Tuesday, February 17, 2015

A Penny For Your Hot Flashes?

I need to preface this blog entry by saying I have zero medical, legal, and pharmacological training.

What I do have is plenty of indignation towards the pharmaceutical industry, the U.S. Federal Communications Commission (FCC), and U.S. Food and Drug Administration (FDA) for their unethical practices. What's got me so hot and bothered (pun intended) is a television commercial I saw a little while ago for a recently approved non-hormonal hot flash medication named Brisdelle.

I was watching the Food Network, and preparing dinner, as I like to do, when a commercial came on for the "first FDA-approved, non-hormonal treatment for hot flashes". My interest was piqued, because like so many other post-chemo-women-treated-for-estrogen-positive-breast-cancer-who-are-now-menopausal, I've been having hot flashes. Moreover, after roasting concludes, I will be taking Tamoxifen for five years, which means those hot flashes will likely be my best friend for a long time.

Naturally, I would love to talk to my doctor about a non-hormonal remedy that might ease the flop-sweat and allow me to sleep with the window closed when the temperature outside dips below freezing. I was reaching for a pen to scrawl down the name "Brisdelle" when the generic name of the drug was mentioned, followed by the requisite litany of warnings and potential side effects.

It turns out, Brisdelle is an alternate brand name for the drug paroxetine, which is a selective serotonin reuptake inhibitor (SSRI), otherwise known by us lay folk as an antidepressant. It is usually sold under the brand name "Paxil", which in addition to being widely prescribed to about one-in-10 Americans, is the butt of many snide remarks about depression.

Prozac is the most commonly known SSRI, but if you have any experience with this class of drugs, chances are you are also familiar with the names Paxil, Zoloft, Wellbutrin, Celexa, and Lexapro.  And if you have a tendency towards mood swings, someone is probably whispering behind your back, "Is she up on her Prozac dosage?". or, "Geez, she forgot to take her Paxil/Zoloft/Wellbutrin, etc. this morning." Then there's Xanax, Valium, Ativan, Klonopin, and others. Those are anti-anxiety medications, which comprise an entirely different class of drugs.

The reason I am so hot under the collar (another intended pun) is because I know a bit more than your average person about paroxetine and the other SSRIs. For about four years, I wrote copy for Web sites maintained by a personal injury law firm, and read more about the dangers and side effects of SSRIs than I care to talk about. The side effects on unborn fetuses are particularly awful, because if pregnant women take SSRIs, their babies could be born with heart and other organ defects, along with more maladies that can cause lifelong problems. The pharmaceutical companies that manufacture and market these drugs failed to warn doctors and pregnant women about the risks they were exposing their unborn children to, which resulted in billions of dollars in lawsuits being filed after women who took SSRIs while pregnant started giving birth to babies with birth defects.

According to this news story, Brisdelle was originally voted down by an FDA advisory panel as a treatment for hot flashes. My guess is that a few smart doctors on that panel wanted to put the brakes on the rampant off-label use of certain drugs. If you watch the interview at the top of the story, you'll see that the gynecologist interviewed by the news anchors admitted to long prescribing Paxil as an off-label treatment for hot flashes. She claims that fifty percent of her practice consists of menopausal women who experience "debilitating" hot flashes on a daily basis.

I get hot flashes multiple times during the day. At night, I usually can't fall asleep without a few waves washing over me before finally nodding off. Is it a pain in the ass? Yes. Do I wish they would go away? Of course. But since I already take Celexa for depression, I will not be talking to my doctor about taking another antidepressant that may or may not reduce the occurrence or intensity of my hot flashes. Chances are, I'm just going to have to live with them.

Yes, I take an SSRI for depression. Before my cancer diagnosis, my life was not very pleasant. My doctor took pity on me and gave me a sample package of Lexapro to try. When I reported that it made me feel better, she wrote me a prescription. When I needed to find an alternate medication because my insurance stopped covering Lexapro, she switched me over to Celexa. I've been taking it for about seven years.

I read up on the other SSRIs just for shits and giggles, and found that Paxil and Zoloft are the two most hardcore of the bunch. I was looking for something just to take the edge off, not because I was suicidal. Also, Paxil and Zoloft have the shortest half-lives of all the SSRIs, meaning that if you aren't up on your dosage, you are likely to experience some unpleasant side effects.

When I moved back to the U.S. from Canada in October 2012, I did not have health insurance until January 2014. During those 16 months, I made the 90 Celexa tablets I brought with me last until I was covered once again. I never could have done that with Paxil or Zoloft. In short, I would have been a basket case. SSRIs are notoriously difficult to discontinue. I worry about how it will be when I decide to stop taking them. But for now, I've got enough keeping me occupied.

Pharmaceutical companies, along with the FCC and the FDA, are doing Americans a great disservice by advertising prescription medications on television, in magazines, online, and pretty much everywhere. Tens of millions of us take at least one prescription medication, and more of us rush to call our doctors because we think we need the medications we see advertised. Ours has become a nation of pill poppers, and the more we see, the more we think we need to take. If our biggest problems could be solved by swallowing a pill, of course we'd do it. And many doctors enable us by writing millions of prescriptions for drugs we do not need because they are getting paid by these pharmaceutical outfits to do so.

I've long been a proponent of not allowing prescription drugs to be advertised. After all, the FCC no longer allows tobacco products to be advertised. The difference is, prescription drugs are supposed to help you, not hurt you. The truth is, they will hurt you, if you don't do your homework. It all goes back to being an informed patient, and not relying only on your physician to determine your path to good health.

And by the way, I do remember mentioning that oncology is rife with off-label drug use. I was given a prescription for Ativan to take for nausea. I took it; it helped me. When I no longer needed it, I stopped taking it. All bets are off when it comes to chemotherapy. If my oncologist told me that dropping acid would have made me feel better, I would have done it.



  1. I take venlafaxine (Effexor) which is an SNRI - the next generation of SSRIs. I started taking it several years ago when I got peri and could not understand WHO WAS LIVING INSIDE MY BRAIN BECAUSE IT WAS OBVIOUSLY NOT ME. This one also has the hot flash-reducing side effect, my gyn told me. Since I am likely to have night sweats if I forget my before-bed dose, I guess this is true. I'm lucky - I experience zero side effects with the venlafaxine, and since I take just about the lowest possible dose, I'm not planning to stop taking it any time soon (especially since my 71 year-old mother still flashes 12 - 15 times a day without her esterol). I know it has its risks, but at this point I'm all about putting off hormones as long as possible and hey, if it ain't broke... Anyhoodle, long-story short I wonder if an SNRI might give you the hot-flash benefits without messing up your even keel.

  2. That's an interesting question, and I have no idea. My oncologist told me that he does prescribe Paxil for hot flashes, but made no mention of any other medication. I took Ativan (lorazepam) for nausea, so I wouldn't be surprised by what else is prescribed off-label for other chemo and menopause-related side effects.