Hormones Matter TM

SSRI Efficacy in Menopausal Women

May 20, 2012  |  Amy Sandberg


No wonder I couldn’t get out of bed last week. That selective serotonin reuptake inhibitor (SSRI) I’ve been using since 1993 to combat the depression I inherited from all the women on my mother’s side of the family, may slowly be losing its effectiveness.

In a classic case of women’s health research getting the short end of the stick, SSRI clinical trials originally excluded women because “researchers didn’t want to deal with the difficulties of controlling menstrual cycles,” according to Susan Kornstein, director of the Women’s Mental Health Institute at Virginia Commonwealth University.

Turns out that SSRIs work best in the presence of estradiol. Which could explain why 10mg daily dose of Prozac (the most prescribed SSRI in the world) worked for me in the past, but doesn’t seem to do the trick for me now that I’m menopausal.

A 2008 study published in the journal Psychoneuroendocrinology, found that the SSRI sertaline (Zoloft) had no effect on female rats that didn’t produce estradiol. The drug improved their depression-like symptoms, however, if accompanied by estradiol treatment.

The fact that SSRIs perform best in the presence of estradiol reveals the influence of estradiol on mental health, and suggests that, like men, menopausal women needing antidepressants should consider with their doctor whether an antidepressant that targets the neurotransmitters dopamine and norepinephrine, instead of serotonin, would be most effective.