Newsflash! SSRIs & Hot Flash Rebound
You may recall the researchers have been studying the ability of the antidepressant Lexapro to reduce the frequency and severity 0f hot flashes.
The results have been impressive, with onset of action within a month of initiating therapy. Missing, however, has been information about how long a woman needs to say on Lexapro to gain benefit. And what happens when she stops taking the drug. In one trial, women who stopped using Lexapro after 8 weeks experienced a resurgence of flashes. This is not much different than the reaction seen when HRT is stopped; both types of drug regimens only appear to work so long as a woman continues to use them.
Researchers are now reporting that when they examined the diaries of the same group of women referenced above (whose frequency, severity and bothersome factor of vasomotor symptoms improved after 8 weeks of Lexapro treatment) they found that a significant relapse occurred three weeks after stopping treatment. In fact, by the end of three week period, roughly a third (34%) of the women who had experienced a reduced frequency of their hot flashes, and roughly 39% who had experienced less severe flashes relapsed. In both of these groups of women, respectively, relapse was defined as a 15% increase in more frequent hot flashes and a roughy 11% increase in hot flash severity over the symptoms that they had when they first started the study. Overall, the women lost at least 50% of the original benefit they had gained.
The most important factor appears to be higher degree of insomnia symptoms before taking Lexapro and a weaker overall response to it while on it. In fact, every one point difference in the insomnia severity scale was associated with an 11% greater odds of a relapse; women who responded less well to Lexapro by week 8 had a threefold greater chance of relapse after stopping the agent for three weeks.
The choice is clear. It is much easier to start both hormonal and non-hormonal treatments than it is to stop them. And when you stop, you increase the odds that you will be experiencing worsened symptoms. When you do the math, it doesn’t look so good. Big gain, bigger loss.
Read MoreWho’s your advocate?
Do you have an advocate? Someone who understands you, knows you well enough to read between the lines, trusts you and actually likes you?
If you do, luck is your lady. And if you have an advocate in your professional life? Boy, that’s the lottery, the gold ring, Nirvana.
So let’s talk about that, shall we?
I’ve written previously about becoming invisible in the work world as we age. I have written about friendships and the health benefits that can be gleaned. And I have written about how the transition can change our outlook on work and life. But what happens when all of these things converge? Is it the perfect storm? Or just perfect?
I want to share a story. When I was in my Twenties, just starting out in my career, I worked for a NYC PR agency. After the head of our department sadly passed away from AIDS, he was replaced by someone from our parent company who was very competent but very insecure. I was already a fixture so she had to deal with me and reluctantly she did. And then she brought in a woman who I was supposed to hate. Seriously, those were her words. And that person? She was told she would hate me.
Guess what? Not only did we not realize pretty quickly that we did not hate one another but it turned out to be one of the most productive and functioning professional relationships I have ever experienced. More importantly, I gained a friend.
And, after many decades, while the friendship has remained, fate has brought our professional relationship back into being. Who would have thunk it when both of us were in our twenties and living in NYC and two women who were theoretically not destined to get along?
I’m tough to work with at times. No, I am downright difficult and impatient. But I have a birdseye view of things and can see waaaay into the future of a project, which is an important asset. And her? She’s really smart and patient and has really good instincts. And is really strategic, like me. Together, we make a pretty fine couple. And a fantabulous team and probably should have always been merged into one. A professional one.
What a concept!
So, I digress. Because I want to share that advocates are SO important as we grow into our professional roles. I have been fortunate to have several in my life. Really fortunate. But more importantly, when you find that special advocate (or advocates), don’t let them go. Let them know how much you appreciate them. And nurture them as they nurture you.
Hey Melon. You are da bomb. No really!
Thank you. I love you through and through.
We ain’t 26 or 27 anymore sister, but we still are. Wow! How lucky am I?
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Wednesday Bubble: It’s getting hot in here…
Hot flashes.
Does anyone really know what occurs in the body to cause the sudden surge of temperature, the licking of the of the internal flame and the momentary feeling that those droplets of sweat dripping down your face are doing NOTHING to alleviate the heat that is emanating from every pore of your body?
