Hot-flash help

With the dangers of hormone replacement therapy now well-known to millions of American women, many of them have begun looking elsewhere for relief from hot flashes. Antidepressants could help.

A new study has found that the popular drug Paxil reduces the severity and frequency of hot flashes in women suffering from the sudden spikes in body temperature. Similar successes have been reported with other relatively new antidepressants.

Hot flashes, which are often accompanied by flushing and heart palpitations, occur in more than three-quarters of menopausal women and may persist five years or longer. Although their origins aren’t well-understood, hot flashes are thought to involve low levels of serotonin, a chemical that lets brain cells communicate with each other.

Dr. Vered Stearns, a breast cancer oncologist at the Johns Hopkins School of Medicine in Baltimore, reported in the current issue of the Journal of the American Medical Assn. that women with two to three hot flashes a day got relief from paroxetine (Paxil). Like other selective serotonin reuptake inhibitors (SSRIs), it boosts brain levels of serotonin.

Paxil not only reduces menopausal women’s hot flashes; it also “stabilizes their moods, their tearfulness, sometimes gives them more energy and eliminates the blahs,” said Dr. Louann Brizendine, director of the Women’s Mood and Hormone Clinic at UC San Francisco, who was not involved in the study but who frequently prescribes antidepressants for menopausal symptoms. Since the JAMA study was published, “we’re getting a lot of requests directly for it.”

Last July, part of the federally funded Women’s Health Initiative study was ended three years early because it showed that women taking estrogen combined with progestin for several years increased their risks of developing breast cancer, heart disease and strokes. Additional findings from the WHI published in the May 28 issue of JAMA indicated that women who take the hormone combination after menopause nearly double their risk of dementia.

Given the increasing concerns about hormone replacement, Brizendine expects psychiatrists and psychopharma- cologists “to be called upon to prescribe these medicines and help manage side effects of antidepressants, like headache, nausea and some sexual dysfunction.”

Stearns lead the 17-site study of 165 menopausal women, in which 51 got 12.5 milligrams of Paxil; 58 got 25 milligrams and 56 women got a dummy pill daily. After six weeks, during which the women scored their hot flashes by frequency, severity and duration, more than 60% of those getting Paxil reported at least a 50% reduction in their hot flash scores. Those getting a placebo posted 38% reductions.

Brizendine said the study was especially important because it was the first to be conducted on healthy women. Others have been conducted on breast cancer patients who can’t take estrogen.

For example, last year, researchers at the Mayo Clinic in Rochester, Minn., reported that 75 milligrams of long-acting venlafaxine (Effexor), which boosts both serotonin and another brain-signaling chemical called norepinephrine, taken for eight weeks reduced hot flashes among breast cancer patients by more than 60%. Mayo researchers also found that fluoxetine (Prozac) reduced hot flashes by about 50%.

Although many questions remain about using antidepressants to treat hot flashes, such as what dosage is appropriate and how long to take them, Brizendine suggested women might want to start at the lowest doses. They could gradually increase the amount of medication until symptoms abate, he said, and remain on the drugs for the two to three years when hot flashes are most severe.