilton Rating Scale for Depression (17-item) (HAM-D) was the primary
outcome measure. Hot flashes were monitored prospectively using daily diaries, the
Greene Climacteric Scale (GCS), and the Hot Flash-Related Daily Interference Scale
(HFRDIS). Anxiety was measured with the Generalized Anxiety Disorder scale (GAD-7).
Results
Of 19 participants treated with duloxetine, 16 (84.2%) were evaluable (returned for
≥1 follow up), and 13 (68.4%) completed the study. Three discontinued due to side
effects. The pre-treatment and final median HAM-D scores were 15 (interquartile range
[IQR] 14–18), and 6.5 (IQR 4–11.5), respectively, reflecting a significant decrease
(p = .0006). The response and remission rates were 56.3% (all responders were also remitters,
having ≥50% decrease in HAM-D scores and final scores ≤7). Anxiety improved with treatment
(p = .012). GCS and HFRDIS scores decreased significantly. Among those who reported hot
flashes at baseline, number and severity of hot flashes improved significantly overall
(p = .009 and p = .008, respectively). Daytime but not nighttime hot flashes improved significantly.
Conclusions
These data support further study of duloxetine for the treatment of a spectrum of
symptoms associated with the menopausal transition.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to MaturitasAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A longitudinal analysis of the association between menopause and depression: results from the Mass, Women's Health Study.Annals of Epidemiology. 1994; 4: 214-220
- Vasomotor symptoms are associated with depression in perimenopausal women seeking primary care.Menopause. 2002; 9: 392-398
- Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles.Archives of General Psychiatry. 2006; 63: 385-390
- The epidemiology of depression. An update on sex differences in rates.Journal of Affective Disorders. 1984; 7: 179-188
- Epidemiology of women and depression.Journal of Affective Disorders. 2003; 74: 5-13
- Associations of hormones and menopausal status with depressed mood in women with no history of depression.Archives of General Psychiatry. 2006; 63: 375-382
- Persistent mood symptoms in a multiethnic community cohort of pre- and perimenopausal women.American Journal of Epidemiology. 2003; 158: 347-356
- The role of anxiety and hormonal changes in menopausal hot flashes.Menopause. 2005; 12: 258-266
- Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial.JAMA. 2002; 288: 321-333
- Short-term efficacy and safety of desvenlafaxine in a randomized, placebo-controlled study of perimenopausal and postmenopausal women with major depressive disorder.Journal of Clinical Psychiatry. 2010; 71: 1088-1096
- Efficacy of escitalopram for hot flashes in healthy menopausal women: a randomized controlled trial.JAMA. 2011; 305: 267-274
- Treatment of depression and menopause-related symptoms with the serotonin-norepinephrine reuptake inhibitor duloxetine.Journal of Clinical Psychiatry. 2007; 68: 943-950
- An open trial of mirtazapine in menopausal women with depression unresponsive to estrogen replacement therapy.Journal of Women's Health and Gender-Based Medicine. 2001; 10: 999-1004
- Efficacy of citalopram as a monotherapy or as an adjunctive treatment to estrogen therapy for perimenopausal and postmenopausal women with depression and vasomotor symptoms.Journal of Clinical Psychiatry. 2003; 64: 473-479
- Desvenlafaxine and escitalopram for the treatment of postmenopausal women with major depressive disorder.Menopause. 2010; 17: 700-711
- Sertraline to treat hot flashes: a randomized controlled, double-blind, crossover trial in a general population.Menopause. 2006; 13: 568-575
- Serotonergic agents as an alternative to hormonal therapy for the treatment of menopausal vasomotor symptoms.Treatments in Endocrinology. 2006; 5: 83-87
- Non-hormonal interventions for hot flushes in women with a history of breast cancer.Cochrane Database of Systematic Reviews. 2010; 9 (CD004923)
- Executive summary: Stages of Reproductive Aging Workshop (STRAW).Fertility and Sterility. 2001; 76: 874-878
- A rating scale for depression.Journal of Neurology, Neurosurgery and Psychiatry. 1960; 23: 56-62
- Increased estradiol and improved sleep, but not hot flashes, predict enhanced mood during the menopausal transition.Journal of Clinical Endocrinology and Metabolism. 2011; 96: E1044-E1054https://doi.org/10.1210/jc.2010-2503
- Methodologic lessons learned from hot flash studies.Journal of Clinical Oncology. 2001; 19: 4280-4290
- The Hot Flash Related Daily Interference Scale: a tool for assessing the impact of hot flashes on quality of life following breast cancer.Journal of Pain and Symptom Management. 2001; 22: 979-989
- Vitamin E and climacteric syndrome; failure of effective control as measured by menopausal index.AMA Archives of Internal Medicine. 1953; 91: 792-799
- ECDEU assessment manual for psychopharmacology. US Dept Health, Education, and Welfare Publication (ADM) 76-338.National Institute of Mental Health, Rockville, Maryland1976: 218-222
- Handbook of psychiatric measures.First ed. American Psychiatric Association, Washington, DC2000
- Depressive symptoms and menopausal burden in the midlife.Maturitas. 2009; 62: 306-310
- Eszopiclone improves insomnia and depressive and anxious symptoms in perimenopausal and postmenopausal women with hot flashes: a randomized, double-blinded, placebo-controlled crossover trial.American Journal of Obstetrics and Gynecology. 2010; 202: 171.e1-171.e11
- Augmentation of venlafaxine and selective serotonin reuptake inhibitors with zolpidem improves sleep and quality of life in breast cancer patients with hot flashes: a randomized, double-blind, placebo-controlled trial.Menopause. 2010; 17: 908-916
- Interactions between tamoxifen and antidepressants via cytochrome P450 2D6.Journal of Clinical Psychiatry. 2009; 70: 1688-1697
- Newer antidepressants and the cytochrome P450 system.American Journal of Psychiatry. 1996; 153: 311-320
- Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study.British Medical Journal. 2010; 340: c693
Article info
Publication history
Published online: April 08, 2013
Accepted:
March 8,
2013
Received:
February 5,
2013
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
