Medical researchers have conducted a few studies concerning Zoloft and hot flashes. A few more studies have been done concerning Paxil and hot flashes. Twice as many published studies have focused on black cohosh and hot flashes and there are even more concerning this herb and other symptoms related to menopause. Why so many studies?
Traditional herbal remedies are often the subject of scientific scrutiny, because modern medicine would like to either “prove” or “disprove” their effectiveness. They would also like to know “why” botanical remedies are effective; so, many studies revolve around isolating the active component.
Researchers began studying antidepressants like Zoloft and hot flashes in 2002, around the same time that the Women’s Health Initiative released conclusions concerning the long-term health risks associated with hormone replacement therapy. Research concerning Paxil and hot flashes prior to 2002 focused on breast cancer survivors who are unable to use estrogen replacement therapy.
Scientists and researchers are unable to explain why these drugs may be effective, or even why they would be considered for use. It is likely that they were prescribed to women who were suffering from depression, which sometimes accompanies menopause. These women may have reported a reduction in hot flashes, leading doctors to suggest that they might be useful for controlling hot flashes.
Both Zoloft and Paxil belong to a group of drugs known as Selective Serotonin Reuptake Inhibitor or SSRI. These drugs are approved by the FDA to treat depression and some are approved for the treatment of premenstrual dysphoric disorder. They are not approved by the FDA to treat hot flashes, other symptoms related to menopause, nor are they approved to treat PMS, but doctors often prescribe them for these purposes.
Even though they are not approved by the FDA to relieve hot flashes, both the American College of Obstetricians and Gynecologists (ACOG) and the North American Menopause Society recommend that women with moderate to severe, menopause related hot flashes should consider an SSRI, if they cannot or choose not to take hormone replacement therapy. Interestingly, a brochure released by the ACOG mentions that herbs and botanicals are not approved by the FDA, but they never mention that SSRI drugs are not approved by the FDA to treat menopausal symptoms.
One study concerning Paxil and hot flashes experienced by breast cancer survivors is similar to a more recent study concerning the use of black cohosh. (Black cohosh is an herb used traditionally by Native American healers and passed down from generation to generation for the relief of hot flashes and other menopausal symptoms.) As previously mentioned, women who have had breast cancer are unable to take estrogen replacement therapy, in fact they must take a drug that limits the effects of estrogen for several years following surgery. Even in women who are not near menopause, this drug causes severe hot flashes.
In the study of Paxil and hot flashes, the antidepressant was shown to reduce hot flash frequency by as much as 79%. Black cohosh was shown to reduce hot flash frequency by as much as 100%. Of the 90 women who participated in the black cohosh study, none reported adverse side effects and no one dropped out. Of the 30 women who participated in the study of Paxil and hot flashes, three (10%) dropped out because of drowsiness and one dropped out because of anxiety, a possible adverse reaction to Paxil.
Recently research was conducted by the College of Medicine at the University of Arizona concerning Zoloft and hot flashes. A group of women aged 40-65, currently suffering from hot flashes, but not taking hormone replacement therapy, were recruited. The researchers used a number called the “hot flash score”, which is equal to the number of hot flashes a woman experiences multiplied by the numerical expression of their severity, to evaluate the effectiveness of the SSRI over a four week period. A similar study concerning black cohosh and hot flashes was conducted by the Mayo Clinic.
In the study of Zoloft and hot flashes, the average number of hot flashes the women experienced per week was 45. In the black cohosh trial, the average was 8 per day or 56 per week. Zoloft reduced the frequency of hot flashes by 5 per week or 11%. Black cohosh reduced the frequency by 28 per week or 50% and reduced the average “hot flash score” by 56%.
In the study of Zoloft and hot flashes there was no significant reduction in severity, but in their concluding statement the researchers say that “sertraline (the generic name for Zoloft) reduced the number of hot flashes and improved the hot flash score relative to placebo and may be an acceptable alternative treatment for women experiencing hot flashes”.cheap zoloft, So, these researchers believe that an 11% reduction in the hot flash score represents an effective alternative treatment. Numerous studies have shown that treatment with placebo can reduce hot flashes by 20-40%.
In the Zoloft and hot flashes study, 15 women dropped out, six because of adverse reactions to the drug, 9 without giving reason. None of the women dropped out of the black cohosh trial. No adverse events or unwanted side effects of any kind were reported. Women did note that their sleep improved, they were less tired and had less abnormal sweating.
The unwanted side effects related to the use of cheap zoloft include sleep disorders, weakness, dizziness, tremors, confusion, nausea, vomiting, decreased sex drive and inability to achieve orgasm. It can induce mood swings. At least one study has shown that it increased the risk of suicide in seniors, as it does in teens and pre-teens. In fact, the FDA has released a public health warning which states that “anyone currently using Zoloft for any reason has a greater chance of exhibiting suicidal thoughts or behaviors, regardless of age.”
Worldwide, 20% of all patients in clinical trials relating to Paxil dropped out due to unwanted side effects. The side effects are similar to those of Zoloft. Both drugs can cause increased sweating, which makes it even harder to understand why researchers would conduct studies concerning Zoloft and hot flashes, Paxil and hot flashes or any other drug that can cause increased sweating, since increased sweating is what frustrates women most about hot flashes and night sweats.
Over the years, hundreds and hundreds of studies have been conducted concerning the safety of black cohosh. No one knows how long native healers have used the herb.cheap zoloft, The only known side effect is stomach ache and this is an infrequent complaint. Recent scientific evaluations have shown that it does not increase the risk of breast or endometrial cancer. So, it is unclear why medical practitioners and societies would recommend something with as many side effects as Zoloft and Paxil, when there is a safer and more effective treatment.
