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Comment & Response |

Estrogen-Based Therapies and Depression in Women Who Naturally Enter Menopause Before Population Average

Michael Pascal Hengartner, PhD, MSc1
[+] Author Affiliations
1Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
JAMA Psychiatry. 2016;73(8):874. doi:10.1001/jamapsychiatry.2016.0709.
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To the Editor In their article in JAMA Psychiatry, Georgakis et al1 report an odds ratio of 0.98 (95% CI, 0.96-0.99) for a 2-year increment in age at menopause in association with depression. I was surprised that the authors attribute this minor effect to estrogen exposure and that they recommend estrogen-based therapies to treat depression in menopausal women. I wonder how the authors came to such conclusions. In outcomes with rather low probability, the odds ratio corresponds to the risk ratio; thus, we may infer that in women who enter menopause 2 years after the population average, their relative risk is 2% smaller (hence, 0.98). Assuming that women with average age at menopause have a risk of 10% for major depression, then women with a 2-year prolonged age at menopause would have a risk of 9.8% (0.098/0.10 = 0.98). Thus, the absolute risk reduction is only 0.2%. Even when extrapolated to a 10-year increment, which is approximately twice the SD of age at menopause, the absolute risk reduction is only about 1%.

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August 1, 2016
Marios K. Georgakis, MD; Alkistis Skalkidou, MD, PhD; Eleni Th. Petridou, MD, MPH, PhD
1Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
2Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
JAMA Psychiatry. 2016;73(8):874-875. doi:10.1001/jamapsychiatry.2016.0953.
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