A team of Finnish researchers
just wanted to get some longerterm data on the efficacy
of the selective serotonin reuptake inhibitors (SSRIs)
in treating menopause symptoms when they stumbled on an
unpleasant discovery. They found that while symptom control
was good with SSRIs, they didn't fare much better than
placebo. So, were improvements due to subjects' skewed
perceptions? Was it all in their heads?
As the risks associated with hormone
therapy have become clearer, women are looking for other
ways to deal with menopause. Based on the results of
clinical trials, SSRIs have become candidates for treating
both the psychological and the physical symptoms of
menopause.
LOOKING
LONGTERM
However, many of these studies only looked at shortterm
effects. A Finnish team, led by Oulu University's Dr
Suvanto-Luukkonen, wanted to change that. "Our study
is the first study with a longer followup, up to nine
months," she explains. "In previous studies the followup
time has been only four to six weeks. In clinical work,
that's far too short a time to evaluate clinical compliance
and effectiveness."
The team conducted a randomized,
double-blind, placebo-controlled study that included
150 healthy symptomatic postmenopausal women. The study,
published in the January/ February 2005 issue of the
journal Menopause, looked at the number of hot
flushes experienced by women receiving one of two common
SSRIs, citalopram and fluoxetine, or placebo. The women
also answered questionnaires that evaluated the effect
of treatment on their psychological health and quality
of life.
NOT
AS EFFECTIVE AS ESTROGEN
When the results were analyzed, the researchers found
that all treatments decreased the number of hot flushes:
fluoxetine, by 50%, citalopram, by 70%, and placebo,
by 60%. In the study, the team "regarded the medication
to be effective if it was 20% better than placebo. That
was not achieved by citalopram or fluoxetine." On the
bright side, citalopram did improve insomnia better
than placebo.
Over nine months of treatment,
SSRIs "give some relief to menopausal hot flushes, but
the effectiveness is not comparable to estrogen and
therefore, they cannot be regarded as an effective treatment
option for menopausal hot flushes," concludes the doctor.
Other studies have shown estrogen therapy decreases
hot flushes by up to 80%.
As for the high response seen in
women receiving placebo, Dr Suvanto-Luukkonen comments,
"In our study the placebo effect was considerably high,
but not exceptionally high. Also in hormone therapy
studies, a 50% placebo effect is frequently seen. The
blinding was complete, and the results of our study
were surprising to us too!" It may be that for symptoms
of menopause the attention and support provided by a
caring physician is as important as the pharmacologic
effect provided by a drug.
Menopause Jan/Feb, 2005;12:18-26
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