Pharmacological interventions and hormonal therapies for depressive symptoms in peri- and post-menopausal women: a network meta-analysis of randomized controlled trials

Ping-Tao Tseng¹, Hsien-Jane Chiu², Mein-Woei Suen³, Bing-Syuan Zeng⁴, Ming-Kung Wu⁵, Yu-Kang Tu⁶, Kuo-Chuan Hung⁷, Yi-Cheng Wu⁸, Kuan-Pin Su⁹, Dian-Jeng Li¹⁰, Tien-Yu Chen¹¹, Brendon Stubbs¹², Andre F Carvalho¹³, Marco Solmi¹⁴, Trevor Thompson¹⁵, Maria Gabriella Caruso¹⁶, Yutaka J Matsuoka¹⁷, Yen-Wen Chen¹⁸, Pao-Yen Lin¹⁹, Cheuk-Kwan Sun²⁰, Yu-Shian Cheng²¹, Yow-Ling Shiue²²

Affiliations

¹ Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.
² Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
³ Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Gender Equality Education and Research Center, Asia University, Taichung, Taiwan; Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
⁴ Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
⁵ Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁶ Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
⁷ Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
⁸ Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan.
⁹ Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan.
¹⁰ Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
¹¹ Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
¹² Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK; Positive Ageing Research Institute, Faculty of Health, Medicine, Social Care and Education, Anglia Ruskin University, Chelmsford, UK.
¹³ Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia.
¹⁴ Department of Psychiatry, University of Ottawa, Ontario, Canada; Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, Ontario, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
¹⁵ Faculty of Education and Health, University of Greenwich, London, UK.
¹⁶ Ambulatory of Clinical Nutrition, National Institute of Gastroenterology-Research Hospital IRCCS "Saverio de Bellis", Castellana Grotte (Bari), Italy.
¹⁷ Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Former Division Chief of Health Care Research, National Cancer Center Japan, Tokyo Japan.
¹⁸ Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan.
¹⁹ Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
²⁰ Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University Kaohsiung, Taiwan. Electronic address: lawrence.c.k.sun@gmail.com.
²¹ Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan. Electronic address: n043283@gmail.com.
²² Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan. Electronic address: shirley@imst.nsysu.edu.tw.

PMID: 37399764
DOI: 10.1016/j.psychres.2023.115316

Pharmacological interventions and hormonal therapies for depressive symptoms in peri- and post-menopausal women: a network meta-analysis of randomized controlled trials

Ping-Tao Tseng et al. Psychiatry Res. 2023 Aug.

. 2023 Aug:326:115316.

doi: 10.1016/j.psychres.2023.115316. Epub 2023 Jun 17.

Authors

Affiliations

¹ Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.
² Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
³ Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Gender Equality Education and Research Center, Asia University, Taichung, Taiwan; Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
⁴ Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
⁵ Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁶ Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
⁷ Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
⁸ Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan.
⁹ Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan.
¹⁰ Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
¹¹ Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
¹² Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK; Positive Ageing Research Institute, Faculty of Health, Medicine, Social Care and Education, Anglia Ruskin University, Chelmsford, UK.
¹³ Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia.
¹⁴ Department of Psychiatry, University of Ottawa, Ontario, Canada; Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, Ontario, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
¹⁵ Faculty of Education and Health, University of Greenwich, London, UK.
¹⁶ Ambulatory of Clinical Nutrition, National Institute of Gastroenterology-Research Hospital IRCCS "Saverio de Bellis", Castellana Grotte (Bari), Italy.
¹⁷ Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan; Former Division Chief of Health Care Research, National Cancer Center Japan, Tokyo Japan.
¹⁸ Department of Medical Research, Asia University Hospital, Asia University, Taichung, Taiwan.
¹⁹ Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
²⁰ Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University Kaohsiung, Taiwan. Electronic address: lawrence.c.k.sun@gmail.com.
²¹ Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan. Electronic address: n043283@gmail.com.
²² Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan. Electronic address: shirley@imst.nsysu.edu.tw.

PMID: 37399764
DOI: 10.1016/j.psychres.2023.115316

Abstract

Although significant portion of women experience depressive symptoms during or after menopausal transition, there has been considerable controversy over the benefits of hormone replacement therapy (HRT) and antidepressants due to insufficient evidence supporting the superiority of either treatment. This frequentist model based network meta-analysis (NMA) included randomized controlled trials (RCTs) of menopausal depression symptoms management in menopausal women. Seventy RCTs involving a total of 18,530 women (mean age 62.5) were analyzed. The results demonstrated that fluoxetine plus oral HRT [standardized mean difference (SMD)=-1.59, 95% confidence interval (95%CIs)=-2.69 to -0.50] were associated with the largest improvement in depressive symptoms than placebos in overall menopausal women. Similar findings were also noted in the subgroup of participants with a definite diagnosis of depression, while no pharmacological or hormone replacement therapy was better than placebo in the subgroup of post-menopausal women (amenorrhea > 1 year) or in patients without diagnosis of depression. This NMA presented evidence that fluoxetine plus HRT may be beneficial to menopausal women with a definite diagnosis of depression but not to those without depression or post-menopausal women. Trial registration: PROSPERO (CRD42020167459).

Keywords: Depression; Efficacy; Menopause; Systematic review; Tolerability.

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Conflict of interest statement

Declaration of Competing Interest The authors report no financial interests or potential conflicts of interest. The authors of this work were supported by the following grants: Brendon Stubbs was 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 was 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.

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Pharmacological interventions and hormonal therapies for depressive symptoms in peri- and post-menopausal women: a network meta-analysis of randomized controlled trials

Affiliations

Pharmacological interventions and hormonal therapies for depressive symptoms in peri- and post-menopausal women: a network meta-analysis of randomized controlled trials

Authors

Affiliations

Abstract

Conflict of interest statement

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Full Text Sources

Medical