Hormone and Mood Meds Don't Butt Heads

Depression meds still work with hormone therapy and contraception among pre and postmenopausal women

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Hormones are often to blame when women's moods are swinging. With medicines to balance hormones and stabilize mood, new research suggests it's okay to combine the two.

A recently published study found that hormonal birth control methods and hormone therapy did not affect how antidepressants worked in pre- and postmenopausal women with depression.

The findings showed that depression medicines can still be effective regardless of the medicines women take to control their hormones.

"Feeling unusually blue? Talk to your doctor."

Researchers led by Susan Kornstein, MD, professor of psychiatry and obstetrics/gynecology and executive director of the Institute for Women’s Health at Virginia Commonwealth University, aimed to see how hormonal medicines might impact the effects of the antidepressant medication citalopram (Celexa, Cipramil).

The study included 896 depressed premenopausal women and 544 depressed postmenopausal women between 18 and 75 years of age who had been treated with citalopram for 12 to 14 weeks.

A quarter of the premenopausal women were on hormonal contraceptives, while a quarter of the postmenopausal women were on hormone therapy.

The daily dose of citalopram was increased gradually over the course of the study from 20 milligrams to 60 milligrams. The participants were encouraged to come in for treatment every couple of weeks during the first half of the study period.

The participants were able to increase their dose before the twelfth week or stop taking citalopram if they had side effects from the medication.

Researchers tracked whether patients experienced any side effects. They also tracked patients' depression remission scores, which show whether their depression symptoms decreased.

They found that a woman's menopausal status and whether or not she was on hormone therapy did not affect how citalopram worked in treating depression symptoms.

In total, about 28 percent of the premenopausal women and 25 percent of the postmenopausal women experienced remission of depression.

Among the premenopausal women, more than a third of the women who took contraceptives were less depressed and had improved depression scores compared to 28 percent of those who were not on contraception.

And among postmenopausal women on hormone therapy, a little more than 29 percent had improved depression scores compared to about 25 percent of the women not on hormone therapy.

"These results suggest that, overall, neither menopausal status nor hormonal contraception or menopausal hormone therapy status impact outcomes of depression treatment with citalopram," researchers wrote in their report.

Previous research contradicts Dr. Kornstein's findings, but the researchers said that the differences in their results could be due to other reasons, such as social and biological changes.

"Many specific stresses that impact depression, such as child rearing and widowhood, vary across age," the authors wrote.

"Also, we know that many of the diseases of aging, such as cardiovascular disease, may affect or even cause depression, which appears to be different neurobiologically than depression in younger patients," they wrote.

The authors noted that the results could not be generalized to all depressed women since they only studied patients with non-psychotic major depressive disorder. Different kinds of hormonal contraception may have also skewed results.

The researchers also noted that their definition of menopause was based on the age of the women and their menopausal status, which does not necessarily take into account women who had skipped or irregular menstrual cycles.

The study was published February 11 in the Journal of Women's Health. The National Institute of Mental Health under contract to UT Southwestern Medical Center at Dallas funded the study.

Several of the authors received research grants and support for their work. Some also received fees and honoraria for their work as consultants and on advisory board for a number of companies that may have an in interest in the research.

Reviewed by: 
Review Date: 
February 21, 2013
Last Updated:
February 26, 2013