Wednesday Bubble: hot flashes and antidepressants

Posted by on Jan 19, 2011 in hot flash | 4 comments

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.

4 Comments

  1. 1-20-2011

    Hey Liz, this is great info and analysis. I am not a fan of Lexapro, but may consider tyring it. I have been using acupuncture, chinese herbs, low dosages of neurotin (also for other reasons) and recently started estroven without much relief. I have been meaning to ping you, but thought I would do some more homework. Very frustrating to have chronic pain and then hot flashes…I am tired of wrapping myself in towels at night, and not being able to sleep. Ughhh.

    • 1-20-2011

      Hi. Have you tried Remifemin? Let’s chat.

  2. 1-24-2011

    Hi Liz,
    First, I’d like to thank you for your well researched and well written blog, which I just found out about!

    I understand that you are concerned about menopause being treated as a disease, and looking for alternative strategies to deal with the symptoms of menopause.

    I had tried a number of alternative remedies, mainly because of sleep deprivation, and this due to only mild night and day sweats (from what I’d read other women were suffering with). However, I was also suffering from an inability to concentrate and mild depression (all due to a lack of sleep, I assumed). My doctor finally suggested I try a very low dose of bioidentical hormone therapy (estrogel and prometrium, as I need to take progesterone) or a low dose anti-depressant. It was not her first suggestion, as she is not big on pushing medications.

    After doing some research I got very scared of the anti-depressant route, as I felt that some of the (albeit less common) side effects included suicidal tendencies and a lot of interference with brain chemistry. It really seemed that bioidentical hormones (low dose, mind you) was a more natural and safe route. As it turned out, it was the answer for me. I’m now sleeping like a baby and have no more night sweats or hot flashes, and no depression!

    I realize everyone has to find what works best for them, and what they feel most comfortable with. However, I feel that, although I don’t think that menopause is a disease per se, there are many things that happen to the body that require some tweaking, and natural hormones seem to be something that falls under this category. I compare it to people who have to take thyroid hormones (the dose is adjusted until they find the amount that they need).

    Sorry for being so long winded, but I really do enjoy reading your blog and find it very insighful, but I must admit I find that the politics of menopause to be a bit tiresome (and somewhat off the mark more often than not).

    I hope you accept my comments in the spirit in which they are intended (to further the discussion about an important topic for all women). Keep up the good work!

    Thanks, Debra

    • 1-24-2011

      Thank you Debra and I am happy that you found me. I would encourage you to delve into the blog archives; I think that you will find that I do support well-researched decisions when it comes to healthcare. But what I don’t support is disease mongering and unfortunately, menopausal women have long been the target of the either-or syndrome. I too, take antidepressants and I support their use. In so far as hormones go, if you are going to go that route, so long as you are happy, then go for it. I merely try to share as much information as possible about alternatives so that women know that they do have a choice and say in the matter.

      All the best to you and thank you for sharing!

Trackbacks/Pingbacks

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