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Hormonal and Pharmacologic Interventions for Depressive Symptoms in Peri- And/Or Post-Menopausal Women: A Network Meta-Analysis of Randomized Controlled Trials

49 Pages Posted: 24 Sep 2019

See all articles by Yu-Shian Cheng

Yu-Shian Cheng

Tsyr-Huey Mental Hospital - Department of Psychiatry

Ping-Tao Tseng

WinShine Clinics in Specialty of Psychiatry

Yu-Kang Tu

National Taiwan University - Graduate Institute of Epidemiology and Preventive Medicine; National Taiwan University - Department of Public Health; National Taiwan University - Department of Dentistry

Yi-Cheng Wu

Chang Gung University - Chang Gung Memorial Hospital

Kuan-Pin Su

China Medical University - Mind-Body Interface Laboratory (MBI-Lab)

Ching-Kuan Wu

Tsyr-Huey Mental Hospital - Department of Psychiatry

Dian-Jeng Li

Kaohsiung Medical University - Graduate Institute of Medicine

Tien-Yu Chen

National Defense Medical Center - School of Medicine

Brendon Stubbs

South London and Maudsley NHS Foundation Trust - Physiotherapy Department; University of London - Department of Psychological Medicine

Andre F. Carvalho

University of Toronto - Centre for Addiction and Mental Health (CAMH); University of Toronto - Department of Psychiatry

Marco Solmi

University of Padova - Department of Neurosciences; University of Padova - Neuroscience Center; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab

Trevor Thompson

University of Greenwich - Department of Psychology, Social Work and Counselling

Maria Gabriella Caruso

National Institute of Gastroenterology Saverio de Bellis

Yutaka J. Matsuoka

China Medical University - University Hospital

Yen-Wen Chen

Prospect Clinic for Otorhinolaryngology & Neurology

Pao-Yen Lin

Kaohsiung Chang Gung Memorial Hospital

Ming-Kung Wu

Chang Gung University - Department of Psychiatry

Cheuk-Kwan Sun

I-Shou University - Department of Emergency Medicine

More...

Abstract

Background: Although various pharmacological interventions and hormone replacement therapies for depressive symptoms in menopausal women have been investigated, their relative efficacies and safety remain unclear.

Methods: Based upon literature search on PubMed, Cochrane Library, and ScienceDirect, randomized controlled trials (RCTs) examining all the pharmacological interventions or hormone replacement therapy for depressive symptoms in menopausal women had been included. Data that met inclusion criteria were extracted from RCTs. The current network meta-analysis was conducted under the frequentist model.

Findings: Seventy RCTs in total were included with a total of 18,530 women (mean age = 62.5). The network meta-analysis (NMA) demonstrated that fluoxetine plus oral combined therapy [standardized mean difference (SMD) = -1.59, 95% confidence interval (CI) = -2.69 to -0.50], transdermal estradiol (SMD = -0.67, 95% CIs= -1.15 to -0.19), tibolone only (SMD = -0.64, 95% CIs= -1.18 to -0.09), and oral estrogen therapy (SMD = -0.55, 95% CIs= -0.92 to -0.18) were associated with significantly better overall improvement in depressive symptoms than that for placebos in menopausal women. Fluoxetine plus oral combined therapy was ranked the best among all the interventions. Similar findings were also noted in the subgroup of participants with definite diagnosis of depression; while for patients without diagnosis of depression, no pharmacological or hormone replacement therapy was better than placebo. Finally, most medications showed good tolerability with drop-out rate and rate of discontinuation due to adverse events comparable to those in placebo groups.

Interpretation: This NMA demonstrated that fluoxetine plus oral combined therapy was associated with the best improvement in menopausal depressive symptoms among the investigated interventions. Future large-scale RCTs on pharmacologic relief of depressive symptoms in menopausal women, especially in aspect of antidepressant regimens, are warranted to support or refute the results of the current study.

