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


METHODS
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 microg/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 chi2 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.
Soares
Claudio N
CN
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada. csoares@mcmaster.ca
Arsenio
Helga
H
Joffe
Hadine
H
Bankier
Bettina
B
Cassano
Paolo
P
Petrillo
Laura F
LF
Cohen
Lee S
LS
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000627:therapeutic use*; D015283:Citalopram / Q000008:administration & dosage / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D004967:Estrogens / Q000008:administration & dosage / Q000627:therapeutic use; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D019584:Hot Flashes / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D009640:Norethindrone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077563:Norethindrone Acetate; D047648:Perimenopause / Q000187:drug effects; D017698:Postmenopause / Q000187:drug effects; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012890:Sleep / Q000187:drug effects*; D016896:Treatment Outcome; D014666:Vasomotor System / Q000187:drug effects*
D018687:Antidepressive Agents, Second-Generation; D004967:Estrogens; D015283:Citalopram; D004997:Ethinyl Estradiol; D000077563:Norethindrone Acetate; D009640:Norethindrone