Serotonergic antidepressants are effective against sleep disturbances in perimenopausal and postmenopausal women, including those without major depressive disorder, according to study results published in Menopause.
While previous studies have explored the effects of hormonal treatment for menopausal sleep disturbances, limited data exist regarding the safety and efficacy of antidepressants in these women. The aim of the current study was to assess the efficacy and safety of antidepressants in menopausal sleep disturbances.
A systematic search for English articles through PubMed, the Cochrane Library, and Science Direct databases identified 7 eligible randomized, controlled trials that were included in the meta-analysis. The studies included a total of 953 women prescribed with antidepressants and 996 women without the prescriptions.
Data suggested a significant improvement in sleep quality in menopausal women treated with serotonergic antidepressant (Hedge g=0.24; 95% CI, 0.11-0.38; number needed to treat, 7.72).
Serotonergic antidepressants were significantly more effective than placebo for postmenopausal women (Hedge g=0.25; 95% CI, 0.04-0.45), study patients with hot flashes (Hedge g=0.18; 95% CI, 0.02-0.34), and those participants without major depressive disorder diagnosis (Hedge g=0.23; 95% CI, 0.06-0.40).
Even serotonergic antidepressants without sedating effect were effective against sleep problems during or after menopausal transition. In fact, sedating and non-sedating serotonergic antidepressants displayed no difference in therapeutic benefits.
Additionally, antidepressants were well-tolerated and the odds ratio of dropout were similar between the serotonergic antidepressant and placebo groups.
The study had several limitations, including potential publication bias, the inclusion of predominantly studies from the US, and the inclusion of mostly postmenopausal women without a diagnosis of major depressive disorder, limiting the generalizability of results to other populations. Furthermore, the included trials evaluated the efficacy of serotonergic antidepressants and, consequently, cannot be applied to nonserotonergic antidepressants.
“Based on the results of the meta-analysis, antidepressants were effective against sleep disturbances in perimenopausal and postmenopausal women. Efficacy remained significant for women without major depressive disorder,” concluded the study researchers.
Cheng YS, Sun CK, Yeh PY, Wu MK, Hung KC, Chiu HJ. Serotonergic antidepressants for sleep disturbances in perimenopausal and postmenopausal women: a systematic review and meta-analysis. Menopause. Published online September 7, 2020. doi: 10.1097/GME.0000000000001647