Neurophysiologic changes during estrogen augmentation in perimenopausal depression.
BACKGROUND
Estrogen augmentation of antidepressant medication has been an effective treatment in a subgroup of women experiencing affective symptoms during perimenopause. It has been suggested that estrogen facilitates serotonergic transmission in brain regions involved in mood disorders. We investigated differences in physiologic brain changes with estrogen augmentation in women with perimenopausal depression who reached remission compared to those who did not reach remission. We also assessed whether such changes were correlated with serum hormone levels.


METHODS
Quantitative electroencephalography (QEEG) was used to examine neurophysiologic brain changes in remission and non-remission of depressive symptoms. Women with major depressive disorder (MDD) in partial remission who were taking antidepressant medication for a minimum of 8 weeks and were experiencing two or more perimenopausal symptoms (hot flashes, night sweats, irregular periods, memory impairment, vaginal dryness) were recruited from the community. Absolute power, relative power, and QEEG cordance, a measure that has moderately strong associations with cerebral perfusion, were obtained before and after 6 weeks of treatment with 0.625 mg of conjugated estrogen per day.


RESULTS
Women who experienced remission of depressive symptoms (Ham-D< or =7) had a significant decrease in right frontal QEEG cordance (p=0.008, t((8))=-3.54) which was not present in non-remitters. No significant correlations were found between hormone levels and QEEG cordance.


CONCLUSIONS
In women with perimenopausal depression, physiologic brain changes in the right frontal region during estrogen augmentation were associated with remission of depression.
Morgan
Melinda L
ML
Laboratory of Brain, Behavior, and Pharmacology, Department of Psychiatry and Biobehavioral Sciences, UCLA Neuropsychiatric Institute, 760 Westwood Plaza, Suite 37-439, Los Angeles, CA 90024-1759, United States. melinda@ucla.edu
Cook
Ian A
IA
Rapkin
Andrea J
AJ
Leuchter
Andrew F
AF
D000284:Administration, Oral; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy*; D004569:Electroencephalography / Q000523:psychology; D015914:Estrogen Replacement Therapy / Q000523:psychology*; D005260:Female; D005625:Frontal Lobe / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D047648:Perimenopause / Q000502:physiology* / Q000523:psychology*
D000928:Antidepressive Agents