Depression affects up to 20% of alle women entering perimenopause. The symptoms of depression are often debilitating and are related to the decrease of the steroid hormones progesterone and estrogen. Treatments such as SSRIS and SNRIs often worsen the physical symptoms of perimenopause such as hot flashes and there is some evidence that a decrease of estrogen inhibits the effectiveness of SSRIs. Thus, we investigated whether agomelatin was effective in treating perimenopausal depression without worsening hot flashes and other perimenopausal-related physical symptoms.

35 women with moderate to severe depression related to perimenopause as diagnosed by a typical hormonal constellattion and by systematic psychiatric assessment were treated with agomelatin for 6 weeks. Symptom change of both depression and of physical symptoms was evaluated weekly by several rating scales.

Agomelatin improved both depression and physical symptoms of perimenopause, particularly hot flashes and night sweats. After 6 weeks 70% of the women reported remission from depression and all said that their sleeping pattern had improved as well as their overall quality of life. They related this strongly to the significant improvment of hot flashes and night sweats.

Agomelatin improves both depressive and physical symptoms of perimenopause. Since hot flashes and night sweats are among the most debilitating symptoms of perimenpause and since about 80% of women suffers from them, agomelatin might be a good option for those women who do not want HRT.