Hypnosis, Antidepressant Therapies Confer Similar Reductions In Hot Flash Symptoms

By: Healio Endocrine Today

Postmenopausal women who reported bothersome hot flashes experienced a similar reduction in symptoms when assigned to antidepressant therapy or hypnosis, whereas a combination of the two therapies yielded no greater benefit than the individual treatments, according to findings from a pilot, proof-of-concept study.

"Hypnosis is an effective treatment for hot flashes," Debra L. Barton, PhD, RN, the Mary Lou Willard French endowed chair of oncology nursing at the University of Michigan, and colleagues wrote. "Future research is needed to clarify whether hypnosis could be combined with a different low-dose pharmacologic intervention to provide optimal relief of hot flashes synergistically without ceiling effects and without side effects, or to identify a population who could benefit more from such a combination."

Barton and colleagues analyzed data from 71 postmenopausal women with and without a history of breast cancer, who could not or did not take estrogen therapy for hot flash relief. All the women reported bothersome hot flashes for at least 1 month, at a frequency of at least four per day. Researchers randomly assigned women to one of four treatments for 8 weeks from 2010 to 2011: venlafaxine (75 mg; Effexor, Pfizer) plus hypnosis therapy (n = 15); venlafaxine plus sham hypnosis (n = 19; white noise therapy); placebo pill plus hypnosis (n = 22); or placebo pill plus sham hypnosis (n = 15).

All women kept track of hot flashes in a daily diary beginning 1 week before treatment, indicating the number and severity of hot flashes during 24 hours. From week 2 to week 5, women completed weekly visits with a study therapist to learn about and experience hypnosis or sham therapy; behavioral intervention continued at home for weeks 6 through 8, using a CD. Primary endpoint was average difference in hot flash score from baseline to end of study; hot flash severity (mild, moderate, severe or very severe) was given a value ranging from 1 to 4. Women also completed the menopausal-specific quality of life (MENQOL) questionnaire.

Researchers found that women in the combined therapy arm reported hot flash reductions that were not statistically different from those of women in the venlafaxine/sham hypnosis arm (P = .05). Researchers also observed no statistically significant differences between women assigned to placebo pill plus hypnosis and women assigned to venlafaxine/sham hypnosis. Participants assigned to the placebo/sham hypnosis arm experienced a 25% decrease in hot flashes during the study period, whereas women in each active arm reported hot flash score reductions of just more than 50%, according to the researchers. There were no significant adverse effects during the study.

"In this pilot study, the combination of venlafaxine and hypnosis did not yield greater reductions in hot flashes," the researchers wrote. "Although this was a surprise, the dose of 75 mg of venlafaxine may have been too strong, eclipsing the effect of hypnosis and resulting in a mechanistic ceiling effect. However, based on the practice and medication log, since the venlafaxine/hypnosis arm listened to the CD the longest and took less medication, it could be that this was not as good of an evaluation of the combination of the two treatments as it could have been." – by Regina Schaffer

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