Efficacy and safety of phytoestrogens in the treatment of postmenopausal
depressive disorders: a systematic review and meta-analysis
Abstract
Background:Depression is one of the most common and specific symptoms
among postmenopausal women, leading to significant personal, family, and
economic burdens. Some studies have shown that phytoestrogens can help
relieve symptoms of depression. Objectives: This systematic review and
meta-analysis aims to assess the efficacy and safety of phytoestrogens
in treating depression among postmenopausal women. Methods: A
comprehensive search for relevant studies published until November 25,
2020, was conducted in PubMed, the Cochrane Library, Chinese Biomedical
Literature Database, Web of Science, and EMBASE. Statistical analyses
were performed with Stata12.0, Comprehensive Meta-Analysis 3.0, and
Review Manager 5.4. Results: 2,183 studies were identified and 10
studies were included, involving 1,248 participants. The quality of the
four studies was assessed as high risk, six studies were assessed as
unclear. The analyses conducted according random effects model indicated
a positive effect on depressive symptoms for postmenopausal women
compared to the placebo (SMD=-0.45; 95% [CI]= -0.60 to -0.29;
Q=40.42, df=18, P=0.002; I2=55.5%). The high dose phytoestrogens
(dose>100mg/day) have better effectiveness (SMD =-0.48;
95%[CI]= -0.76 to -0.20; I2=52.8%, P<0.05) than low dose
(25mg/day≤dose≤100mg/day) (SMD=-0.45; 95%[CI]=-0.68 to-0.23;
I2=66.7%; P>0.05) and ultralow dose (00.05). Isoflavones
had better effectiveness (SMD=-0.52; 95% [CI]= -0.75 to 0.30;
I2=65.8%, P<0.05) than lignans of phytoestrogens (SMD= -0.23;
95% [CI]= -0.05 to 0.01; I2=0%, P>0.05). The
effectiveness varies in regions. The adverse reactions frequently
reported were gastrointestinal symptoms and cold or upper respiratory
tract infection. Conclusions: Phytoestrogen can relieve depression
symptoms among postmenopausal women. High-dose isoflavones is the most
effective. Although mild adverse reactions have been reported,
phytoestrogen could be considered as a complementary treatment for
postmenopausal depression.