Assessment of the Improvement in Cognitive Levels of Postmenopausal Depression Patients by Estrogen

• Fematon (estradiol/estradiol-norethindrone acetate combination tablet package)+SSRIs (Drug): In the combination group, eligible subjects will receive 1 tablet/day of estradiol/estradiol-norethindrone acetate combination tablet for 8 weeks. The estradiol/estradiol-norethindrone acetate combination tablet will be taken orally before bedtime, 1 tablet/day (trade name: Fematon, Abbott Laboratories, USA, this product is a combination package, with estradiol 1 mg in the first 14 days of each treatment cycle, and estradiol 1 mg and norethindrone acetate 10 mg in the last 14 days of each treatment cycle). This study uses SSRIs class drugs, including fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram, and escitalopram.
• SSRIs (Drug): This study uses SSRIs class drugs, including fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram, and escitalopram, with no specific restrictions on the type of drugs. During the study, medication doses will be quantitatively adjusted based on the results of each visit assessment combined with drug concentrations.

Primary outcomes

• The average change value of MOCA total scores from baseline to 8 weeks of treatment, as assessed by raters, is the primary efficacy endpoint(0-8week). [8 week]: Montreal Cognitive Assessment (MoCA) Test is based on scores with a maximum score of 30. It takes 10 to 12 minutes to complete.The cutoff for a normal MoCA score is 26. Scores of 25 and below may indicate mild cognitive impairment.

Secondary outcomes

• The average change value of HAMD-17 total scores from baseline to 8 weeks of treatment, as assessed by raters, is secondary Outcome Measures [8 week]: Hamilton Depression Rating Scale (HAMD-17) is scored by summing the item scores. The total score can range from 0 to 54, with higher scores indicating a greater severity of depression. 0 - 7 = Normal. 8 - 13 = Mild Depression. 14-18 = Moderate Depression. 19 - 22 = Severe Depression. > 23 = Very Severe Depression
• The average change value of HAMA total scores from baseline to 8 weeks of treatment, as assessed by raters, is secondary Outcome Measures [8 week]: Hamilton Anxiety Rating Scale (HAMA) ,Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0-56, where <17 indi- cates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe.
• The average change value of Kupperman total scores from baseline to 8 weeks of treatment, as assessed by raters, is secondary Outcome Measures [8 week]: The Blatt-Kupperman menopausal index included 11 symptoms which were rated on a four point scale from 0=none to 3=severe. These ratings were then summed across the 11 items and the score was categorized as follows: none 0-5, mild 5-10, moderate 10-15, severe 15+.
• The average change value of PSQI total scores from baseline to 8 weeks of treatment, as assessed by raters, is secondary Outcome Measures [8 week]: Pittsburgh Sleep Quality Index (PSQI) Each of the sleep components yields a score ranging from 0 to 3, with 3 indicating the greatest dysfunction. The sleep component scores are summed to yield a total score ranging from 0 to 21 with the higher total score (referred to as global score) indicating worse sleep quality.
• The average change value of ADL total scores from baseline to 8 weeks of treatment, as assessed by raters, is secondary Outcome Measures [8 week]: Activities of Daily Living (ADL) scores of 0-20 indicate "total" dependency scores of 21-60 indicate "severe" dependency scores of 61-90 indicate "moderate" dependency scores of 91-99 indicate "slight" dependency most studies use a score of 60/61 (moderate dependency) as a cutting point

Sex: Female, ages: any to 70 Years

Inclusion Criteria:

1. Female patients from outpatient or inpatient departments;
2. Patients who sign a written informed consent form;
3. Natural menopause for at least 1 year, with first-onset depression, aged ≤70 years;
4. Meeting the diagnostic criteria for Major Depressive Disorder according to the Diagnostic and Statistical Manual of Mental Disorders-fifth Edition (DSM-5);
5. HAMD-17 score ≥17 points;
6. Presence of cognitive impairment symptoms, Montreal Cognitive Assessment scale (MoCA) <26 points;
7. Education level of primary school or above.

Exclusion Criteria:

1. Patients with significant physical illness, cranial trauma, or other serious unstable physical illnesses;
2. Patients who have participated in another interventional clinical study in the past month;
3. History or current diagnosis of the following psychiatric disorders according to DSM-5: organic mental disorders, Alzheimer's disease, other causes of secondary dementia, schizophrenia, schizoaffective disorder, bipolar affective disorder, delusional disorder, unspecified mental disorders, patients with a history of substance abuse, including alcohol and active substance abuse in the past 12 months, excluding nicotine;
4. Currently taking antidepressants, cognitive enhancers, or other psychiatric medications in the past 2 weeks;
5. Severe speech, visual, or hearing impairments that prevent completion of scale assessments;
6. Individuals with severe suicidal ideation or suicidal behavior;
7. Patients with malignant tumors;
8. Known or suspected history of breast cancer;
9. Known or suspected estrogen-dependent malignant tumors (such as endometrial cancer);
10. Known or suspected progesterone-dependent tumors;
11. Untreated endometrial hyperplasia;
12. Unexplained vaginal bleeding.