Table 1.
Estrogen as monotherapy for depression
| Study | Population (menopausal status) | Diagnosis method | Patients, n | Duration | Treatment | Study design | Results |
|---|---|---|---|---|---|---|---|
| Campbell and Whitehead [47] | POST (age not reported) | Depression: BDI | 68 | 2 mo per drug | CEE (6.25 mg/d) vs placebo | PC, DB, XO | ET > P |
| Klaiber et al. [46] | PRE (mean age, 32); POST (mean age, 49) | Resistant MDD: DSM-II | 50 | 3 mo | CEE (15–25 mg/d) vs placebo | PC, DB | ET > P; significant drop in HAM-D scores in CEE-treated group |
| Coope [48] | PRE and PERI (ages 40–60) | Mild to moderate depression: BDI | 55 | 6 mo per drug | Estrone sulphate (1.5 mg/d) vs placebo | PC, DB, XO | ET = P |
| Schmidt et al. [49] | PERI (age not reported) | MDD: DSM-III | 20 | 6 wk | CEE (0.625 mg/d) vs placebo | PC, DB | ET > P |
| Schmidt et al. [45] | PERI (ages 44–55) | Minor or MDD: DSM-III | 34 | 3 or 6 wk | Transdermal 17β-estradiol (50 μg/d) vs placebo | PC, DB | ET > P; partial or full remission in 80% with E2 vs 20% with placebo |
| Soares et al. [44] | PERI (ages 44–55) | MDD or minor dysthymic disorder: DSM-IV | 50 | 3 mo | Transdermal 17β-estradiol (100 μg/d) vs placebo | PC, DB | ET > P; remission in 68% with E2 vs 20% with placebo |
| Cohen et al. [50] | PERI and POST (ages 42–57) | MDD: DSM-IV | 22 | 1 mo | Transdermal 17β-estradiol (100 μg/d) vs placebo | Open label | ET > P; remission in 67% of women (remission = MADRS < 10) |
| Shapira et al. [51] | PRE and POST (ages 26–74) | MDD: DSM-II | 11 | 1 mo | Imipramine (200 mg) + CEE (1.25–3.75 mg) vs imipramine (200 mg) + placebo | PC, DB, XO | Imipramine + ET = imipramine + placebo |
| Schneider et al. [52] | POST (mean age, 67.9) | MDD: DSM-III | 367 | 6 wk | ET + fluoxetine vs ET + placebo vs fluoxetine alone vs placebo alone | Retroanalysis of PC, DB | Fluoxetine + ET > fluoxetine + placebo |
| Amsterdam et al. [53] | Women > 45 years on HT or no HT; women and men < 45 years | MDD: DSM-IIIR | 568 (40 women > 45 on HT) | 12 wk | HT + fluoxetine vs fluoxetine alone | Open label | Fluoxetine + HT = fluoxetine alone |
| Schneider et al. [54] | POST (age > 60) | MDD: DSM-IIIR | 127 | 12 wk | ET + sertraline (n = 34) vs sertraline alone (n = 93) | Retroanalysis of PC, DB | Sertraline + ET > sertraline alone on CGI (HAM-D results not significant) |
BDI—Beck Depression Inventory; CEE—conjugated equine estrogen; CGI—Clinical Global Impressions; DB—double blind; DSM—Diagnostic and Statistical Manual of Mental Disorders; ET—estrogen therapy; HAM-D—Hamilton Scale of Depression; HT—hormone therapy (estrogen and progestin); MADRS—Montgomery-Asberg Depression Rating Scale; MDD—major depressive disorder; P—placebo; PC—placebo controlled; PERI—perimenopausal; POST—postmenopausal; PRE—premenopausal; XO—crossover.