Abstract
Objective: Both of selective serotonin reuptake inhibitors (SSRIs) and estrogen can modulate emotion and cognition function in post-menopause women, moreover SSRIs can influence estrogen system in rats and aquatic wildlife but most of them for reproductive ability. The aim of this study was to investigate the possible relationship between SSRI, estrogen, and emotion and cognition in post-menopause women with anxiety and depressive symptoms .Methods: A double-blind, randomized controlled trials of Paroxetine, an SSRI (n = 44), versus placebo (n = 38) for 6 months in post-menopausal women with anxiety and depressive symptoms. For screening anxiety, depression and mild cognitive impairment (MCI), we use the Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D) and the Chinese Version of the Montreal cognitive assessment (MoCA-CV). And sex hormones were measured by ELASE method which is serum estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH). Results: Paroxetine increased serum E2 and decreased LH, FSH significantly (P < 0.05). Meanwhile, HAM-A and HAM-D scores declined and MoCA-CV score raised by Paroxetine (P < 0.05). We also found that a negative association between E2 and scores of HAM-A and HAM-D at pre-treatment and post-treatment of Paroxetine (HAM-A: R = ?0.27, R = ?0.24; HAM-D: R = ?0.65, R = ?0.37), while a positive correlation between E2 and MoCA-CV scores (R = 0.52, R = 0.47). Conclusions: This founding suggests that SSRI can increase serum estrogen levels and the change of estrogen may be one of mechanism in SSRI’s improve emotion and cognitive function in post-menopausal women.
Highlights
Mood disorder, especially depression, and dementia are commonly in comorbidity occurring in the aged population (Korczyn et al, 2009)
When estrogen increased by Paroxetine, the luteinizing hormone (LH) and follicle stimulating hormone (FSH) declined demonstrating preservation of the negative feedback in hypothalamic pituitary ovarian (HPO) axis, which is consistent with the results of Shaw’s study in 2011 (Shaw, 2011), that LH and FSH decrease in 22 postmenopausal women by administering a controlled intravenous steroid infusion that mimics estradiol (E2) and progesterone (P) levels across the follicular phase
As far as we know, the current study is the first one to evaluate the correlation between Paroxetine and estrogen in postmenopausal women, and finding that the altered estrogen levels are significantly related to emotional and cognitive function
Summary
Especially depression, and dementia are commonly in comorbidity occurring in the aged population (Korczyn et al, 2009). Both of the diseases affect much more women than men (Korczyn et al, 2009). The frequency of a psychiatric disorder is associated with poorer cognitive functioning among older women (Colenda et al 2010). It supported by another study which reported that the percent of women aged 48 to 50 suffering cognition disorder increase to 40% (Amyaloysi et al, 2006) (menopausal average age is 51). The hypoestrogenic state may be an important factor causing affective and cognitive disorder in post-menopausal women
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