Pharmacological interventions and hormonal therapies for depressive symptoms in peri- and post-menopausal women: a network meta-analysis of randomized controlled trials

• Published in: Psychiatry Research Vol. 326; p. 115316
• Main Authors: Tseng, Ping-Tao, Chiu, Hsien-Jane, Suen, Mein-Woei, Zeng, Bing-Syuan, Wu, Ming-Kung, Tu, Yu-Kang, Hung, Kuo-Chuan, Wu, Yi-Cheng, Su, Kuan-Pin, Li, Dian-Jeng, Chen, Tien-Yu, Stubbs, Brendon, Carvalho, Andre F, Solmi, Marco, Thompson, Trevor, Caruso, Maria Gabriella, Matsuoka, Yutaka J., Chen, Yen-Wen, Lin, Pao-Yen, Sun, Cheuk-Kwan, Cheng, Yu-Shian, Shiue, Yow-Ling
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.08.2023; Elsevier BV
• Subjects: Depression; Depression - drug therapy; Efficacy; Female; Fluoxetine; Fluoxetine - therapeutic use; Humans; Menopause; Middle Aged; Network Meta-Analysis; Postmenopause; Randomized Controlled Trials as Topic; Systematic review; Tolerability; Efficacy; Systematic review; Depression; Tolerability; Menopause
• ISSN: 0165-1781; 1872-7123; 1872-7123
• DOI: 10.1016/j.psychres.2023.115316

•Hormone replacement therapy +/- antidepressants can relieve menopausal depression.•Fluoxetine + oral combined estrogen-progesterone therapy best reduce depression.•Similar finding was also noted in subjects with definite depression diagnosis. Although significant portion of women experience depressive symptoms during or after menopausal transition, there has been considerable controversy over the benefits of hormone replacement therapy (HRT) and antidepressants due to insufficient evidence supporting the superiority of either treatment. This frequentist model based network meta-analysis (NMA) included randomized controlled trials (RCTs) of menopausal depression symptoms management in menopausal women. Seventy RCTs involving a total of 18,530 women (mean age 62.5) were analyzed. The results demonstrated that fluoxetine plus oral HRT [standardized mean difference (SMD)=-1.59, 95% confidence interval (95%CIs)=-2.69 to -0.50] were associated with the largest improvement in depressive symptoms than placebos in overall menopausal women. Similar findings were also noted in the subgroup of participants with a definite diagnosis of depression, while no pharmacological or hormone replacement therapy was better than placebo in the subgroup of post-menopausal women (amenorrhea > 1 year) or in patients without diagnosis of depression. This NMA presented evidence that fluoxetine plus HRT may be beneficial to menopausal women with a definite diagnosis of depression but not to those without depression or post-menopausal women. Trial registration: PROSPERO (CRD42020167459).