Here's an interesting article that tries to explain the interaction of hormones & neurotransmitters. Much of what is known about flushing is from studying menopausal hot flushes. From clonidine to antidepressants:
http://www.science.com.br/henrys_corner/artigos_tecnicos/the_role_of_serotonin_in_hot_flushes.pdf *
If down: http://www.angelfire.com/journal2/sadhelp/shf.pdf
(* Requires Adobe Acrobat since in .pdf format - Free Acrobat readers at http://www.acrobat.com
)
My initial impression of the article is that while I can appreciate the scope of it, I feel their 5HT2A hypothesis is
oversimplistic. If it were that simple then nefazodone/Serzone would likely have popped up as promptly effective for hot flushes already. It is considered a decent antidepressant at the right dose but not very effective for panic or anxiety but does not generally cause sexual dysfunction or weight gain so it may be worth a trial. Serzone unfortunately interacts with a lot of meds like Xanax so that should be looked at prior.
Remeron/mirtazapine has had some positive reports in the literature & mixed reviews anecdotally from
rosacea flushers, some respond well while others don't at all. This may be because it blocks 5HT2, &
5HT3-like ondansetron/Zofran (reported effective anecdotally for
erythematous rosacea & ocular rosacea) as well as
histamine; what could be negating benefit is that it is primarily an Alpha2NE-Antagonist (opposite of clonidine
-used for hot flushes & anxiety). Interactions have been noted for mirtazapine & clonidine. If it works well it could also be normalizing a dysfunctional alpha2
autoreceptor. Also some selective alpha2NE-antagonists have been shown to
be anxiolytic (anti-anxiety) while less specific antagonists are not:
| Life Sci 1994;54(10):PL179-PL184 | Related Articles, Books |
Since mirtazapine blocks clonidine it is likely not very selective:
| Abo-Zena RA, Bobek MB, Dweik RA. | Related Articles |
| Bengtsson HJ, Kele J, Johansson J, Hjorth S. | Related Articles |
We are still learning
about neurotransmitters, their subtypes, interaction with other neurotransmitter
systems & how psychotropics work. Remeron is considered effective for serious depression
& again mixed reviews for anxiety with low incidence of sexual dysfunction commonly associated with SSRIs but more commonly causes increased hunger/weight gain.
Even if SSRIs are effective it has been shown that they have effects on NE which this article doesn't bother
addressing:
| Shores MM, Pascualy M, Lewis NL, Flatness D, Veith RC. | Related Articles |
It does specify Zoloft & the SNRI Effexor in their literature search as potentially efficacious for flushing. Their 5HT2A conclusion may be biased on the fact that it is associated with Organon products like Remeron & mianserin. Of course there are far more neurotransmitters involved than 5HT (serotonin) & NE (norepinephrine) in flushing & stress responses but it was a decent albeit academic read on hot flushes.
Social Anxiety-another condition linked to flushing & good intro to other relevant neurotransmitters:
| Ameringen MV, Mancini C, Farvolden P, Oakman J. | Related Articles |
The flip side of using psychotropics for affective conditions anyway can be found at http://www.breggin.com . This Harvard educated MD argues for psychotherapy, empathy and love & against biopsychiatry. While depression, anxiety, affective conditions in general may have serious medical consequences, the concept of a chemical imbalance he argues is a simplified marketing ploy that may not be addressing the true etiology or impetus & he testifies of dangers involved. He feels psychotropic drugs are brain disabling. I am very glad Dr. Breggin is around & he truly is the "conscience of Psychiatry" but his no biopsychiatry drug stance may not be practical for many sufferers especially for conditions with a strong biological component. Disabling the CNS with total anesthesia can come in handy when undergoing surgery and likewise psychotropic drugs can be useful for otherwise unbearable conditions.
I just saw a commercial for Zoloft which explains Depression as a serious illness affecting 20 million Americans potentially caused by a chemical imbalance, then presented a lame nerve A & nerve B neurotransmitter exchange. This .pdf article is at least a bit more sophisticated in reviewing the interaction of neurotransmitters & hot flushes of potentially several causes. Again I think their hypothesis is interesting but oversimplified.
Coming Soon: Learning from the Carcinoid Syndrome Flush.