Clinical Report: Estradiol, Serotonin, and BDNF in Perimenopausal Depression

Overview

This study compares the efficacy of integrated traditional Chinese medicine and acupuncture (TCM-Acu) versus selective serotonin reuptake inhibitors (SSRIs) in treating perimenopausal depression (PMD). TCM-Acu showed greater improvement in HAMD-17 scores and increases in serotonin and BDNF levels.

Background

Perimenopausal depression (PMD) is a significant public health concern, with a two- to threefold increased risk of depression during the menopausal transition. Current treatments, including SSRIs, often have limited efficacy and adverse effects.

Data Highlights

Key Findings

• TCM-Acu showed a greater improvement in HAMD-17 scores compared to SSRIs (adjusted β = 3.79 points, P < 0.001).
• Absolute treatment response rates were low in both groups (14.2% for TCM-Acu vs. 5.0% for SSRIs).
• TCM-Acu was associated with greater increases in serotonin levels (adjusted β = 9.24 ng/mL, P < 0.001).
• TCM-Acu also resulted in greater increases in BDNF levels (adjusted β = 1.60 ng/mL, P < 0.001).
• No significant difference in estradiol levels was observed between the two treatment groups (P = 0.592).
• Changes in serotonin and BDNF were positively associated with HAMD-17 improvement across the cohort.

Clinical Implications

The findings suggest that TCM-Acu may offer a relative advantage over SSRIs in improving depressive symptoms in perimenopausal women, particularly through serotonergic and neurotrophic pathways. However, the low absolute response rates indicate that both treatment modalities may require further optimization.

Conclusion

This study highlights the differences in treatment effects between TCM-Acu and SSRIs in PMD, showing greater improvements in depressive symptoms and biomarker levels with TCM-Acu.

Related Resources & Content

1. BMC Psychiatry (Springer) — Variations in Serum Neuropeptide Y Concentrations and Appetite Alterations in Major Depressive Disorder Patients Based on Sex and Reproductive Age
2. Drug Safety — Impact of Antidepressant Initiation on Sexual Function in Male Patients
3. BMC Psychiatry (Springer) — Real-world evaluation of change in depressive symptoms among patients with treatment-resistant depression treated with esketamine
4. Recommendations | Menopause: identification and management | Guidance | NICE
5. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial
6. Effect of acupuncture on menopausal depressive disorder and serum hormone levels: a systematic review and meta-analysis
7. BMC Psychiatry (Springer) — The Role of Anxiety as a Mediator in the Link Between Childhood Trauma and Suicidal Thoughts in Individuals with Depression
8. Recommendations | Menopause: identification and management | Guidance | NICE
9. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial
10. Effect of acupuncture on menopausal depressive disorder and serum hormone levels: a systematic review and meta-analysis