Effects of tibolone on depressive and anxiety symptoms in symptomatic postmenopausal women
Amaç: Semptomatik doğal yolla menopoza girmiş kadınlarda tibolonun menopozal semptomlar, depresyon ve anksiyete skorları üzerine etkilerini Kupperman Skalası, Hamilton Depresyon Skalası ve Beck Anksiyete Envanteri kullanarak kontrol grubu ile karşılaştırmalı olarak inceledik. Yöntem: Menopoz semptomları olan 130 hasta çalışmaya dahil edildi, 121 hasta çalışmayı tamamladı. Grup I hastalar tibolon 2.5 mg/gün ile tedavi edildi. Grup II hastalara plasebo verildi (kalsiyum fort tablet 1000 mg/gün). Hastaların tedavi öncesi ve sonrası menopoz, depresyon ve anksiyete semptomları; Kupperman Skalası, Hamilton Depresyon Skalası ve Beck Anksiyete Envanteri kullanılarak değerlendirildi. İstatistik analiz için eşleştirilmiş t testi, çok değişkenli analiz testleri kullanıldı. Bulgular: Üç aylık tedavi sonunda, her iki gruptaki hastalarda menopoz semptomları, depresyon ve anksiyete skorlarında belirgin düzelme gözlendi. İki grubun tedavi öncesi ve sonrası Kupperman ve Beck Anksiyete Envanteri skorları karşılaştırıldığında, Grup I’in skorları Grup II’ninkilerden daha iyi idi. Tibolonun depresif belirtiler üzerine plaseboya üstünlüğü gösterilemedi. Sonuç: Östrojen ve progesteron kombinasyonunun veya tek başına östrojenin olası yan etkileri göz önüne alındığında, tibolonun vasomotor semptomları azaltıcı ve anksiyete semptomlarını düzeltici etkileri bir alternatif olarak düşünülebilir.
Semptomatik postmenopozal kadınlarda tibolonun aksiyete ve depresif belirtiler üzerindeki etkileri
Effects of tibolone on depressive and anxiety symptoms in symptomatic postmenopausal women Aims: We investigated the effect of tibolone therapy on menopausal symptoms, depression and anxiety scores in women with symptomatic natural menopause compared to control group using Kupperman’s Index, Hamilton Depression Rating Scale and Beck Anxiety Inventory. Methods: One hundred thirty patients with menopausal symptoms enrolled into the study, and 121 patients completed. Group I patients were treated with tibolone 2.5 mg/day. Group II patients received placebo (calcium forte tablet 1000 mg/day). The menopausal, depressive and anxiety symptoms were assessed using Kupperman’s Index, Hamilton Depression Rating Scale and Beck Anxiety Inventory before and at the end of the treatment. For statistical analysis, paired t, multivariate analyses tests were used. Results: At the end of 3 months of therapy, we observed significant improvement in menopausal symptoms, depression and anxiety scores in both groups. When we compared two groups’ Kupperman and Beck Anxiety Inventory (BDI) scores according to time before and after the treatment, Group I scored better than Group II. The superiority of tibolone comparing placebo on depressive symptoms could not be shown in this study. Conclusion: Tibolone’s effects in calming vasomotor symptoms and improving anxiety symptoms suggest it as an alternative when the possible side effects of estrogen and progesterone combination or estrogen alone are taken into account.
___
- 1. Harlow BL, Cohen LS, Otto MW, Spiegelman D, Cramer DW. Prevalence and predictors of depressive symptoms in older premenopausal women: the Harvard study of moods and cycles. Arch Gen Psychiatry 1999; 56:418-424.
- 2. Inan I, Kelekci S, Yilmaz B. Psychological effects of tibolone and sequential estrogen-progestogen therapy in perimenopausal women. Gynecol Endocrinol 2005; 20:64-67.
- 3. Veeninga AT, Kraimaat FW. A multifactorial approach to complaints during the climacteric. J Reprod Infant Psychol 1995; 13:69-77.
- 4. Genazzani AR, Petralgia F, Facchinetti F, Grasso A, Alessandrini G, Volpe A. Steroid replacement treatment increases β endorphin and β lipoprotein levels in postmenopausal women. Gynaecol Obstet Invest 1988; 26:153-159.
- 5. Kloosterboer HJ, Sands R. Intracrinology: the secret of the tissuespecificity of tibolone. J Br Menopause Soc 2000;6 (Suppl.2):23-27.
- 6. Bukulmez O, Al A, Gurdal H, Yarali H, Ulug B, Gurgan T. Short term effects of three continuous hormone replacement therapy regimens on platelet tritiaed imipramine binding and mood scores: a prospective randomized trial. Fertil Steril 2001; 75:737-743.
- 7. Van der Vies J. Pharmacological studies with (7 alpha,17 alpha)- 17-hydroxy-7-methyl-19-norpregn-5(10)-en-20-yn-3-one (Org OD 14). Maturitas 1987; 1:15-24.
- 8. Kupperman HS, Blat MHG, Wiesbader H, Filler W. Comparative clinical evaluation of estrogenic preparations by the menopausal and amenorrheal indices. J Clin Endocrinol Metab 1953; 13:688- 703.
- 9. Bech P. The Bech, Hamilton and Zung Scales for Mood Disorders: Screening and Listening. Second ed., Berlin: Springer, 1996.
- 10. Akdemir A, Orsel S, Dag I, Turkcapar H, Iscan N, Ozbay H. The validity, reliability and clinical use of Hamilton Depression Rating Scale. 3P Dergisi 1996; 4:251-259.
- 11. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol 1988; 56:893-897.
- 12. Ulusoy M, Şahin N, Erkman H. Turkish version of the Beck anxiety inventory: psychometric properties. J Cognitive Psychotherapy 1988; 12:28-35.
- 13. Carranza-Lira S, Valentino-Figueroa ML. Estrogen therapy for depression in postmenopausal women. Int J Gynaecol Obstet 1999; 65:35-38.
- 14. Tax L, Goorissen EM, Kicovic PM. Clinical profile of Org OD 14. Maturitas 1987; (Suppl.1):3-13.
- 15. Guennoun R, Fiddes RJ, Gouezou M, Lombes M, Baulieu EE. A key enzyme in the biosynthesis of neurosteroids, 3 betahydroxysteroid dehydrogenase/D5-D4-isomerase (3beta-HSD), is expressed in rat brain. Brain Res Mol Brain Res 1995; 30:287- 300.
- 16. Egarter C, Huber J, Leikermoser R, Haidbauer R, Pusch H, Fischl F, Putz M. Tibolone versus conjugated estrogens and sequential progestogen in the treatment of climacteric complaints. Maturitas 1996; 23:55-62.
- 17. Ross LA, Adler EM, Cawood EHH, BrownJ, Gebbie AE. Psychological effects of hormone replacement therapy: a comparison of tibolone and a sequential estrogen therapy. J Psychosom Obstet Gynaecol 1999; 20:88-96.
- 18. Gülseren L, Kalafat D, Mandaci H, Gülseren S, Camli L. Effects of tibolone on the quality of life, anxiety-depression levels and cognitive functions in natural menopause: an observational follow-up study. Aust N Z J Obstet Gynaecol 2005; 45:71-73.