Neurotransmitters & Flushing

[Guest guest]

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_s

erotonin_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. We are still learning about neurotransmitters, their

subtypes, interaction with other neurotransmitter systems & how

psychotropics work. It 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. 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. If

you just want to peep a quick flow-chart click

http://www.dreamwater.org/health/sadhelp/5hta.htm or mirror site

http://www.angelfire.com/journal2/sadhelp/5ht2a.htm .

The flip side of using psychotropics for affective conditions anyway

can be found at http://www.breggin.com . He basically argues against

biopsychiatry that while depression & anxiety & affective conditions

in general may have serious medical consequences, the concept of a

chemical imbalance is a simplified marketing ploy which may not be

addressing the true etiology or impetus & he testifies of the dangers

involved.

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 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.