Funding Statement: The authors of this work were supported by the following grants: Brendon Stubbs is supported by a Clinical Lectureship (ICA-CL-2017-03-001) jointly funded by Health Education England (HEE) and the National Institute for Health Research (NIHR). Brendon Stubbs was partly funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust. Brendon Stubbs is also supported by the Maudsley Charity, King’s College London and the NIHR South London Collaboration for Leadership in Applied Health Research and Care (CLAHRC) funding.

Declaration of Interests: The authors report no financial interests or potential conflicts of interest.

Keywords: tolerability; efficacy; systematic review; network meta-analysis; depression; menopause

Suggested Citation

Cheng, Yu-Shian and Tseng, Ping-Tao and Tu, Yu-Kang and Wu, Yi-Cheng and Su, Kuan-Pin and Wu, Ching-Kuan and Li, Dian-Jeng and Chen, Tien-Yu and Stubbs, Brendon and Carvalho, Andre F. and Solmi, Marco and Thompson, Trevor and Caruso, Maria Gabriella and Matsuoka, Yutaka J. and Chen, Yen-Wen and Lin, Pao-Yen and Wu, Ming-Kung and Sun, Cheuk-Kwan, Hormonal and Pharmacologic Interventions for Depressive Symptoms in Peri- And/Or Post-Menopausal Women: A Network Meta-Analysis of Randomized Controlled Trials (09/19/2019 11:05:31). Available at SSRN: https://ssrn.com/abstract=3457416 or http://dx.doi.org/10.2139/ssrn.3457416

Yu-Shian Cheng

Tsyr-Huey Mental Hospital - Department of Psychiatry

Taiwan

Ping-Tao Tseng

WinShine Clinics in Specialty of Psychiatry

Kaohsiung City
Taiwan

Yu-Kang Tu

National Taiwan University - Graduate Institute of Epidemiology and Preventive Medicine

1 Sec. 4, Roosevelt Road
Taipei 106, 106
Taiwan

National Taiwan University - Department of Public Health ( email )

Taiwan

National Taiwan University - Department of Dentistry ( email )

Taiwan

Yi-Cheng Wu

Chang Gung University - Chang Gung Memorial Hospital

No.199, Tunghwa Rd
Taipei
Taiwan

Kuan-Pin Su

China Medical University - Mind-Body Interface Laboratory (MBI-Lab)

Taichung
Taiwan

Ching-Kuan Wu

Tsyr-Huey Mental Hospital - Department of Psychiatry

Taiwan

Dian-Jeng Li

Kaohsiung Medical University - Graduate Institute of Medicine

Kaohsiung
Taiwan

Tien-Yu Chen

National Defense Medical Center - School of Medicine

Taiwan

Brendon Stubbs

South London and Maudsley NHS Foundation Trust - Physiotherapy Department ( email )

London
United Kingdom

University of London - Department of Psychological Medicine

London
United Kingdom

Andre F. Carvalho

University of Toronto - Centre for Addiction and Mental Health (CAMH)

1001 Queen Street West
Toronto, Ontario M6J 1H4
Canada

University of Toronto - Department of Psychiatry

Toronto
Canada

Marco Solmi

University of Padova - Department of Neurosciences

Padua
Italy

University of Padova - Neuroscience Center

Padua
Italy

King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab

London
United Kingdom

Trevor Thompson

University of Greenwich - Department of Psychology, Social Work and Counselling

London
United Kingdom

Maria Gabriella Caruso

National Institute of Gastroenterology Saverio de Bellis

Bari
Italy

Yutaka J. Matsuoka

China Medical University - University Hospital

No. 91 Hsueh-Shih Road
Taichung, 40402
Taiwan

Yen-Wen Chen

Prospect Clinic for Otorhinolaryngology & Neurology

Kaohsiung
Taiwan

Pao-Yen Lin

Kaohsiung Chang Gung Memorial Hospital

Kaohsiung City
Taiwan

Ming-Kung Wu

Chang Gung University - Department of Psychiatry ( email )

No.123, Dapi Rd.
Kaohsiung City, 833
Taiwan

Cheuk-Kwan Sun (Contact Author)

I-Shou University - Department of Emergency Medicine ( email )

No.1, Yida Road, Jiaosu Village
Kaohsiung City, 82445
Taiwan

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