ESTROGEN REPLACEMENT AND RESPONSE TO FLUOXETINE IN A MULTICENTER GERIATRIC DEPRESSION TRIAL

The estrogen decrease of the postmenopausal state may be a factor in b oth the pathogenesis of late-life depression and in therapeutic respon se. Studies of nondepressed women over 60 given estrogen replacement t herapy (ERT) suggest improvement in mood. The authors compared clinica l response of elderly depressed women outpatients entering a 6-week, r andomized, placebo-controlled, double-blind, multicenter trial of fluo xetine (20 mg/day); 72 patients received ERT, and 286 did not. There w as a significant inter-action between ERT status and treatment effect (P = 0.015). Patients on ERT who received fluoxetine bad substantially greater mean Ham-D percentage improvement than patients on ERT who re ceived placebo (40.1% vs. 17.0%, respectively); fluoxetine-treated pat ients not on ERT did not show benefit significantly greater than place bo-treated patients not on ERT. ERT use may augment fluoxetine respons e in elderly depressed outpatients and should be considered as a facto r in clinical trials in elderly women.