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Escitalopram versus ethinyl estradiol and norethindrone acetate for symptomatic peri- and postmenopausal women: impact on depression, vasomotor symptoms, sleep, and quality of life

Soares, Claudio N. MD, PhD1,2,3; Arsenio, Helga BS2; Joffe, Hadine MD, MSc2,3; Bankier, Bettina MD2; Cassano, Paolo MD2; Petrillo, Laura F. MD2; Cohen, Lee S. MD2,3

doi: 10.1097/01.gme.0000240633.46300.fa
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Objective: To examine the efficacy and tolerability of escitalopram (ESCIT) compared to estrogen and progestogen therapy (EPT) for the treatment of symptomatic peri- and postmenopausal women.

Design: Forty women (aged 40-60 years) with depressive disorders and menopause-related symptoms were randomly assigned to an 8-week open trial with ESCIT (flexible dose, 10-20 mg/day; fixed dose, 10 mg/day for the first 4 weeks) or estrogen plus progestogen therapy (ethinyl estradiol 5 μg/day plus norethindrone acetate 1 mg/day). Primary outcome measures included Montgomery-Asberg Depression Rating Scale and the Greene Climacteric Scale at week 8. Secondary outcome measures included the Clinical Global Impressions as well as sleep and quality of life assessments.

Results: Thirty-two women (16 on EPT, 16 on ESCIT) were included in the analyses. Full remission of depression (score of <10 on the Montgomery-Asberg Depression Rating Scale) was observed in 75% (12/16) of subjects treated with ESCIT, compared to 25% (4/16) treated with EPT (P = 0.01, Fisher's exact tests). Remission of menopause-related symptoms (>50% decrease in Greene Climacteric Scale scores) was noted in 56% (9/16) of women treated with ESCIT compared to 31.2% (5/16) on EPT (P = 0.03, Pearson's χ2 tests). Improvement in sleep, hot flashes, and quality of life was observed with both treatments.

Conclusions: ESCIT is more efficacious than EPT for the treatment of depression and has a positive impact on other menopause-related symptoms. ESCIT may constitute a treatment option for symptomatic menopausal women who are unable or unwilling to use hormone therapy.

Peri- and postmenopausal women may present with depression and vasomotor symptoms, affecting their functioning and quality of life. This study showed that escitalopram effectively improved depression in this subpopulation; in addition, the therapy with antidepressants had similar positive results compared with hormone therapy with respect to the treatment of menopause-related symptoms and overall quality of life improvement.

From the 1Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario; 2Perinatal and Reproductive Psychiatry Clinical Research Program, Massachusetts General Hospital, Boston, MA; and 3Department of Psychiatry, Harvard Medical School, Boston, MA.

Received October 10, 2005; revised and accepted January 19, 2006.

Study partially supported by a National Alliance for Research on Schizophrenia and Depression (NARSAD) Award (Dr. Soares), and a research grant from Forest Pharmaceuticals (Drs. Cohen and Soares).

Address correspondence to: Claudio N. Soares, MD, PhD, Department of Psychiatry and Behaviour Neurosciences, McMaster University, Women's Health Concerns Clinic, St. Joseph's Healthcare, 301 James St. South, FB #638, Hamilton, ON L8P 3B6 Canada. E-mail: csoares@mcmaster.ca.

©2006The North American Menopause Society