I’m currently studying this topic and have found quite a few RCTs where Estradiol patches have had an extremely positive effect on perimenopausal depression and a recurrent theme is that this is independent of Vaso motor symptoms. Am suprised by your conclusions . I agree there is plenty of evidence that SSRIs are affective for clinical depression related to perimenopause but NICE guidelines refer more to “low mood” surely in the presence of other symptoms & absence of serious depressive symptoms HRT should at least be tried? If NICE change this guidance it would be very disappointing as women really have to battle to get HRT over SSRIs very often anyway.
Would be interested to see these RCTs and whether they were included in Whedon's 2017 meta-analysis! I was surprised there wasn't better evidence for HRT, given this is a NICE recommendation.
Definitely not opposed with HRT being trialled if patient preference, but think NICE guidelines have to be based on evidence. From my reading there is evidence for SSRIs being beneficial for low mood associated with the menopause but not much evidence for HRT. Happy to be proven wrong!
I’ve not looked at Wheldons meta analysis but I’ve looked at one published April 23 by Zhang et Al “the effect of exogenous estrogen on depressive mood in women…. “ they look at 14 RCTS but only 5 relate to perimenopause.
RCTs that have shown Estrogen an effective treatment for PM depression include
Schmidt et Al 2000 Estrogen replacement in perimenopausal related depression
Soares et Al 2001 Efficacy of estrodiol for the treatment of depressive disorders in perimenopausal women
Kulkarni et Al 2018 Tibolone improves depression in women through the menopause transition …
Morgan et Al 2005 Estrogen augmentation of antidepressants in perimenopausal depression
Am really interested in subject due to personal experience and hoping to put together an article about this. I agreed NICE guidelines should be evidence based but so many women get prescribed SSRIs alone whereas I think many would benefit from having both SSRI & HRT . I thibk there are other studies on the efficacy of augmentation of ADs with Oestrogen but I haven’t got right through the literature yet!
So much research needed! I was shocked to discover papers dating back to the 1940s on menopausal depression yet still very little consensus on it. Thank you
Not sure if I can private mesage you on here? I might be wrong (I’m not a clinician I’m a retired nurse ) but just looking again at the NICE guidelines and it seems to read to me as if they looked at over 20 studies to develop the “low mood” guideline. I can send you links if I can message you? Or if you have a suitable email address ?
Thanks Douglas! I guess maybe a couple of hours to research, half a day solid writing and then a couple of hours here and there editing it (when I should be doing other work).
Because I’m writing about topics that take my interest, I already have an idea about what research is out there and find the process enjoyable!
I think once a month is a good balance of regularity but not taking up too much of my time.
1. I feel I am not a good writer (which is why I try to write!). That being the case, simply verbalizing my thoughts into a coherent piece I'm satisfied with takes more time than it should. (this comment taking like 10 minutes being an example)
2. I am starting psychiatry residency and have a new kiddo which preoccupy my time. I naturally think about psychiatry and all its adjecent facets, but having time dedicated to uninterrupted doing so is difficult.
3. What would take me the longest would be avoiding the rabbit holes and being able to come to a conclusion!
Your balance seems great - keep it up! Looking forward to the stuff you produce.
Update to concerns about Wu et al., including a correction issued by Scientific Reports in below twitter thread:
https://twitter.com/rational_psych/status/1565052738802778112?s=12
I’m currently studying this topic and have found quite a few RCTs where Estradiol patches have had an extremely positive effect on perimenopausal depression and a recurrent theme is that this is independent of Vaso motor symptoms. Am suprised by your conclusions . I agree there is plenty of evidence that SSRIs are affective for clinical depression related to perimenopause but NICE guidelines refer more to “low mood” surely in the presence of other symptoms & absence of serious depressive symptoms HRT should at least be tried? If NICE change this guidance it would be very disappointing as women really have to battle to get HRT over SSRIs very often anyway.
Would be interested to see these RCTs and whether they were included in Whedon's 2017 meta-analysis! I was surprised there wasn't better evidence for HRT, given this is a NICE recommendation.
Definitely not opposed with HRT being trialled if patient preference, but think NICE guidelines have to be based on evidence. From my reading there is evidence for SSRIs being beneficial for low mood associated with the menopause but not much evidence for HRT. Happy to be proven wrong!
I’ve not looked at Wheldons meta analysis but I’ve looked at one published April 23 by Zhang et Al “the effect of exogenous estrogen on depressive mood in women…. “ they look at 14 RCTS but only 5 relate to perimenopause.
RCTs that have shown Estrogen an effective treatment for PM depression include
Schmidt et Al 2000 Estrogen replacement in perimenopausal related depression
Soares et Al 2001 Efficacy of estrodiol for the treatment of depressive disorders in perimenopausal women
Kulkarni et Al 2018 Tibolone improves depression in women through the menopause transition …
Morgan et Al 2005 Estrogen augmentation of antidepressants in perimenopausal depression
Am really interested in subject due to personal experience and hoping to put together an article about this. I agreed NICE guidelines should be evidence based but so many women get prescribed SSRIs alone whereas I think many would benefit from having both SSRI & HRT . I thibk there are other studies on the efficacy of augmentation of ADs with Oestrogen but I haven’t got right through the literature yet!
Will check these refs out, thank you!
For me, it’s an area which still has a lot of uncertainty and more research needed. Good luck with your article!
So much research needed! I was shocked to discover papers dating back to the 1940s on menopausal depression yet still very little consensus on it. Thank you
Not sure if I can private mesage you on here? I might be wrong (I’m not a clinician I’m a retired nurse ) but just looking again at the NICE guidelines and it seems to read to me as if they looked at over 20 studies to develop the “low mood” guideline. I can send you links if I can message you? Or if you have a suitable email address ?
Sure! My contact details are on this page https://www.psych.ox.ac.uk/team/thomas-reilly
Fun read. I learned a lot. Curious - how long does it take you to put an article like this together?
Thanks Douglas! I guess maybe a couple of hours to research, half a day solid writing and then a couple of hours here and there editing it (when I should be doing other work).
Because I’m writing about topics that take my interest, I already have an idea about what research is out there and find the process enjoyable!
I think once a month is a good balance of regularity but not taking up too much of my time.
Interested to hear how this compares with you.
1. I feel I am not a good writer (which is why I try to write!). That being the case, simply verbalizing my thoughts into a coherent piece I'm satisfied with takes more time than it should. (this comment taking like 10 minutes being an example)
2. I am starting psychiatry residency and have a new kiddo which preoccupy my time. I naturally think about psychiatry and all its adjecent facets, but having time dedicated to uninterrupted doing so is difficult.
3. What would take me the longest would be avoiding the rabbit holes and being able to come to a conclusion!
Your balance seems great - keep it up! Looking forward to the stuff you produce.
I’m in a similar position - but have started a research fellowship which gives me more time/freedom than previous clinical jobs!