Hormones won’t cut older women’s depression risk

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Using hormone therapy won’t prevent women from becoming depressed after menopause, new research shows.

But women who quit taking hormones may be more likely to begin having depressive symptoms, Dr. Marie-Laure Ancelin of Hopital La Colombiere in Montpellier, France, and her colleagues found. Based on the findings, “physicians should closely monitor the psychiatric well-being and mood of women when they decide to discontinue HT,” Ancelin told Reuters Health via e-mail.

In 2002, the Women’s Health Initiative study debunked long-standing claims that hormone replacement therapy (HRT) would reduce cardiovascular disease risk in women taking it after menopause. While HRT may have protective effects against colon cancer, it actually increases cardiovascular risks in postmenopausal women. 

Short-term HRT use is nevertheless still the best treatment for menopausal symptoms such as hot flashes and night sweats. It “remains the treatment of choice for more than 25 million women who pass through the menopause each year, of which approximately 80 percent experience menopausal symptoms for years,” Ancelin said.

Women are at increased risk of developing depression for the first time as they enter menopause, the researcher noted. Recent studies have hinted that estrogen delivered transdermally (meaning through the skin, for example with a patch) might help treat depression in women entering the menopause, but the hormone’s effects were “much weaker” in women who had already gone through menopause, she and her colleagues write in the Journal of Clinical Psychiatry.

To investigate whether HRT might have any protective effect against depression in older women, the researchers followed 4,069 French women 65 and older for four years.

Fifteen percent were using hormone therapy, while 20 percent reported having used it in the past. About 80 percent of the women taking hormones were using transdermal estrogen, with or without progestin.

At the study’s outset, about one in five of the women had symptoms of depression or were taking antidepressant drugs. Seventeen percent of women who were not depressed at the beginning of the study developed depressive symptoms during follow-up.

Current HRT use didn’t reduce women’s risk of developing symptoms of depression. But women who quit taking hormones within two years of the study’s outset were nearly three times as likely to start having depressive symptoms. And women who used a particular type of hormone therapy-transdermal estrogen plus progestin-were 60 percent more likely to develop depression than women who didn’t use HRT.

The findings shouldn’t be interpreted to mean that women should not take hormone replacement therapy in the first place because quitting may up their depression risk, Ancelin said. “A large number of international top obstetrics-gynecology and menopause societies support the use of HT in symptomatic women,” she added.

The authors do suggest that “practitioners may need to monitor women who decide to discontinue HT treatment more closely,” and offer alternatives to treat depression if it emerges.

In addition, Ancelin told Reuters Health, “HT prescription should be preceded by a screening examination to determine the risk/benefit ratio for a given individual, rather than generalized prescription for all women.”

“Natural estradiol-based formulas, particularly those given transdermally, may be preferred given their probable lower side effects (and their potentially greater impact on neuropsychiatric disorders),” she added.

SOURCE:  Journal of Clinical Psychiatry, published online August 10, 2010.

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