Do the Postmenopausal Women Differently Respond to Antidepressant Medication?: Comparison of the Effect of Mirtazapine Treatment between the Premenopausal and Postmenopausal Women with Depression

Ko, Young Hoon; Joe, Sook Haeng; Jung, In Kwa; Kim, Seung Hyun; Lee, Moon Soo; Lee, Chang Hyun

Abstract

PURPOSE: Female gonadal hormones are implicated in the psychopathology of the depression. Menopausal state may affect the response to antidepressant medication but treatment options for menopause have not been investigated extensively. Thus, the authors explored the differences in therapeutic response between pre- and post-menopause female patients with depression by evaluating the efficacy and tolerability of mirtazapine treatment during 4 weeks.
METHODS
Seventy-five female patients with depression were included. 46 patients were assigned to postmenopause group or 29 patients to pre-menopause group. Efficacy was assessed with twelve's 7-point scales modified from subscales in HAM-D-17 and with Clinical Global Severity Scale, and tolerability was assessed from adverse events. Mirtazapine was administered at the flexible dose from 7.5 to 30 mg during 4 weeks.
RESULTS
The post-menopause group showed significantly more reduction in scores on somatization scale (p=0.029) and shows a decreasing tendency in scores on anxiety/agitation scale (p=0.071). Significant differences between two groups were shown in the proportion of patients classified as responders (50% decreased from baseline) in anxiety/agitation (p=0.031) scale. Even though it is not statistically significant, the post-menopause group showed to be more the proportion of responders compared with the pre-menopause group in and somatization symptoms (p=0.084) scales. The proportion of responders (score <1 or 2) in CGI-S was not significantly different between two groups.
CONCLUSION
Somatic symptoms and anxiety/agitation in postmenopause female patients with depression would be more likely susceptible to treatment with mirtazapine. Some symptoms of depressive disorder could differently respond to antidepressant medication between pre- and post-menopause patients, which implicated that optional treatment is required in female patients with depression.