(099) Deprescribing of Antidepressant and Anxiolytic Medications Following MHT

Abstract Introduction Fluctuating and declining hormone levels during perimenopause and menopause are associated with an increased prevalence of anxiety, low mood and depression in midlife. Around 1 in 3 perimenopausal women are offered or prescribed antidepressants and anxiolytics for negative mood symptoms. However, current guidelines state that there is no clear evidence of benefit for antidepressants when used to treat low mood in perimenopausal women not diagnosed with clinical depression, and menopausal hormone therapy (MHT) should instead be considered. Prescribing MHT and testosterone to perimenopausal women with psychological symptoms can improve quality of life and enable deprescribing in women already initiated on antidepressant therapy, reducing the risk of side effects and harms associated with long term antidepressant use. Objective To determine the proportion of women who reduced or discontinued their antidepressant or anxiolytic medication after starting MHT. Methods A cross-sectional study of patients attending a UK-based specialist menopause clinic between 1 October 2023 – 31 May 2024 (8 months). Patients were included if they were receiving antidepressants at the time of their initial consultation, before starting MHT. Patients were asked at the 3-month follow-up appointment whether they had reduced or discontinued their antidepressant/anxiolytic medication after starting MHT. Results 1081 perimenopausal and menopausal patients were taking antidepressants/anxiolytics prior to starting MHT. The average age of the patients was 51.7 years (SD 6.5 years). Overall, 419 women out of the 1081 (39%) either reduced or discontinued their antidepressant/anxiolytic medication. Among patients who received standard MHT (oestrogen +/- a progestogen; n = 92), 9 out of 92 patients (10%) reduced their medication, whilst 15/92 (16%) discontinued it. In women additionally treated with testosterone (n = 989), 119 (12%) reduced their medication, and 276/989 (28%) discontinued, suggesting discontinuation rates were 33% higher among women using testosterone alongside standard MHT). Conclusions Our findings show that, for some women, MHT is a more appropriate treatment for negative mood symptoms due to a hormone deficiency and can avoid the need for – or enable deprescribing of – less appropriate treatments that can be associated with side effects and long-term harms. The addition of testosterone to MHT can provide more benefits to psychological symptoms and may lead to higher rates of deprescribing. Disclosure No.