Hot flashes, Oy Veh!
Submitted by Dr.Kattlove’s Cancer Blog
I think I wrote about this before – postmenopausal women who have been treated for breast cancer and suffer from hot flashes. I remember some women practically begging for some kind of relief because their hot flashes were so intense. They were losing sleep, were unable to function during the day, and were generally miserable. Back then, we thought it safe enough to prescribe them small doses of estrogen to allay their symptoms. No more. Studies have shown that this may make the cancer recur.
So what to do? A recent article in the Journal of Clinical Oncology has provided us with a little hope. The study was led by Charles Loprinzi, who has done a lot of work in this area. Antidepressants seem to be the most effective drugs for countering hot flashes. Although the women may be depressed over their symptoms, that isn’t why the drugs work. Rather, the drugs may work on the same chemical pathways in the brain that lead to the hot flashes.
In the article, Loprinzi and his co-researchers reviewed all the properly performed studies that tested the effectiveness of antidepressants as well as another drug called gabapentin (Neurontin) in reducing hot flashes in breast cancer survivors. The studies were all placebo controlled - meaning that half the women in the study received a non-active pill, to eliminate the power of suggestion as a cause of feeling better, and the other half received the real drug.
Hot flashes were measured with a “hot flash score” which depends totally on patients’ reporting their symptoms. This is why a placebo control is so important. Everyone wants to feel better so they may think they are better, even though they only got the “sugar pill”. In fact, in almost every study, women who received the placebo reported a drop in their “hot flash score” of around 20 percent. But the antidepressants and gabapentin did much better. They lowered this score by around 40-50 percent, sometimes even more depending on the dose used.
All the antidepressant studies used the more modern kind, called SSRI inhibitors, like Prozac or Paxil. In fact Paxil, which is a generic SSRI, worked as well as the more expensive brands. Although it still isn’t cheap (50 cents to a dollar a day depending on dose), it is still much less than a Starbucks a day.
The downside is, of course, that there are side effects – check them out on the web. Also, probably fewer than half the women were helped by these drugs, and I don’t think many if any saw their symptoms disappear altogether. Still, antidepressants are worth trying. The authors also suggest that if one drug doesn’t work, another might.
Nothing ventured, nothing gained.
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June 23rd, 2009 at 2:15 am
Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.