Wednesday Bubble: hot flashes and antidepressants
Researchers have been studying antidepressant therapy (namely selective serotonin reuptake inhibitors – SSRIs, and serotonin/norepinephrine reuptake inhibitors –SNRIs) for some time now in hopes of discovering an effective treatment for hot flashes and an alternative to hormone replacement therapy (HRT). However, antidepressants’ ability to ameliorate hot flashes have yielded mixed results in the study arena. One potential advantage of using an antidepressant in this regard is the ability to also effectively address mood swings and depression that occur as hormone levels wane and decline throughout menopause. Hence, I was intrigued by a new study, published this week in the Journal of the American Medical Association, that not only evaluated the benefit of using the SSRI Lexapro for hot flashes but also, whether or not factors such as race and coexisting depressed mood and/or anxiety would affect the results. Notably, African-American women are reportedly more likely than report having particularly bothersome hot flashes.
In this particular trial, 205 menopausal or postmenopausal women reporting at least 28 hot flashes or night sweats per week over a three week period that were bothersome or severe the majority of time were asked to take 10 mg escitalopram (Lexapro) or placebo tablet daily for 8 weeks. This dosage was increased midway through the trial if hot flash frequency didn’t decrease by at least 50% and if severity did not change.
The findings:
- More than half of women reported that the frequency of their hot flashes declined by at least 50% from the study starts (compared to slightly more than a third of women taking placebo)
- Women taking Lexapro reported that the severity of their hot flashes decreased by 24% compared to the study’s start (and a 14% decline in severity among the placebo group)
- The response to Lexapro was rapid and improvements started to be seen within one week
- Reported side effects between the two groups were fairly equal, and mostly related to feeling tired, stomach issues and dry mouth
- Race did not appear to play a role in either group
- Hot flashes returned after Lexapro was stopped
Although the researchers caution that the group of women in the study were highly motivated and not necessarily reflective of women in the general population, I would argue that a woman with severe and frequent hot flashes is motivated, period. I’m not a huge fan of using pharmaceutical medications to address menopausal symptoms for two reasons: 1) menopause is not a disease and, 2) as evidenced by the archives, there is an evolving body of literature that supports the use of alternative strategies for managing menopause. Nevertheless, as someone who has had lifelong bouts of depression that are exacerbated by hormones, I welcome an effective alternative to HRT that might be more broadly embraced by the medical community. Until a greater proportion of healthcare practitioners begins to accept the distinctions between between eastern and western medical philosophies and the potential advantages of complementary strategies, the learning (and begging) curve will continue to be steep.
Perhaps antidepressants are an initial stop-gap while the body of evidence supporting alternatives like acupuncture or isoflavones for hot flashes and depression grows. I’m optimistic we’ll get there. And I will always be happy to see women provided with an alternative to HRT.
Read MoreIn training? Make sure it’s resistance!
For some time now, experts have advised that aerobic exercise is preferred over other forms of physical activity for reducing the risk of heart disease. One key reason is that it confers favorably changes in the arteries, making them pliant and able to assist with blood flow and maintenance of normal blood pressure. Although our arteries tend to stiffen naturally with age (losing their elasticity), other factors, including high cholesterol, an unhealthy diet, obesity and sedentary behavior also contribute. Unfortunately, the stiffer arteries become, the more difficult it is for blood to flow, meaning that the heart has to work harder to pump blood. This leads to high blood pressure, stroke and of course, death.
So, is the only physical option aerobic? Evidently not.
Historically, resistance training has been shown to increase the stiffness of the arteries. However, it also protects bone (thereby lowering the risk for osteoporosis), helps to maintain normal weight and promotes general health and wellbeing. These factors in particular, are essential to women as they age. However, for the first time, researchers are now saying that resistance training may confer heart benefits that are similar to aerobic exercise.
In a very small study published last year in the Journal of Strength and Conditioning Research, the effects of resistance training on the arteries and blood flow were thoroughly examined in young adult men, who, following a brief warm up, performed resistance exercises on weight machines; repetitions ranged from 3 to 15, and subsequent weight was added or reduced in increments to achieve the most optimal effort from each man. They found that 45 minutes moderate intensity resistance training, despite causing the arteries to stiffen, actually increased blood flow and as a result, lowered participant’s blood pressure by as much as 20%. What’s more, these benefits were greater than those seen with aerobic exercise, but, residual effects appeared to continue at least 30 to 60 minutes after resistance training stopped and recovery started. Among individuals who trained 30 to 45 minutes three times a week, these benefits continued for at least 24 hours.
The researchers point out that although it’s difficult to directly compare aerobic activity and resistance training, particularly with regards to exercise intensity, they believe that resistance training has an important role in lowering blood pressure and may be as “good as or better” than the benefit seen with antihypertensive medications.” They also say that for people who have orthopedic or weight limitations and can’t walk or run for long distances, these findings offer an important alternative: resistance training.
