Antidepressants For Hot Flashes: What You Need To Know

antidepressants-for-hot-flashes-what-you-need-to-knowAntidepressants really aren’t very useful for combating menopausal complaints. But that hasn’t stopped a lot of people from trying them.

But consider this: Even the Food and Drug Administration’s own panel of experts voted against the use of their newly approved antidepressant to treat hot flashes in menopausal women. The published data showed minimal benefits, and the risks of side effects and addiction are serious. In the 24-week study, it was reported that there were three cases of suicidal outlooks and one suicide attempt after only 12 weeks of treatment.

But in an unusual override, the FDA approved the use of this drug, called Brisdelle, to treat moderate to severe hot flashes. This drug belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) that come with a lengthy list of side effects. Furthermore, Brisdelle shows only minimal benefits against hot flashes. Even with the small percentage of results that were observed, the drug’s mechanisms of action are still unclear.

So why did the agency approve Brisdelle for hot flashes? Low-dose antidepressants have been used “off label” to treat hot flashes. SSRIs were initially thought to be good for women with breast cancer who were on Tamoxifen, a common breast cancer treatment, and who experienced increased hot flashes. Recently, however, it was found that these antidepressants can interfere with Tamoxifen, so they are no longer recommended. Then, the results of the large Women’s Health Initiative study came out that revealed the risks of taking synthetic and animal-derived hormones for menopausal symptoms. As a result, thousands of women stopped all hormone therapies. Thus, the need for new treatments for hot flashes led to a booming market.

The Trouble With Antidepressants

Antidepressants are rarely a recommendation of mine, but they may be helpful for a small percentage of people in combination with holistic mental health approaches. Potential side effects of these drugs are serious, and their long-term benefits and effects are largely unknown (as is the case with so many new drugs). Reported potential side effects of SSRIs include joint and muscle pain, upset stomach, insomnia, rashes, headaches, nausea and diarrhea.

Then there are the more serious potential side effects of these antidepressants:

  • Reduced blood-clotting capacity that increases risk for stomach or uterine bleeding. Using an SSRI along with NSAIDs (aspirin, ibuprofen, naproxen, COX-2 inhibitors) more than doubles the risk of internal bleeding.
  • SSRIs can diminish sexual interest, desire, performance and satisfaction.
  • Suicide. “When compared with a placebo, all antidepressants, including SSRIs, seem to double the risk of suicidal thinking, from 1 percent-2 percent to 2 percent-4 percent, in both children and adults.”

Natural Support For Hot Flashes

Luckily, there are integrative approaches that can help restore hormone balance and reduce menopausal symptoms while supporting long-term health.

The exact causes of hot flashes during menopause are unknown, but a number of factors point to a dysregulation of the hypothalamus, the body’s thermostat. This area at the base of your brain helps regulate body temperature and is closely influenced by other endocrine glands and overall hormonal balance. It is believed that the rapid estrogen reduction that occurs during menopause could be one reason for hypothalamic dysfunction. Obesity, smoking, alcohol intake and lack of exercise have all been shown to increase the frequency of hot flashes.

Using Bioidentical Hormone Replacement Therapy

As the research into hormone replacement therapy continues to evolve, one thing is clear: Synthetic hormone replacement therapy comes with its own set of serious risks — mainly breast cancer and increased risk of cardiovascular disease. The body simply doesn’t do well with synthetic hormone compounds or with hormones made from animal urine or other animal-based sources.

Natural, plant-based bioidentical hormones with the same chemical structure as those made by the body may be much safer; but large studies have yet to be done. Many women are using low doses of bioidentical hormones, often in the form of cream, sublingual tablets or patches that allow the hormone to go directly into the bloodstream without being broken down in the liver. I generally recommend that women try natural, nonhormonal alternatives as a first choice. Every woman considering hormone therapy should be carefully evaluated for individual risks of breast cancer as well as tested for proper  hormone metabolism. For more information, watch this informative video from Amitabha Medical Clinic.

Diet, Lifestyle And Supplements

Many women find relief from hot flashes by making dietary and lifestyle changes: increasing exercise; reducing fats, alcohol and spicy foods in their diets; and undertaking stress-reducing practices such as meditation, tai chi or chi gong. Acupuncture and the use of Chinese herbs can also be very effective.

I often recommend herbal formulas such as a Tibetan Herbal Formula, which has cooling properties, increases circulation and promotes the release of excess heat from the body. Combinations of herbs and compounds such as black cohosh, red clover, sage, dong quai and hesperidin can be effective as well. The addition of flax seeds and fermented soy products such as miso and tempeh to meals can provide a mild estrogenic effect that can reduce hot flash severity. I also recommend a comprehensive multi-nutrient and herbal formula specifically designed to offer support for women going through the transition of menopause.

One study combined the extract of magnolia bark, which includes honokiol, with phytoestrogen compounds from soy. Results showed significant reduction in not only hot flashes, but in anxiety, insomnia and irritability — common symptoms that are often intensified during menopause. Getting sleep cycles and anxiety under control contributes to reducing hot flash frequency and severity.

My advice to my patients is to start with diet and lifestyle changes, adding in herbal remedies and food sources of phytoestrogens first. If these measures are not sufficient, low doses of bioidentical hormones can be considered. Menopause can be a time to take charge of your health and incorporate changes that will improve your overall vitality and well-being while controlling hot flashes and other potentially uncomfortable symptoms naturally.

For more information, visit http://www.dreliaz.org/.

Dr. Isaac Eliaz

By Dr. Isaac Eliaz

Dr. Isaac Eliaz is a renowned integrative medical doctor, licensed acupuncturist, researcher, product formulator and frequent guest lecturer. He has been a pioneer in holistic medicine since the early 1980s, and has published numerous peer-reviewed research papers on several of his key integrative health formulas. He is the founder and medical director of Amitabha Clinic in California, an integrative health center specializing in cancer and chronic conditions. Dr. Eliaz is an expert in using highly strategic, synergistic protocols to address numerous areas of health including metastatic cancer, immunity, digestion, detoxification, diabetes, cardiovascular health and more. His approach integrates modern science with traditional healing wisdom for optimal health and wellness. To download any of Dr. Eliaz's comprehensive wellness guides, click here.  

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