Antidepressant can help treat major depression during perimenopause, menopause, study shows

The research compared the effectiveness and safety of the antidepressant desvenlafaxine, known as Pristiq, to a placebo in a double-blind trial led by Susan G. Kornstein, M.D., a professor of psychiatry and obstetrics/gynecology in the VCU School of Medicine. It was published in the Journal of Clinical Psychiatry.

In the United States, depression is approximately twice as common in women as in men. More than 20 percent of women will experience depression in the course of their lifetime, and depression seems to be influenced by reproductive events, such as the menstrual cycle, the postpartum period and menopause.

Research, including earlier work by Kornstein, has shown that women may respond to antidepressants differently from men and may also respond to medication differently at different times in their lives, she said.

"It's really an assumption to say that because an antidepressant works for depression in general that it works for depression related to reproductive events," she said. "This is the first large study testing the effectiveness of an antidepressant specifically in peri- and postmenopausal women with depression."

Kornstein is an internationally recognized researcher in women's mental health and depression at VCU who studies how depression affects women across their life span and the influence of the menstrual cycle and menopausal status on depression and its treatment.

Some women report mood swings, irritability, anxiety and depression in the years leading up to menopause, called the perimenopause. The reason for these emotional problems isn't known, but the drop in estrogen levels that typically occurs during perimenopause and menopause may affect mood. The transition to menopause has been shown to be a high-risk period for major depression, in women both with and without a past history of depression.

In the new study, Kornstein and colleagues evaluated Pristiq's ability to alleviate major depression among women experiencing or about to experience menopause. The study enrolled 387 women who were peri-or postmenopausal and were diagnosed with major depression at 37 outpatient sites across the country. The women were randomly assigned to take either 100 mg or 200 mg daily of Pristiq or placebo for eight weeks.

The study found that women who took Pristiq showed significant improvement as measured by the 17-item Hamilton Depression Rating Scale and other psychological tests. The response rates were 58.6 percent for those taking Prstiq, compared to 38.2 percent for those on placebo. The drug was effective among the subgroups of perimenopausal women as well as those who were postmenopausal.

At the time the study started, the federal Food and Drug Administration had not yet approved Pristiq, which patients now typically take in 50 mg daily doses to treat depression. Kornstein said she is about to start recruiting patients for a new, similar study using the 50 mg daily dose.

Pristiq works by increasing the amounts of serotonin and norepinephrine, natural substances in the brain that help maintain mental balance. It is manufactured by Pfizer and was approved in 2008 to treat depression among adults. Wyeth, now a subsidiary of Pfizer, financially supported the study.

Kornstein, a consultant for Pfizer, is co-founder and executive director of the VCU Mood Disorders Institute and of the VCU Institute for Women's Health, a groundbreaking center for treatment, research, education, and community outreach. She is also medical director of the VCU Clinical Trials Office. Her co-authors from Pfizer were Qin Jiang; Sujana Reddy, M.D.; Jeff J. Musgnung; and Christine J. Guico-Pabia, M.D., MBA, MPH.