The Antidepressant Debate
More and more menopausal women, reluctant to partake of hormone replacement therapy (HRT) because of the slight risks for breast cancer and cardiovascular disease are asking their doctors to prescribe antidepressants to ease their menopause symptoms. Some doctors may be too impatient to spend time explaining why antidepressants may be a bad choice for treating menopause symptoms. It's tempting to just give their women patients what they want and be done with it—but menopause isn't a mental health issue and antidepressants may not be the answer.
Back in the 1950's, women were handed scripts for valium for the relief of moodiness and anxiety. Outdated? Actually, many women are still being given antidepressants for the symptoms of menopause. Some women feel that this tendency to prescribe such medications is a kind of negative subliminal message that tells women that menopause is a bad time for them in which there are factors that can make them depressed and which they cannot avoid. Furthermore, says this voice, there is a magic pill that can fix you and make that bad stuff go away.
An intelligent consumer, however, will want to check out whether this magic bullet approach is effective and safe. After all, using these medications for menopause symptoms is off-label use. Women will also want to find out how these medications affect them over the long term.
There are four major classes of antidepressants: MAOI's, tricyclics, SSRI's, and SNRI's. Those from the latter two groups, SSRI (selective serotonin reuptake inhibitors) and SNRI's (serotonin and norepinephrine reuptake inhibitors) have been shown to reduce hot flashes during some clinical trials. At the same time, of course, they can help with the moodiness that sometimes comes during menopause. Some of these drugs have received approval and in some cases, have had their names changed to address their marketing potential for women suffering from premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). But none of these drugs have been approved by the FDA as treatments for menopause symptoms such as mood fluctuations, insomnia, or hot flashes.
One SNRI, Venlafaxine, also known as Effexor and Pristiq has been shown to reduce hot flashes but as yet has not received final FDA approval as a treatment for menopause. It received instead, something the FDA called an "approvable" letter. Sounds like a technicality, but in fact, Pristiq, when prescribed for hot flashes, is still an off-label use of the medication. The upshot is that you may want to think twice about accepting that piece of paper from your doctor offering you oblivion and relief from menopausal symptoms. After all, it is all about choice.