It sounds like the beginning of a bad joke—women have been on the receiving end of jokes and quips about menopause in all its hot-flashing, mood-roller-coastering, sleep-destroying glory for decades—and now antidepressants can be prescribed for some of these symptoms. I can hear women all over the United States uttering their most sarcastic “really?” and awaiting the punch line. The truth is that menopause, while not an illness or a disorder, can be terribly debilitating. Hot flashes might not sound all that bad until they disrupt sleep for months on end. Poor sleep is a leading cause of irritability and poor concentration—both of which wreak further havoc on menopausal women and their families, friends, partners, coworkers, etc. Depression and anxiety are also common menopausal symptoms. Add in other discomforts and indignities such as acne—yes, acne often returns during menopause—and discomfort during intercourse, diminished libido, memory loss, weight gain and other age- and hormonally-linked concerns such as decreased bone density, and for some women the whole process feels more like a trial to be endured than a natural rite of passage. While the severity of the impact varies from woman to woman, most women do experience at least some unwanted symptoms, hot flashes being among the most common.
SSRIs for Hot Flashes?
The hope of some relief has recently come to light in the form of FDA approval for using paroxetine (known by its brand name, Paxil) for hot flashes. Paxil is a serotonin-specific reuptake inhibitor (SSRI): an antidepressant that works by preventing serotonin from being reabsorbed, thus increasing the overall serotonin level in the brain. While there has been some question about the precise nature of the link between serotonin levels and depression, the FDA’s approval of low doses of paroxetine specifically for hot flashes is hopeful news for women suffering from these menopausal symptoms. The specific medication that has been approved is called “Brisdelle,” made by the Japanese pharmaceutical company Noven. In clinical trials, Brisdelle performed better than the placebo, reducing the frequency of hot flashes by 57 percent to 59 percent in women who had been reporting at least seven hot flashes per day. The dosage studied was 7.5 milligrams, a dose significantly lower than the typical 30 to 40 milligrams used to treat depression. However, the control group in the study (that is, women who received a placebo) also reported a reduction in the frequency of hot flashes: these women reported a reduction of between 40 percent and 48 percent. Women experiencing fewer than seven hot flashes per day were not included in this study, raising the question as to whether Brisdelle would be helpful is milder cases.
Hormone Replacement Therapy?
Prior to the approval of paroxetine for this use, hormone replacement therapy (HRT) was the treatment frequently recommended for women experiencing severe hot flashes. HRT is considered problematic by many women due to the laundry list of serious cardiovascular side effects, and the increased risk of developing breast cancer. For some women, the source of the hormones used in traditional HRT is an additional concern. However, in terms of effectiveness for use in reducing hot flashes, HRT has outperformed paroxetine to a significant degree, with women reporting a 65 percent to 80 percent reduction in frequency of flashes. The FDA’s approval comes despite a recommendation by the committee studying Brisdelle not to approve the medication for this specific use. The lack of a recommendation was due to the minimal effectiveness seen when compared to the control group, and not due to any concerns regarding side effects or dangers of using paroxetine. Neurontin, another medication also seeking approval for use as treatment for hot flashes, was also not recommended.
SSRI Side Effects to Consider
While SSRIs are very well tolerated by many people, some side effects are common. Upset stomach and headache are common at first and often disappear after a few days or weeks. Other side effects of paroxetine are somewhat more vexing, harder to treat, and seem resistant to efforts to alleviate them. These more troublesome side effects include decreased libido, decrease in bone density and a risk of osteoporosis, and more rare but serious mood issues with which SSRIs are known to be correlated.
Other Options?
Struggling with hot flashes, insomnia and mood issues due to menopause, but not sure you want to take medication? Many women seek alternatives to medications during menopause and some of the lifestyle changes you implement now may be wonderful additions to your routine as you grow older. Yoga, meditation, tai chi or chi gong are all potential aids to stabilize mood, promote relaxation, and may even help with insomnia. Certain herbs can be extremely helpful to some women during menopause; dietary changes may also help curb weight gain and decrease hot flashes. Even simple changes to your daily routine may help ease your symptoms: taking a walk after dinner might help ease night-time hot flashes, and, for some women, placing a towel on the fitted sheet before getting into bed at night seems to help minimize the disruption of night sweats.