FEBRUARY 15, 2005
VOLUME 2 NO. 3
 

Was the benefit all in their heads?

Sugar pills seem to perform just as well as SSRIs for hot flushes


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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