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Anti-depressant counters hot flashes from menopause, chemotherapy


(CNN) -- Researchers based at the Mayo Clinic in Rochester, Minnesota, have found that a medication used to treat depression is also effective against one of the most disturbing symptoms of menopause.

"I am not aware of any other non-hormonal treatment that has been studied that is as effective" as venlafaxine, said Dr. Charles Loprinzi, an oncologist at the clinic and principal investigator of a study on the drug. "I think it represents the best of the non-hormonal options for treating hot flashes in women with breast cancer."

Hot flashes also can be a major problem for women undergoing chemotherapy treatment for cancer. Chemotherapy can induce premature menopause, and a commonly prescribed medication for breast cancer patients called tamoxifen also is known to cause hot flashes.

"For people who do not want to take hormonal therapy for hot flashes, this represents an option," Loprinzi said. "It also ought to work well for menopausal women without breast cancer."

Occurring several times a day, hot flashes can often feel disabling. Associated symptoms may include severe sweating, and hot flashes that take place at night also can disrupt sleep.

The symptoms generally start on the chest, neck and face, and can be accompanied by headache, nausea or difficulty concentrating.

Women who are being treated for breast cancer are often prohibited from using traditional hormone replacement therapy because breast cancer can be sensitive to estrogen, the predominant female hormone.

Alternative hormone-free treatments are available -- herbs such as black cohosh, for example, or chamomile -- but there have been few scientific studies.

"We've done a series of trials over the last 10 years or so looking at ways of treating women in menopause and with breast cancer," said Loprinzi, who is professor and chair of medical oncology at Mayo.

Anecdotal evidence suggested that venlafaxine, one of a newer class of antidepressants called selective norepinephrine reuptake inhibitors, could alleviate hot flashes, he explained.

A four-week trial involving 229 women, most of whom had a history of breast cancer, revealed that venlafaxine was 60 percent effective against hot flashes.

Researchers studied dosages at 37.5, 75 and 150 milligrams a day. The optimum dosage was 75 milligrams daily, Loprinzi said. "And the effects we saw were within a week."

Side effects reported were generally mild, and included dry mouth and loss of appetite. The most severe side effects were nausea and some vomiting, but most of the patients who were able to continue taking venlafaxine overcame nausea as their bodies adjusted to the medication, he said.

Some women may be wary of taking an antidepressant for menopausal symptoms, and cost also may be a negative factor, the physician noted. Venlafaxine, marketed as Effexor, can cost about $2 a tablet.

Still, it may be a useful treatment for women who are leery of hormone replacement therapy and its associated risks. Other non-hormonal treatments studied thus far have not been as effective as venlafaxine, said Loprinzi.

These substances have included Vitamin E and the blood pressure medication clonodine.

Researchers also are continuing to study newer treatments, including other antidepressants and a progesterone-based medication, he said.

Anti-depressants can ease hot flashes in cancer patients
May 23, 2000
Breast cancer risk greater with estrogen/progestin combination
January 25, 2000
Alternatives to hormone replacement therapy for menopause
June 4, 1999
Pregnancy, hot flashes keep women awake, research says
October 22, 1998

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