Intended for healthcare professionals

Rapid response to:

Practice Therapeutics

Hormone replacement therapy

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e763 (Published 16 February 2012) Cite this as: BMJ 2012;344:e763

Rapid Response:

Re: Hormone replacement therapy

Hickey and her colleagues [1] described indications, efficacy and severe side- effects of hormone replacement therapy (HRT). Under psychiatric aspects the benefits in treating depressed postmenopausal women are discussed controversial. Results from epidemiological or clinical studies have been inconsistent. Scali J et al. [2] evaluated depressive symptoms in about 4000 postmenopausal women. Hormone therapy was not associated with a protective effect against the depressive symptoms in these elderly patients. Yalamanchili and Gallagher [3] detected in a double-blind placebo-controlled prospective study involving 489 postmenopausal older women no effect of hormone therapy and either individually or in combination with depression symptoms. Scali et al. [4] found no effect of HRT in postmenopausal women with anxiety disorders. Bromberger et al. [5] investigated the relationship between serum hormone levels and high depressive symptoms in a longitudinal study with 3302 women. It remains unclear whether alterations in hormone concentrations across the menopausal transition are linked to depressions. Other relevant studies showed that some postmenopausal women had relevant somatic and/or psychological problems. Risk groups to get a depression are women with a history of depression up to 5 times more likely during this critical time period. Studd [6] says that “Psychiatrists fail to use transdermal estradiol for postnatal depression, premenstrual depression and perimenopausal depression in spite of randomized trials demonstrating their efficacy ” and described that SSRI are associated with libido problems and the risk of osteoporosis. I think that HRT must be used carefully and individual, HRT is not beneficial for depressions or mild cognitive impairment (MCI). The long-term side-effects of HRT should observed very intensively, but screening of depressive symptoms in the menopausal transition and recognition of severe menopausal symptoms are relevant, too.
1) Hickey M, Elliot J, Davison SL. Hormone replacement therapy. BMJ 2012; 344:e763
2) Scali J, Ryan J, Carrière I, Dartigues JF, Tavernier B, Ritchie K, Ancelin ML. A prospective study of hormone therapy and depression in community-dwelling elderly women: the Three City Study.J Clin Psychiatry. 2010;71(12):1673-9
3) Yalamanchili V, Gallagher JC. Treatment with hormone therapy and calcitriol did not affect depression in older postmenopausal women: no interaction with estrogen and vitamin D receptor genotype polymorphisms.Menopause. 2011 Dec 27. [Epub ahead of print]
4) Scali J, Ryan J, Carrière I, Ritchie K, Ancelin ML.A prospective study of hormonal treatment and anxiety disorders in community-dwelling elderly women (the Esprit Study).J Affect Disord. 2009;115(1-2):274-9.
5) Bromberger JT, Schott LL, Kravitz HM, Sowers M, Avis NE, Gold EB, Randolph JF Jr, Matthews KA. Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women's Health Across the Nation (SWAN).Arch Gen Psychiatry. 2010;67(6):598-607
6) Studd J. Why are physicians reluctant to use estrogens for anything--or do they prefer 'PROFOX'? Menopause Int. 2009;15(2):52-4

Competing interests: No competing interests

22 February 2012
Detlef Degner
psychiatrist
University of Göttingen, Germany, Department of Psychiatry and Psychotherapy
D-37073 Göttingen, Germany