Antidepressant reduces hot flushes

Main Category: Public Health
Also Included In: Flu / Cold / SARS
Article Date: 06 Jun 2003 - 0:00 PDT


An antidepressant has been found to help women by reducing menopausal symptoms such as hot flushes.

The study of the drug paroxetine was funded by its makers GlaxoSmithKline.

Menopausal symptoms are usually treated with hormone replacement therapy, which reduces flushes by 80 to 90%.

But concerns have been raised about HRT, after a study suggested an increased risk of heart attack, stroke, blood clots and breast cancer, so doctors have been looking for alternatives.

It is thought hot flushes occur when falling oestrogen levels affect the central nervous system's temperature control mechanism.

Drugs including paroxetine had been seen to reduce hot flushes in women with a history of breast cancer.

It is believed they worked inhibited the brain's reuptake of serotonin, a natural chemical that modulates mood, emotion, sleep and appetite.

Improvements

Paroxetine, sold in the US as Paxil and in the UK as Seroxat, is usually used to treat depression or anxiety.

But concerns have been raised that paroxetine, a selective serotonin reuptake inhibitor (SSRI), can be addictive, contrary to manufacturers' claims - and increase the risk of suicide in some patients.

An independent expert also said it may not help all women with menopausal symptoms.

The US study looked at 138 women who had been having two to three hot flushes a day, most for at least a year.

They were questioned about their symptoms and allocated to take either 12.5 or 25 milligram tablets, or a dummy version every day for six weeks.

It was found taking either dosage of Paxil reduced hot flushes by over 60%.

Women taking the higher dose showed significant improvements within a week.

Two-thirds of all those taking the drug reported a 50% or more reduction in the severity and frequency of hot flushes after a six-week course of treatment, while 30% had no flushes by the sixth week.

Only mild side effects, such as nausea and headaches, were experienced by women taking paroxetine.

'Less benefit'

Vered Stearns, assistant professor of oncology at Johns Hopkins' Sidney Kimmel Comprehensive Cancer Center, who led the study, said paroxetine was 'the best nonhormonal drug we know about right now'.

'If a woman wants to try nonhormonal therapy, she will know within days whether it's going to work.'

He said more work was needed to assess the ideal dose and whether all women would experience the benefits.

But Steven Goldstein, a gynaecologist at New York University Medical Center, said antidepressants had far less of a benefit than hormone therapy.

He added: 'For women who cannot, should not or will not take hormone therapy this may be a possible option, but in no way, shape or form is it a substitute for oestrogen for people with disruptive symptoms.

'I would probably only think of something like this in women who absolutely cannot consider short-term low-dose oestrogen therapy, women with breast cancer, women on the breast cancer drug tamoxifen.

'For that sub-group, this is a nice thing to be able to offer them.'

The research is published in the Journal of the American Medical Association.

• Additional
• References
• Citations