Evidently, researchers are coming closer to discovering the ‘why’ behind the flash. And the reason that this is so important is that when medical experts discover the why, they are then one step closer to figuring out how to fix it.
So, let me tell you what’s what.
As I wrote just last week, experts believe that hot flashes are related to a dysfunction in a process called ‘thermoregulation;’ this is the ability to keep our body temperature in a steady state, even when the environment changes. A decrease in estrogen levels, coupled with increased activation of the sympathetic nervous system (which assists in controlling the body’s functions and the fight or flight mechanism) narrows the natural comfort zone and tolerance for temperature fluctuations. Voila! A flash is born.
Hold on. In a new paper published in the open access Proceedings of the National Academy of Sciences, Dr. Naomi Rance from the University of Arizona College of Medicine explains that while the surface of the skin may feel hot during a hot flash, if one was to measure the internal core temperature, it is not even elevated. Rather, she and her team have identified a role that a group brain cells know as KNDy (kisspepti/neurokinin B/dynorphin) may play. These cells are located in an area of the brain — the hypothalamus — that controls metabolic processes related to the autonomic nervous system, including body temperature.
Dr. Nance and her team have only studied the KNDy neurons in rats so far, but what they’ve found is interesting: when they created a model to mimic menopause by withdrawing estrogen, they found that the KNDy cells response is extreme – they grow extremely large and manufacture greater amounts of neurotransmitters that communicate to the part of the brain that regulates body temperature. More communication equals more signalling that the body too hot and needs to release heat. The result? A hot flash and lots of vasodilation and sweating. But here’s the rub: when they measured the temperature of the tail skin in rats with normal KNDy neurons versus those who neurons were shut off, they found that their skin temperature was lower, even with the depletion of estrogen.
While these findings are not yet specific to women, they do show that the KNDy neurons appear to play an important role in regulating skin temperature and its reaction to signals that ‘it’s getting hot in here.’ Perhaps the silver lining is that if they can take it one step further and figure out how to positively control the KNDy cells in humans, they may be able to influence thermoregulation and literally stop those flashes before they start without affecting our real core body temperature.
Stay tuned!
Read MoreMonday Musings: The More Things Change
The Scream. Edvard Munch 1895.
The ‘Change.’ A time for ‘hysteria.’
I kid you not.
All joking aside, if you trace the history of the menopause, it has long been associated with loss, decline and decay, something is abhorred and shunned in society. And as I wrote earlier this year, in “response, marketers and the media have perpetuated and pathologized what author Louise Foxcroft (in her book, ‘Hot Flushes, Cold Science’) refers to as “one more feature in a woman’s linear life history, an inevitable and natural phenomenon, one more thing to negotiate and nowhere near as astonishing or potentially problematic as pregnancy.”
Even the British Medical Journal has been in the game, publishing a piece in 1937 that highlights how profound an impact the ‘Change’ can have a woman’s ability to function:
“Practically every menopausal woman becomes aware of certain mental clumsiness, an inability to cope with the ordinary problems of daily life, and a tendency to “give in.” The realization of her shortcomings is worrying, and she readily becomes depressed. Emotional instability is well defined, and the patient reacts to trivial situations with rather surprising attacks of laughter or tears. She is subject to rapid and frequent changes of mood: at one moment she will be unbearably irritable, at the next, pathetically contrite. There may be marked changes in personality and severe attacks of mental depression, sometimes lasting for days, during which the patient may become suicidal. A condition of hypochondriasis, which is particularly distressing to those around her, may develop out of the complicated syndrome, even in the milder cases, and persist for the remainder of the patient’s life.”
No wonder pharmaceutical manufacturers started pushing thorazine and benzadrine.
