Tibolone as Adjunctive Treatment in Perimenopausal Depression by Prof Jayashri Kulkarni

Posted on July 16, 2019

Professor Jayashri Kulkarni became a Fellow of the Royal Australian and New Zealand College of Psychiatrists in 1989. As the first Associate Professor/Director of Psychiatry to Dandenong Hospital in 1994, she founded and directed the Dandenong Psychiatry Research Centre (DPRC) and the Monash University Research Centre for Women’s Mental Health. She was Director of Psychiatry of Dandenong Area Mental Health Service (DAMHS) for  eight years and directs a large psychiatric research group in her current appointment as Professor of Psychiatry, The Alfred and Monash University.

Author Quotes  

In terms of actual treatment, it [tibolone] is a form of oral HRT. It has a little bit of estrogen, a little bit of progesterone, a little bit of androgen – and it’s easy to take because it’s a tablet.

 Overall, women’s mental health has not become a national priority and I think it really should be.

Summary and slides  

Prof Kulkarni begins this final video excerpt of her presentation with a look at hormone therapy and how estrogen increases the density of serotonin receptors and transporter sites in the brain. 

A study of tibolone as an adjunctive treatment for perimenopausal depression showed a significant decrease in MADRS score over 12 weeks in women who used it.1 

Prof Kulkarni concludes this presentation with a note to consider the hormonal and social situation of the patient before answering some questions from the audience. 

Take Home Points  

  • Tibolone is a synthetic steroid hormone and an alternative to conventional HRT. 
  • Second-line treatments for peri-menopausal depression include standard HRTs (estradiol plus Prometrium®). 
  • Too many HRTs contain depressogenic progesterone. 
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