DEPRESSION AND ANXIETY IN CLIMACTERIC WOMEN - ROLE OF HORMONE REPLACEMENT THERAPY

Objective: To better define the effect exerted by menopause and hormon e replacement therapy (HRT) on depression and anxiety in women. Design : In a cross-sectional study, we tested anxiety by the State-Trait Anx iety Inventory and depression by the Self-Evaluation Depression Scale (Zung, Arch Gen Psychol 1965;12:63-70) on 1,031 women who came to our clinics, 275 of which were in perimenopause, 509 in postmenopause with out treatment, and 247 in postmenopause on HRT. Results: Depression an d anxiety scores were significantly lower (p < 0.01) in perimenopausal than in untreated postmenopausal women. When considered together, wom en in postmenopause on HRT had significantly lower scores than women i n postmenopause without treatment (p < 0.01) and perimenopause (p < 0. 02 for depression and p < 0.01 for anxiety). Scores for both depressio n and anxiety obtained in women studied during the combined administra tion of estrogens plus progestins were lower (p < 0.05) than during es trogens alone. These results were confirmed by two placebo-controlled prospective trials. At the third month of treatment, depression and an xiety scores were not affected by placebo, whereas these scores were s ignificantly (p < 0.01) reduced by transdermal estradiol plus norethis terone acetate (n = 36) or transdermal estradiol plus dydrogesterone a cetate (p < 0.01 for depression and p < 0.02 for anxiety; n = 18) trea tment. Neither progestin counteracted the positive response of both de pression and anxiety to estrogen administration. Conclusions: The pres ent data indicate that depression and anxiety states are worsened by p ostmenopausal sex steroid withdrawal and are improved by HRT. Progesti ns do not counteract the effect of estrogens on depression and anxiety .