Healthy Skepticism Library item: 996
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: news
Kirkey S.
Relief from hot flashes can come from anti-depressants
CanWest News Service 2003 Jan 3
Full text:
Women rattled by recent bombshell studies linking hormone therapy to health risks can find relief from hot flashes with psychiatric drugs, a new study has found.
A slow-release version of Paxil, which is the most commonly prescribed antidepressant in Canada last year, can reduce hot flashes in menopausal women by up to 65 per cent, according to research published today in the Journal of the American Medical Association.
The study comes at a time when women are scrambling for alternatives to hormone replacement therapy in the wake of studies linking a popular estrogen-progestin regimen with an increased risk of heart attack, stroke, blood clots and dementia.
But, not everyone is comfortable with the prospect of women who aren’t suffering from a psychiatric illness routinely using mood-altering pills to get through menopause.
“We’re urging a fair amount of caution that both natural remedies and things like anti-depressants come with a bevy of potential side-effects that need to be looked at very, very carefully before they’re considered,” says Kathleen O’Grady, editor of A Friend Indeed, a non-profit newsletter for women in menopause and midlife.
It’s not clear what causes the sudden rush of heat, flushing and heart palpitations associated with hot flashes, the most common complaint of menopause. Doctors suspect declining estrogen levels scramble the settings of a woman’s internal thermostat.
Hot flashes are also a frequent problem among women with breast cancer who are plunged into early menopause from chemotherapy. It was in these women that researchers first noticed that those who took antidepressants known as SSRIs, or selective serotonin reuptake inhibitors, had far fewer hot flashes.
In depression, the drugs are thought to work by blocking the brain’s re-absorption of serotonin, a chemical that regulates mood and emotion. Exactly how they might help in menopause remains a mystery, though doctors suspect they act on neurotransmitters that control body temperature.
Two other studies have found that other SSRI’s, including Prozac, can relieve hot flashes in women who had breast cancer. But this is the first to involve post-menopausal women who, for the most part, were not breast cancer survivors.
The study, which was paid for by GlaxoSmithKline Pharmaceuticals, makers of Paxil, involved 165 women. They were randomly assigned to receive a placebo or a slow-release form of paroxetine (the chemical name for Paxil) in either a 12.5 mg or 25 mg dose every day for six weeks. The standard starting dose for depression is 25 mg. The women kept a daily hot flash diary.
At the start of the study, women were experiencing an average of 6.5 hot flashes a day. By week six, the low-dose Paxil reduced hot flashes by about 62 per cent, the standard dose by about 65 per cent, and the placebo by 38 per cent. The most common side-effects reported were headache, nausea and insomnia.
“I believe this is the most effective non-hormonal therapy we have right now for hot flashes,” said the study’s lead author, Dr. Vered Stearns, an assistant professor of oncology at Johns Hopkins’ Sidney Kimmel Comprehensive Cancer Center in Baltimore. She said women will know “within days whether it’s going to work.” The slow-release Paxil tested in the study isn’t yet available in Canada, but similar results have been seen in a different population of women using immediate-release formulations.
Dr. Christine Derzko, associate professor in obstetrics and gynecology at the University of Toronto, cautions that the results “are far short of perfect.” She also added that hot flashes can be subjective: “I’m not saying they’re not real. But the results can be impressive no matter what you try.”