At the end of the day, any training is good, so long as it is supervised. Now it appears that adding resistance training to aerobic activity imparts a lot more benefits than previously thought. Aerobic AND resistance training = win/win for your heart and your health. Want to learn more? The American Council on Exercise has a great website on resistance and strength training. My friend Andrea Metcalf also provides some wonderful guidance in her new book, Naked Fitness.
Read MoreSleep and energy: what’s in a good night’s sleep?
Did you know that a lack of sleep adds up to a whole lotta energy? For the first time ever, scientists have quantified how much energy we lose when we lose a full night’s sleep…and how much we save when we get the required 8 hours.
I’ve written about sleep, aging and menopause often on Flashfree, and the outlook isn’t great. In fact:
- Difficulty falling asleep appears to be associated with menopausal symptoms in general, stress, and lower stress hormone levels.
- Awakening during the night appears to be associated with age, being late in the menopausal transition (before moving into full-blown menopause), having had early menopause, hot flashes, depressed mood, joint pain and stress.
- Early morning awakening appears to be associated with age, hot flashes, depressed mood, anxiety, joint pain, stress, and lower estrogen/higher fallopian stimulating hormone (FSH) levels.
Now, researchers are saying that a night’s sleep actually depletes the body of energy while getting 8 hours of sleep conserves it.
In a very small study, 7 young adults were asked to stay in bed and consume a carefully regulated diet comprising of 30% fat, 50% carbohydrates and 20% protein During the study period, they had 8 hours of sleep, followed by two days of sleep deprivation (40 hours total) followed by another 8 hours of sleep.
Compared to a typical 8 hours sleep, losing a night’s sleep actually increased the amount of energy expended by as much as 7%. This is equivalent to about 135 calories (i.e. two slice of bread) or walking about two miles. In contrast, getting a normal nights sleep actually saved almost as much energy.
Hence, it appears that sleep deprivation is a waste of energy, literally! And while it may generate some returns in terms of immediate weight loss, other researchers have shown that over time, sleep deprivation actually impairs functioning and leads to weight gain.
So, what’s in a good night’s sleep? Apparently, sleep provides a means by which we are able to conserve enough energy to support other important functions that we need to survive. However, the challenge lies in that magic 8 hours, which appears to be constantly interrupted during the menopausal period. If only we could put that energy to good use and figure out the answer to this particular dilemma that plagues us as we age.
Any thoughts?
Read MoreWednesday Bubble: Get up and…
move? You bet!
According to a newly published study in the advanced online edition of European Heart Journal, taking breaks from long stints at your desk or even while you’re playing couch potato can go a long way towards preventing heart disease and losing some of that waistline bulge. In fact, the researchers say that prolonged periods of being sedentary, even if you regularly participate in moderate to vigorous physical activity, can increase the risk of heart disease. The bottom line? It’s not only the length of time you’re spending at your desk or on your derriere but how often you interrupt that time that counts.
This is the first time that a large, multiethnic population of varying ages has been evaluated to determine how a lack of activity affects certain markers of heart disease, including inflammation, waist circumference, cholesterol and blood fats. Researchers studied 4,757 participants over a period of three years who wore a small device (an accelerometer) that measures both the amount and intensity of activity; this allowed them to collect data on inactivity and breaks in inactivity.
The findings? Irrespective of factors like exercise time, diet and smoking, people who took the most breaks from inactivity (~179 breaks a day) had, on average, a 1.6 inch smaller waist circumference than people who took the least amount of breaks (~14 breaks per day) and remained inactive for the longest period of time. Moreover, taking breaks from being sedentary appeared to improve blood fats and blood glucose levels as well as C-reactive protein level (CRP, a blood protein that many experts believe, increases heart disease risk because of its role in promoting inflammation). Another interesting finding was gender-based; even though women tended to be more sedentary overall, they did take more breaks, thereby improving their heart disease risk. This is especially notable since research has shown that not only is heart disease the number one killer of women, but it tends to increase as estrogen levels wane.
Dr. Healy, the study’s lead researcher, suggests that even small changes, standing for as little as one minute at various intervals throughout the day, may help lower heart disease risk and counter the danger of being sedentary for too long. In a work environment, this means, standing up when talking on the phone, walking over to a colleague, using the restroom, and of course, taking the stairs. If you work at home, some of these recommendations are adaptable, such as making a point to take out the garbage, walk outside for a minute or put in a load of laundry.
Truly, get up and move as often as possible. It may save your life as well as your waistline!
Read MoreHave a heart…
HeartSense, that is.
My colleague Mary Knudson asked me to write a post about my exercise routine over at HeartSense blog, a blog devoted to heart failure. I hope that you’ll visit, not only to read it but also, Mary’s message. Heart failure is no joke and many of us don’t recognize the signs until it’s too late. Moreover, waning estrogen levels and resulting changes in LDL and total cholesterol contribute to increased risk of heart disease as we age.
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