The latest medical ammunition to help postmenopausal women cool their hot flashes and quell their night sweats aims right at the head. Some studies suggest that antidepressants may soon be the next trend in the treatment of women’s menopausal symptoms.
Research shows that certain antidepressants have the remarkable side benefit of reducing the annoying and sometimes debilitating heat surges associated with menopause. The trouble is, the antidepressants’ own side effects might be as bad, or worse, than the hot flashes and night sweats women are trying to avoid. And the price for the medications is not trivial either.
Wyeth Pharmaceuticals has a new antidepressant, Pristiq, currently under review by the FDA for treatment of menopause-related hot flashes and night sweats. “Pristig is going to fill a needed void,” claims researcher David Archer, MD, professor of obstetrics and gynecology at Eastern Virgina Medical School in Norfolk.
Studies on using antidepressant treatments to treat hot flashes or night sweats have been heating up for several years. It started when hormone replacement therapy (HRT), the traditional standard of care for postmenopausal symptoms in the form of estrogen and/or progesterone, dramatically dropped off due to widely publicized reports of increased risks of heart problems, strokes and breast cancer in older women on long-term HRT.
In seeking non-hormonal solutions to menopausal hot flashes, researchers expanded upon an initial finding that some antidepressants helped minimize hot flashes in breast cancer patients treated for depression. Multiple subsequent clinical studies have demonstrated, to varying degrees, the effective use of antidepressants in healthy menopausal women suffering from excessive hot flashes and night sweats.
Antidepressants, however, do not quite measure up to the power of hormone treatments in reducing hot flashes and other menopausal symptoms. In a clinical trial testing another of Wyeth’s antidepressant drugs, Effexor, the antidepressant decreased women’s hot flashes by 60%, while estrogen treatments reduced the frequency of hot flashes by 80%.
In addition, Effexor caused numerous side effects in some women including dry mouth, nauseas and constipation. Other antidepressants can also lead to low sex drive, anxiety and sleep problems. “Some women are fine with them and say it helps and it makes a difference,” said Cynthia Person, executive director of the National Women’s Health Network. “Other women, after two to three weeks, they say ‘Forget it, I don’t feel like myself.’”
Newer, “second generation” antidepressants like Wyeth’s drug pristig have been designed to make antidepressants more tolerable, but the negative effects are not completely erased. “Hormone therapy is probably still the best for hot flashes,” Archer admits. But pristig, if approved, will at least give some women another option, he believes.
Antidepressants are thought to work by modifying levels of key chemicals in the brain called neurotransmittors. Two examples are serotonin and norepinephrine. Serotonin, in particular, appears to play an important role in regulating body temperature, sleep, appetite and mood in a similar manner to estrogen. Researchers think that fluctuations in estrogen during menopause may diminish both serotonin and norepinephrine in the brain. Antidepressants help by restoring normal levels of serotonin and noreprinephrine.
The variable results of antidepressants for the treatment of menopausal symptoms remain to be sorted out. Timing of treatment may be one factor. In some studies, women who were most recently menopausal appeared to benefit more from the antidepressant treatments compared to those who had not had their periods for a year or longer.
“They are helpful for some women, but right now it’s impossible to predict for whom they will work,” says Dr. Shari Lusskin, director of reproductive psychiatry at the New York University Medical Center. “It offers an option for women who don’t want to take hormones. But we don’t know what long-term use of these drugs does to people who are not depressed.”
The bottom line is that the antidepressants currently available could work for menopausal treatments but may be limited in their use due to cost and side effects. “These therapies may be most useful for highly symptomatic women who cannot take estrogen but are not optimal choices for most women,” concludes researchers from Oregon Health and Science University in Portland, Oregon.
Stay tuned. Perhaps as newer antidepressants are developed with menopause symptoms in mind, the use of antidepressant treatments for hot flashes and night sweats may be just warming up.
Links to Original Articles:
Doheny, K., 2007. “Hormone-Free Hot Flash Drug on Horizon,” WebMed News article:
http://www.webmd.com/menopause/news/20070509/hormone-free-hot-flash-drug-on-horizon
Parker-Pope, T., 2007. “Antidepressants Emerge as Coolant for Hot Flashes,” The New York Times article: http://query.nytimes.com/gst/fullpage.html?res=9C05EFDC1531F93AA35753C1A9619C8B63
Nelson, HD., et al., 2006. “Nonhormonal therapies for menopausal hot flashes; systematic review and meta-analysis,” JAMA: http://jama.ama-assn.org/cgi/content/abstract/295/17/2057
Related Link:
WebMD, 2008. “Menopause and Hot Flashes,” on line article: http://www.webmd.com/menopause/guide/hot-flashes