Targeting Premenstrual Breakthrough of Depression with OCs: Is it Effective?

Premenstrual exacerbation of depression has been found to occur in roughly two-thirds of women with depressive disorders
Premenstrual exacerbation of depression has been found to occur in roughly two-thirds of women with depressive disorders

The addition of an oral contraceptive to antidepressants does not appear to treat premenstrual breakthrough of depression, according to a new study published in the Journal of Clinical Psychopharmacology.

Premenstrual exacerbation (PME) of depression has been found to occur in roughly two-thirds of women with depressive disorders, yet studies that specifically look at treatments for PME have been lacking. Previous data have shown that the oral contraceptive drospirenone and ethinly estradiol has the potential to improve these breakthrough symptoms.

To test the effectiveness of this oral contraceptive pill, researchers selected 32 women with unipolar depression that was in remission or was stable on antidepressants and who also experienced PME (30% increase in Montgomert-Åsberg Depression Rating Scale [MADRS] scores from the follicular to luteal phase). The women were randomized to receive either drospirenone/ethinly estradiol or placebo in addition to their antidepressants for two months. Both MADRS and Daily Record of Severity of Problems (DRSP) were used for analysis.

Only 25 women completed the trial (n=12 drospirenone/ethinly estradiol; n=13 placebo).  In the drospirenone/ethinly estradiol group, the premenstrual MADRS scores and DRSP scores declined by a median of 43.6% and 23.5%, respectively, compared to 38.9% and 20.9% for placebo. The results showed that women with fewer lifetime depressive episodes were more likely to see greater improvement in premenstrual DRSP (r=–0.40, P=0.06).

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While the findings of this small study suggest that augmentation of antidepressants with an oral contraceptive pill may not be effective in treating PME of depression, "future studies should target women established to have hormonal sensitivity prior to antidepressant therapy and those with fewer lifetime depressive episodes," conclude the authors.

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