Efficacy of citalopram as a monotherapy or as an adjunctive treatment to estrogen therapy for perimenopausal and postmenopausal women with depression and vasomotor symptoms

Background: Women frequently report depressive and vasomotor symptoms during the menopausal transition. Hormone therapy has been shown to improve some of these symptoms, although its safety as a long-term treatment has been questioned. It is still unclear whether the use of antidepressants alone may alleviate menopause-related mood and vasomotor symptoms or enhance the response observed with short-term use of estrogen therapy. Method: Perimenopausal and postmenopausal women with depressive disorders (DSM-IV criteria) and menopause-related symptoms received treatment with 20 to 60 mg/day of citalopram. alone (N = 22) or adjunctive to estrogen therapy (N = 13). Adjunctive treatment was offered to subjects who had failed to show remission of depression after 4 weeks with estrogen therapy (estradiol [E-2]) alone. Depressive symptoms, menopause-related symptoms, and global clinical improvement were assessed at baseline and at endpoint of adjunctive treatment (8 weeks) or citalopram monotherapy (12 weeks). Remission of depression was defined as a score of < 10 on the Montgomery-Asberg Depression Rating Scale and a score of less than or equal to 2 on the Clinical Global Impressions scale at endpoint. Data were collected from November 2000 to February 2002. Results: Twelve women (92.3%) concluded the 8-week adjunctive treatment; I I subjects (91.6%) achieved full remission of depression. Symptoms that had persisted after an initial 4-week treatment with E-2 alone (e.g., tension, anxiousness, tiredness, and difficulty in concentrating) improved significantly (p < .05). Fifteen subjects concluded the treatment with citalopram monotherapy; 13 subjects (86.6%) showed full remission of depression. Anxiety and other somatic complaints had significant improvement (p < .05), while there was a trend toward improvement in vasomotor symptoms in those receiving monotherapy (p = .06). Conclusion: Citalopram alone is an efficacious treatment for perimenopausal and postmenopausal women with depression. Citalopram also appears to be efficacious as an adjunctive treatment for depressed subjects who remain symptomatic after treatment with E-2 (i.e., E-2 nonremitters). The role of citalopram monotherapy for the management of vasomotor symptoms warrants further investigation.