A prospective study of hormone therapy and depression in community-dwelling elderly women: the Three City Study.
BACKGROUND
The potential benefits of hormone therapy (HT) in treating depressed postmenopausal women are controversial, and data on depression (re)emergence in the context of HT discontinuation are lacking.


OBJECTIVE
To determine whether HT is associated with a modified risk of new-onset depressive symptoms in elderly women.


METHODS
Current depressive symptomatology was evaluated in 4,069 community-dwelling postmenopausal women aged 65 years and over who were randomly recruited from 3 French cities between 1999 and 2001. Depressive symptomatology was assessed using the Center for Epidemiologic Studies-Depression Scale at baseline and as part of the 2- and 4-year follow-up.


RESULTS
Over the follow-up period, multivariate logistic regression analyses adjusted for sociodemographic variables, measures of physical health, and cognitive impairment failed to find a significant association between HT at baseline and the incidence of depressive symptoms. However further analysis indicated an increased risk of incident depressive symptoms for women using transdermal estradiol treatment combined with synthetic progestin specifically (odds ratio [OR] = 1.59; 95% CI, 1.01-2.50; P = .046). In addition, while women taking HT continuously over the 4-year follow-up did not show an increased risk of depressive symptoms, women who stopped their treatment early after study inclusion, had a significantly higher risk (OR = 2.63; 95% CI, 1.52-4.55; P = .0005).


CONCLUSIONS
Hormone therapy was not associated with a protective effect against the emergence of depressive symptoms in elderly postmenopausal women. However, discontinuing treatment could increase the risk of depressive symptoms. Data on the appropriate management of depression in the context of HT discontinuation among postmenopausal women require further investigation.
Scali
Jacqueline
J
Institut National de la Santé et de la Recherche Médicale U888, Montpellier, France.
Ryan
Joanne
J
Carrière
Isabelle
I
Dartigues
Jean-François
JF
Tavernier
Béatrice
B
Ritchie
Karen
K
Ancelin
Marie-Laure
ML
D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000008:administration & dosage / Q000009:adverse effects; D015914:Estrogen Replacement Therapy / Q000009:adverse effects* / Q000379:methods; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D055118:Medication Adherence / Q000523:psychology; D015999:Multivariate Analysis; D016017:Odds Ratio; D017698:Postmenopause; D045167:Progesterone Congeners / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D012307:Risk Factors; D016903:Drug Monitoring
D004967:Estrogens; D045167:Progesterone Congeners; D004958:Estradiol
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