Depression
Encyclopedia of Childhood and Adolescence by Boris Birmaher, M.D. and David Axelson, M.D. Department of Psychiatry University of Pittsburgh School of Medicine Western Psychiatric Institute and Clinic
Until recently, it was thought that children and adolescents could not suffer from clinical depression. It was assumed that children were not physically or psychologically mature enough to develop symptoms of depression and that adolescents with mood difficulties were simply going through “growing pains.” However, several investigations have shown that if appropriately evaluated, children and adolescents do suffer from depression. We will refer to clinical depression that presents with severe symptoms as major depressive disorder (MDD) and depression that has moderate, chronic symptoms as dysthymic disorder (see below for specific criteria). Depression is relatively common; the prevalence (number of cases in one year) of MDD and dysthymic disorder combined is approximately 2% for children and 6% for adolescents.
Clinical features
Every child and adolescent can be occasionally and appropriately sad. However depression is more than just having a sad mood for a while. Children and adolescents with depression have a pervasive change in mood as well as a number of other clinical characteristics. There are four types of depression that child psychiatrists diagnose in children and adolescents: major depressive disorder (MDD), cheap zoloft,dysthymic disorder, adjustment disorder with depressed mood, and bipolar depression. Bipolar disorder (previously called manic-depressive illness) is another type of mood disorder consisting of periods of mania and depression. The diagnostic criteria and clinical presentation of the depressed phase of bipolar disorders is similar to that of MDD.
Major depressive disorder (MDD)
MDD is the most severe form of depression and has the most prominent clinical symptoms. Symptoms of MDD include:
1) persistent depressed or irritable mood most of the day (easily annoyed, angry, sad, anxious, hopeless; sometimes described as not having any emotion)
2) markedly diminished interest or pleasure in all or almost all activities (not able to enjoy activities that were previously fun, easily bored, sits around and does not do much)
3) significant weight loss or gain
4) sleep disturbance (trouble falling asleep, staying asleep, waking up too early, or sleeping more than usual)
5) psychomotor retardation (appearing to have slowed-down thinking and movements) or agitation (new onset of restless activity, pacing, unable to stay still)
6) fatigue or loss of energy (frequent complaints of feeling tired or having to push hard to do usual activities)
7) feelings of worthlessness or excessive guilt (very self-critical, blaming self for minor transgressions)
8.) difficulty concentrating (distractible, unable to focus on challenging tasks, forgetful, indecisiveness)
9) thoughts of death or suicide , or attempting suicide
According to the American Psychiatric Association , to be diagnosed with MDD, the child or adolescent must have at least five of the above symptoms nearly every day for at least two weeks, and one of those symptoms must be either: (1) depressed or irritable mood; or (2) loss of interest and pleasure. These symptoms must represent a change from previous functioning and produce impairment in relationships with others or in performance of usual activities. The symptoms and change in mood cannot be attributed to abuse of drugs, use of medications, certain severe psychiatric illnesses, bereavement, or medical illness.
Overall, the clinical picture of childhood MDD parallels the symptoms of adult MDD, with some minor differences. In children, symptoms of anxiety (including phobias and trouble separating from caretakers), physical complaints, and behavioral problems seem to occur more frequently. Adolescents tend to have more sleep and appetite disturbances, psychosis (hallucinations or delusions), and impairment of functioning than younger children. In addition, the incidence and severity of suicide attempts increase after puberty.
Dysthymic disorder consists of a persistent, long-term change in mood which is generally less intense than in MDD. The associated symptoms of dysthymic disorder are not as severe as MDD. To be given a diagnosis of dysthymic disorder, the child or adolescent must have depressed mood or irritability on most days for most of the day over a period of one year, as well as at least two of the following symptoms: (1) change in appetite; (2) sleep disturbance; (3) low self-esteem; (4) poor concentration or difficulty making decisions; (5) decreased energy; or (6) feelings of hopelessness. In addition, they may have other symptoms,cheap zoloft, such as feelings of being unloved, anger, somatic complaints (such as stomach aches, nausea, or headaches), anxiety , and sometimes disobedience.
Adjustment disorder with depressed mood
Sometimes children and adolescents experience an excessive change in mood in response to a very stressful event or a series of stressful events. If they develop a persistently depressed mood (often with tearfulness and hopelessness) and impairment of functioning within three months of the stressor(s), but do not meet criteria for MDD or dysthymic disorder, then they would receive a diagnosis of an adjustment disorder with depressed mood. An adjustment disorder does not have the associated symptoms of MDD or dysthymic disorder. It is important to emphasize that MDD or dysthymic disorder may be precipitated by stressful events,cheap zoloft, so that if a child or adolescent has the appropriate symptoms, they should receive a diagnosis of MDD or dysthymic disorder. The prevalence, clinical course, and treatment of adjustment disorder with depressed mood have not been well studied in children and adolescents; a few studies indicate that it lasts for approximately six months and usually does not recur.
Presentation to outside observers
The diagnosis of depression can be difficult because the depressed and irritable mood often makes the child and adolescent less able and willing to share how they are feeling. Some of the symptoms of depression are difficult for others to observe because they are related to how the person is feeling inside. Parents and teachers may only notice that the depressed child or adolescent has become withdrawn, whiny, or moody. Little things make them angry or tearful, and they tend to view many situations as negative or overwhelming. They interact less with others and withdraw from favorite activities such as sports, social events, or extracurricular activities. Their school performance often declines, and the child may start to get into trouble at school or skip classes. However when clinically assessed, the depressed child or adolescent will often report sad mood, low energy, poor concentration, sleep or appetite changes, feelings of worthlessness or hopelessness, and thoughts of suicide. This underscores the necessity of gathering information from both outside observers and the child herself when assessing for depression.
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