Hormone therapy for depression: Are the risks worth the benefits?

When you think of menopause, you might think of hot flashes and night sweats. But many women also experience symptoms of depression. The risk of depression doubles or even quadruples during the menopausal transition, which has researchers looking for ways to address — or even prevent — the problem.

One study published in JAMA Psychiatry found that hormone therapy may help ward off symptoms of peri- and postmenopausal depression in some women. Researchers found that perimenopausal and early postmenopausal women who were treated with hormones were less likely to experience symptoms of depression than women in the study who were given a placebo.

But unfortunately, the findings present a far-from-perfect solution. Hormone therapy brings its own set of risks, and for this reason it likely shouldn’t be widely used for preventing depression in women at this stage of life, says Dr. Hadine Joffe, the Paula A. Johnson Associate Professor of Psychiatry in Women’s Health at Harvard Medical School, who wrote an editorial accompanying the study. “It’s not a ‘never,’ but it shouldn’t be a standard approach; in general, all of medicine has moved away from using hormones for prevention,” she says.

About the study

The study included 172 perimenopausal and early postmenopausal women ranging in age from 45 to 65 who were experiencing low-level symptoms of depression. Roughly half used a skin patch containing the hormone estradiol for 12 months, as well as intermittent oral progesterone pills. The rest received a fake skin patch and placebo pills.

The women were evaluated at the beginning of the trial and throughout for symptoms of depression, using the Center for Epidemiologic Studies Depression Scale. Researchers found that only 17% of women in the hormone group developed clinically significant depression, compared with 32% of those in the placebo group.

Untreated depression can cause physical symptoms, such as headaches and fatigue, in addition to emotional symptoms, including persistent sadness and even suicidal thoughts. It can interfere with daily function and reduce quality of life. However, hormone use brings its own health risks, such as a greater chance of blood clots and stroke. “It would be irresponsible to recommend this as a blanket prevention treatment for women,” says Dr. Joffe, who is also executive director of the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital.

Lessons learned

Despite the caveat about hormone therapy, the findings should not be ignored. Rather, the key message for women is that depression during perimenopause and early postmenopause should be taken seriously, and women at this stage of life should be more closely monitored for depressive symptoms. In addition, study authors identified at least one risk factor for depression that stood out among women in this group — recent life stress. “A lot of people have stress, so I think it’s an important message that stress contributes to depression,” says Dr. Joffe.

Depression symptoms are not a sign of someone’s failure to cope. “This really is a brain phenomenon,” says Dr. Joffe. So here are some action points based on the findings.

• Be aware of depression risk. Knowing that depression is more common during perimenopause and early postmenopause can help you identify worrisome symptoms and act quickly. If you are perimenopausal or in early postmenopause, your doctor should ideally be screening you for mood symptoms at your regular visits. If not, bring up the topic yourself. If symptoms do develop, ask your doctor for a referral to a mental health specialist.
• Weigh hormone therapy’s pros and cons. Hormone therapy may be the right choice for some women. Talk to your doctor about the potential benefits and risks. Consider how long to use hormone therapy and whether there are other medical reasons to consider taking it. Keep in mind that more research is needed to fully understand the potential benefits and drawbacks of using this therapy to prevent depression, says Dr. Joffe. Talk with your doctor about whether behavioral strategies or antidepressant drugs might be a good alternative choice for you.
• Consider lifestyle changes and treatment. Regardless of whether you opt for hormone therapy or not, nondrug strategies can also be used to reduce the likelihood of depressive symptoms, including managing stress and boosting physical activity.

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