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Effect of the Menstrual Cycle on the Symptoms of Depression and Treatment Response

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00188396
Recruitment Status : Completed
First Posted : September 16, 2005
Last Update Posted : March 13, 2009
Ontario Mental Health Foundation
Information provided by:
University Health Network, Toronto

Brief Summary:

Objectives: This prospective investigation will compare premenopausal, perimenopausal and postmenopausal women's response to antidepressant medication. The effects of the menstrual cycle on the symptoms of depression and antidepressant response will also be examined.

Hypotheses: Premenopausal women will show a significantly better response to a selective serotonin reuptake inhibitor (SSRI) than peri- or postmenopausal women. Premenopausal women during lower estrogen phases of the menstrual cycle will complain of increased depressive symptoms despite treatment. Perimenopausal and postmenopausal women with irregular periods and generally low estrogen levels will show less symptom variability over time.


Subjects: Eighty-four women (28 premenopausal, 28 perimenopausal, 28 postmenopausal) meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depressive disorder will be enrolled in the study.

Procedure: All the subjects will be followed prospectively for 12 weeks and through 2 menstrual cycles while receiving treatment with a standard SSRI antidepressant agent. All eligible women will have a structured clinical interview and will complete questionnaires assessing their depressive symptoms. Blood samples will be collected to evaluate for reproductive hormone levels during the late follicular, midluteal and late luteal phases of the menstrual cycle for two consecutive cycles. Serum SSRI levels will also be collected at these times. As the women in the perimenopausal and postmenopausal groups either have irregular menstrual cycles or no longer cycle, they will have blood samples drawn at baseline and on 6 other occasions.

Research Implications: As the majority of psychiatric medication is prescribed to women, understanding the interplay between the menstrual cycle and antidepressant medication will ultimately translate into more diverse and improved patient care. The proposed study is one within a developing research program, which will in part be further guided by this study.

Condition or disease Intervention/treatment Phase
Major Depressive Disorder Depression Drug: Citalopram Not Applicable

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 44 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: The Effect of the Menstrual Cycle on the Symptoms of Depression and Treatment Response: A Comparison of Premenopausal, Perimenopausal and Postmenopausal Women
Study Start Date : April 2004
Actual Primary Completion Date : October 2008
Actual Study Completion Date : October 2008

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Menstruation

Primary Outcome Measures :
  1. Hamilton Depression Rating Scale (HAM-D) [ Time Frame: 12 weeks ]

Secondary Outcome Measures :
  1. Clinical Global Impression (CGI) [ Time Frame: 12 weeks ]
  2. Trimodal Anxiety Questionnaire (TAQ) [ Time Frame: 12 weeks ]
  3. Women's Health Questionnaire [ Time Frame: 12 weeks ]
  4. Prism calender [ Time Frame: 12 weeks ]
  5. Biological measures (β-estradiol, estrogen, progesterone, follicle-stimulating hormone [FSH], luteinizing hormone [LH], and testosterone) [ Time Frame: 12 weeks ]

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Women, ages 18-65 years old
  • Fulfilling DSM-IV criteria for major depressive disorder, which is not secondary to another pre-existing psychiatric condition or to a medical condition
  • Hamilton Depression Rating Scale (HAM-D-17) total score of at least 16
  • Able and willing to give meaningful written consent
  • 28 women premenopausal (having monthly periods); 28 women perimenopausal (having irregular periods); and 28 women menopausal (without a period for at least one year).
  • In good physical health.

Exclusion Criteria:

  • Subjects who are taking the birth control pill currently or within the last 3 months
  • Subjects who plan to become pregnant or were pregnant within the last year
  • Subjects who are taking hormone replacement therapy (or received it within the last three [3] months)
  • Subjects who meet DSM-IV criteria for substance abuse (consume > 4 alcoholic beverages per day)
  • Subjects who have tried 2 antidepressants for this episode
  • Subjects who have additional diagnosed psychiatric conditions (i.e. anxiety, substance use and psychotic disorders)
  • Subjects who have had both ovaries surgically removed.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00188396

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Canada, Ontario
University Health Network
Toronto, Ontario, Canada, M5G 2C4
Sponsors and Collaborators
University Health Network, Toronto
Ontario Mental Health Foundation
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Principal Investigator: Sophie Grigoriadis, PhD, MD, FRCPC University Health Network, Toronto

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Responsible Party: Sophie Grigoriadis, PhD, MD, FRCPC, University Health Network Identifier: NCT00188396    
Other Study ID Numbers: 04-0225-AE
First Posted: September 16, 2005    Key Record Dates
Last Update Posted: March 13, 2009
Last Verified: January 2007
Keywords provided by University Health Network, Toronto:
Major Depressive Disorder
Women's Mental Health
Antidepressive agents
Mental Health
Additional relevant MeSH terms:
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Depressive Disorder
Depressive Disorder, Major
Behavioral Symptoms
Mood Disorders
Mental Disorders
Serotonin Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Agents
Serotonin Agents
Physiological Effects of Drugs
Antidepressive Agents, Second-Generation
Antidepressive Agents
Psychotropic Drugs
Antiparkinson Agents
Anti-Dyskinesia Agents
Autonomic Agents
Peripheral Nervous System Agents
Muscarinic Antagonists
Cholinergic Antagonists
Cholinergic Agents