Antidepressants no longer effective?


Question from Ann: I am dealing with stage IV breast cancer and surgical menopause. My menopausal symptoms are brutal. I have been on antidepressants, but they are no longer effective. Any suggestions?
Answers - Mindy Goldman, M.D. There are a number of prescription alternatives to hormones to treat menopausal symptoms. Typically, most people use some of the SSRI antidepressants as first line treatment. With these, it's important to note that the doses used to treat hot flashes are very different from the doses used to treat depression. They are much lower doses.

The antidepressant that has been studied the most is Effexor (chemical name: venlafaxine), but Paxil (chemical name: paroxetine), Prozac (chemical name: fluoxetine), and Zoloft (chemical name: sertraline) may also be beneficial. If you are using low doses of an antidepressant specifically for hot flashes and one isn't working, it's possible to switch to a different one. There are also other prescription drugs which may help.

If your blood pressure is on the high side, there is an antihypertensive medicine called clonidine (brand name: Catapres), which may be helpful. It's important not to use this medicine if you have normal or low blood pressure as it can make you light-headed or dizzy. There have also been two studies recently published looking at the neuropathic pain reliever Neurontin (chemical name: gabapentin) for treatment of hot flashes, so this may also be an option. Another option that some find very useful is Vitamin E at a dose of 400 IU two times per day.

Editor's Note: If you are taking tamoxifen, talk to your doctor about which antidepressants are safe for you to take. Some antidepressants -- including Paxil, Wellbutrin (chemical name: bupropion), Prozac, Cymbalta (chemical name: duloxetine), and Zoloft -- interfere with the body's ability to convert tamoxifen into its active form, preventing you from getting the full benefit of tamoxifen. For more information, please visit the Tamoxifen page.

On Wednesday, July 21, 2004, our Ask-the-Expert Online Conference was called Managing Menopausal Symptoms. Mindy Goldman, M.D. and Marisa Weiss, M.D. answered your questions about how to manage menopausal symptoms, including hot flashes, vaginal dryness, loss of libido, and more.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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