If wandering around in a drugged out state doesn’t calm you down or pep you up, the general 1937 approach might. In fact, I am of the mindset that modern medicine may need to take a page from 1927 clinician Dr. PMF Bishop:
“Assistance can be rendered by the members of the patient’s household. Her husband and relatives should be told that she is passing through a difficult phase of life and that they should therefore be tolerant and sympathetic in their dealings with her. She should be shielded as much as possible from domestic worries, and sometimes a holiday away from her household duties is beneficial, thought i may be harmful if she is a woman of forceful personality who will worry over the conduct of her home in her absence. She should be encouraged to pursue any hobby which will prevent her from becoming introspective about her condition. She may suffer from a secret fear that her symptoms are due to cancer, and it is wise for her doctor to reassure her specifically on this point.”
So, what is the point of my Monday musing? Menopause is still viewed as an hysterical condition in many circles. The trouble is, the recommended solution is HRT (mind you, even Dr. Bishop writes about estrogen replacement) and rarely do practitioners recommend that the woman simply take a long holiday away from the stressors of her mind and body. Relaxation can help; I’ve shown you the data on Flashfree time and again.
Just think if someone could put THAT in a bottle.
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Midlife mishap: blurring the boundaries between work and home
Telecommuting is the new black, right?
Not so fast.
Researchers say that while telecommuting (i.e. working regularly but not exclusively at home) has gained traction in the American workplace, the foothold remains elusive and the proportion of workers with flexible work options has been essentially flat over the past decade and a half. Additionally, the number of hours that workers actually telecommute on a weekly basis is less than one full day, a mere six hours. Although the reasons for this are numerous, it appears that managers remain reluctant to relinquish supervisory control, even though on average, telecommuters work harder and longer than their colleagues who are tied to their office chairs.
Do the math: Fewer telecommuting hours still equates to longer working hours.
What this brings to mind is the potential impact that telecommuting has on our lives outside of work, especially when work takes place at home? And how does this impact in turn, affect stress, which of course, has been linked to worsening of menopausal symptoms such as weight gain, hot flashes and depression?
I have been working at home for 20 years now, having started a business in 1992. While I am not a telecommuter, I am very aware of the black hole that one can fall into and how that has affected my ability to shut it down after a certain time of day. This ability has grown more difficult the more connected the world is and I find that I am consistently interrupted by clients during gym workouts, breaks, early morning coffee reentries and late day ratchet down.
Data demonstrate that my experience is often the norm and not the exception.
Let’s take a look at what the research shows. Analyzing trends from two national data sources — the National Longitudinal Survey of Youth 1979 Panel and the U.S. Census Bureau’s Current Population Study — Sociology Professors Mary Noonen and Jennifer Glass from the University of Texas at Austin learned that while the number of weekly telecommuting hours is relatively modest (just 6 hours, per above), most of the 30% of respondents who work from home add at least five to seven hours to their work week. In fact, 50% to 67% of telecommuting hours reported in these surveys push work hours past the 40 hour workweek model and are essentially overtime work. Just think: if you feel that you are already pushed to the brim in the office and volley for work at home hours, you may actually be relocating hours but not eliminating them. Moreover, your employer may be raising his or her expectations not only of what you deliver but when, including evenings and weekends.
Study findings also show that there is a misconception that telecommuting is more prevalent among parents with dependent children. In fact, parents are not likelier than the general population to work from home; rather authority and status in the workplace appear to drive telecommuting hours.
The researchers note that “telecommuting is intrinsically linked to information technologies that facilitate 24/7 communication between clients, coworkers and supervisors [thereby] potentially increasing the penetration of work tasks into home time.” A 2008 Pew Study supports this contention, demonstrating that the majority of ‘wired workers’ use technology to perform work tasks, even while sick or on vacation.
The perils run deep when the boundaries become blurry between work and home. Moreover, over wired means overload, and the ability to shut off our brains becomes increasingly difficult. Adrenal fatigue may set in, where after prolonged periods of cortisol production overdrive, the adrenal glands can no longer keep up with outside stressors and the body’s demand to handle stress and protect the immune system. In turn, the ability to handle life stressors declines.
Do blurred boundaries yield diminishing returns, midlife mishaps, a mishmash of expectations?
What do you think?
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