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

Menopause. Sep-Oct 2006;13(5):780-6. doi: 10.1097/01.gme.0000240633.46300.fa.

Abstract

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.

Design: 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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antidepressive Agents, Second-Generation / administration & dosage
  • Antidepressive Agents, Second-Generation / therapeutic use*
  • Citalopram / administration & dosage
  • Citalopram / therapeutic use*
  • Depression / drug therapy*
  • Estrogens / administration & dosage
  • Estrogens / therapeutic use
  • Ethinyl Estradiol / administration & dosage
  • Ethinyl Estradiol / therapeutic use
  • Female
  • Hot Flashes / drug therapy
  • Humans
  • Middle Aged
  • Norethindrone / administration & dosage
  • Norethindrone / analogs & derivatives
  • Norethindrone / therapeutic use
  • Norethindrone Acetate
  • Perimenopause / drug effects
  • Postmenopause / drug effects
  • Psychiatric Status Rating Scales
  • Quality of Life*
  • Sleep / drug effects*
  • Treatment Outcome
  • Vasomotor System / drug effects*

Substances

  • Antidepressive Agents, Second-Generation
  • Estrogens
  • Citalopram
  • Ethinyl Estradiol
  • Norethindrone Acetate
  • Norethindrone