Hello? Can You Hear Me? How crazy is this? Suppose you want to avoid risking the adverse side effects of a popular drug. You mention this to your doctor. So your doctor suggests you use another popular drug with its own set of potential health risks. You might be tempted to move your hand back and forth in front of your doctor's eyes and say, "Hello? Anybody in there? Can you hear me?" Recently, while browsing through online articles, I came across this headline: "Antidepressant May Help Treat Hot Flashes." I thought: Can this be as bad as it looks? Answer: Yes it can. The article features comments from an OB/GYN at a prominent Baltimore hospital who notes that research shows paroxitine (Paxil's generic name) may relieve hot flashes. She also states that hormone replacement therapy (HRT) carries risks for some women, so paroxitine is "a great option for them." Well, that would depend on what your definition of "great" is. Would you say that using a powerful antidepressant to address one and only one symptom of menopause qualifies as "great"? The research that the doctor refers to is probably a 2003 study that appeared in the Journal of the American Medical Association. Researchers randomly selected a group of 165 menopausal women who experienced hot flashes and who were not taking a hormone replacement therapy. Roughly one-third of the group received 25 mg of Paxil daily, one-third received 12.5 mg daily, and one-third received a placebo. The frequency and severity of hot flashes were approximately reduced (on average) 65 percent in the first group, 62 percent in the second group, and 38 percent in the placebo group. The researchers concluded that Paxil may be "an effective and acceptable" therapy for treating hot flashes. Going just by the numbers of this study, it appears that Paxil does relieve hot flashes. So I'll give them "effective." But the word I have trouble with is "acceptable." Because when you look at the wide variety of problems that Paxil users have reported over the past decade, it would be stretching the point considerably to call this drug acceptable. But is there a chance that the researchers were unaware of the side effects associated with Paxil use? No. No chance. Because three of the four members of the research team are employees of GlaxoSmithKline, the maker of Paxil. Those howls of outrage you hear are coming from my office. The web site for Paxil CR (controlled release) includes this list of the drug's potential side effects: infection, nausea, diarrhea, constipation, dizziness, sweating, tremor, sexual side effects, weakness, insomnia, sleepiness and abnormal vision. Oh, and one more: depression. That's right - the very thing that Paxil is designed to relieve. For those who try Paxil, experience a side effect and decide to stop using the drug, there's yet another problem lying in wait. Some patients report harsh side effects when they try to discontinue Paxil use. According to a report in the British Medical Journal, in case after case, patients coming off the drug experienced nightmares, dizziness, burning and itching of the skin, agitation, sweating and nausea. And for many of those patients, the only way to treat the side effects was to begin taking Paxil again! The FDA has issued a warning that withdrawal symptoms from Paxil may be severe. All of these problems associated with Paxil are fairly well known. So outside of those who would like to sell us this drug, you have to wonder how anyone could possibly characterize Paxil as an acceptable trade off for hot flashes. Sources:
"Antidepressant May Help Treat Hot Flashes" WBAL TV, 1/23/06, thewbalchannel.com
"Paroxetine Controlled Release in the Treatment of Menopausal Hot Flashes" Journal of the American Medical Association, 2003;289;2827-2834, jama.ama-assn.org
"Frequent Paxil (Paroxetine) Side Effects" Prozac Truth, prozactruth.com
"Withdrawal From Paroxetine Can Be Severe, Warns FDA" Alison Tonks, British Medical Journal, 2002;324:260, 2/2/02, bmj.com
"Halting Hot Flashes - Researchers Say Antidepressants May Help Menopausal Women" ABC News, John McKenzie, 6/3/03, abcnews.com | 
