Subjects: R and D
Hot flashes are a common symptom of menopause. Lasting from two to 30 minutes per episode, they usually begin with a sensation of intense heat on the face or chest which then spreads to other parts of the body. This sensation is often associated with sweating and tachycardia.
Not all women experience hot flashes, and for many others the symptoms amount to little more than a minor annoyance. But for some, hot flashes are down right debilitating. They have been known to precipitate fainting, for example. Some women experience several dozen hot flashes per day, and each one is severe enough to interrupt sleep or force them to cease normal activities until it subsides.
Hormone replacement therapy works like a charm for nearly all affected women, but it has fallen out of favor in the last decade or so, after scientists showed the therapy increased the risk of cardiovascular disease and breast cancer, among other things.
Women who suffer debilitating hot flashes, and the physicians who treat them will thus be heartened to learn that the antidepressant Lexapro reduces the frequency and severity of hot flash symptoms.
That’s the conclusion reached by Ellen Freeman and colleagues at the University of Pennsylvania, who recently published their findings in JAMA.
To reach this conclusion, Freeman’s team randomized 205 healthy menopausal women to receive either Lexapro or a placebo. Each volunteer reported experiencing at least 28 hot flashes per week. As a group, they averaged 9.8 hot flashes per day before the study began.
Women who didn’t have a favorable response after 4 weeks had their dose doubled from one pill to two (for those receiving Lexapro, this meant doubling the dose from 10mg to 20 mg).
After the 8-week study, women who took Lexapro reported experiencing 5.3 hot flashes per day, a 47% drop from baseline levels. Interestingly, the women who took placebo saw their hot flashes drop by 33%, to 6.4 per day, a finding that was significant in its own right.
In addition, Lexapro rendered the hot flashes less bothersome. Women in the Lexapro group said the severity of their hot flashes dropped by 0.6 on a 4-point scale, which compared favorably to the 0.4 point drop reported by women who received placebo.
Freemen’s group suggested that their findings were impressive enough for the drug to be given consideration as a first-line treatment for hot flashes. They cautioned however that the sizable placebo effect suggests “the importance of nondrug factors in clinical care and the potential for nonmedical approaches as other possible therapies for reduction of hot flashes.”
Still, the results of this study suggest Lexapro isn’t nearly as effective as hormone replacement therapy, which eradicates the symptoms in fully 95% of women. What is more, scientists have little knowledge about the long-term effects of Lexapro on healthy, non-depressed women, or what might happen when the drug is withdrawn.
“Will these women become depressed; will they have withdrawal problems?”wondered Wulf Utian, in an email to MedPageToday responding to Freeman’s report. “We simply do not know, and until such time as there is adequate safety information, I would advise clinicians to tread carefully before prescribing, and women to be cautious,” added Utian, who is the former executive director of the North American Menopause Society.