In postmenopausal period, there occur a variety of psychosomatic symptoms in a female organism, which include deterioration of mood, anxiety, fear, sleep disorders, excessive irritability, impaired concentration and memory, overt depression with psychomotor retardation, decreased interest and life activity, decreased or increased appetite. Fluoxetine -selective serotonin reuptake inhibitor (SSRI) is used in the treatment of obesity and depression. Tianeptine--selective serotonin reuptake enhancer (SSRE) is used in the treatment of depressive episodes. Metabolic effects of prolonged tianeptine use are not well known. The aim of the study was the evaluation of the effect of long-term use of fluoxetine and tianeptine on emotional state and eating disorders in postmenopausal women.
Material and methods: The study was conducted in two groups of 30 postmenopausal women each, aged 52-66 years. The patients took fluoxetine for 6 months at a dose of 1 x 20 mg in the morning (group I) or tianeptine at a dose of 3 x 12.5 mg/daily (group II). Follow-up visits were conducted at 2, 4, 8, 12, 16 and 20 weeks. At week 24, extended tests were performed, including the assessment of the level of anxiety (Hamilton Anxiety Rating Scale-HARS) and depression (Beck Depression Inventory-BDI), the body mass index (BMI) and the waist/ hip ratio (WHR), which were compared with the corresponding results prior to the treatment with fluoxetine and tianeptine.
Results: After 6 months, in the group receiving fluoxetine, the reduction of the level of anxiety was obtained from 22.92 +/- 4.08 points to 12.36 +/- 2.43 points (p < 0.001) and a decrease in depression symptoms from 19.28 +/- 2.53 points to 10, 44 +/- 2.02 points (p < 0.001), but no reduction in body mass index was obtained -respectively 29.4 +/- 3.54 and 29.7 +/- 3.26 (p > 0.05) nor in the waist/ hip ratio--respectively 0.886 +/- 0.03 and 0.879 +/- 0.03 (p > 0.05). After 6 months, in the group receiving tianeptine, the reduction of the level of anxiety was achieved from 22.00 +/- 3.35 points to 15.20 +/- 3.42 points (p < 0.001) and a decrease in depression symptoms from 18.80 +/- 2.45 points to 14,16 +/- 4.06 points (p < 0.001), whereas no reduction in body mass index was obtained- respectively 27.7 +/- 2.81 and 27.4 +/- 2.65 (p > 0.05), even though slightly reduced waist/ hip ratio--from 0.877 +/- 0.03 to 0.863 +/- 0.03 (p < 0.05) was observed. Fluoxetine was more effective than tianeptine in the reduction of the level of anxiety (chi2 = 17.459, p < 0.01) as well as the reduction in the symptoms of depression (chi2 = 17.469, p < 0.01).
Conclusions: Both tianeptine and fluoxetine are effective in the treatment of emotional disturbances in postmenopausal women. Both drugs may decrease appetite but long-term treatment does not alter body weight to the desired extent and they do not match the standards as monotherapy for obesity.