While the benefits are clearly explained, the story failed to mention any possible harms, didn’t discuss the cost of the drug, and didn’t explain that there is uncertainty about how long the benefits may last. The story also didn’t put the results in context with hormone replacement, the main alternative for women with more bothersome symptoms. These deficits might have been addressed in comments from an independent expert, but the story didn’t seek out any external perspective on the findings.
We need more treatment options for women with disruptive menopausal symptoms. Although hormone treatment is effective, many women are reluctant to take hormones because of the small increase in potentially serious adverse effects associated with their use. Emerging research suggests that antidepressants may be an alternate option, but the study discussed in this story found that Lexapro is only slightly more effective than a placebo for reducing hot flashes. In addition, use of antidepressants also may cause a variety of adverse effects which, while less serious than the risks of hormone therapy, can be troublesome enough to cause people to stop taking the medication. Stories should provide this full context to help women make the best possible choice about how to manage their symptoms.
This story did not mention costs. Lexapro costs about $110/month and is not available as a generic. Because of this, insurance companies will probably relegate it to 2nd or 3rd tier status with higher copays for those who wish to use it.
The story quantifies the benefits of treatment in appropriate terms using measures that are meaningful to readers. It explains that women taking Lexapro had a 47 percent decrease, or about 4.6 fewer hot flashes per day, whereas women taking a placebo had a 33 percent decrease or 3.2 fewer hot flashes per day. The story could have made the effects even clearer with a statement along the lines of … “On average, women with moderate to severe menopausal hot flashes had 5.4 hot flashes daily when taking lexapro and 6.4 hot flashes daily when taking placebo, a difference of 1 fewer hot flash daily.” As usual, the emphasis on percent reduction tends to obscure the absolute benefit.
The story did attempt to put the size of this effect into some kind of context — calling it “modest” — which is something the WebMD coverage failed to do.
While the competing WebMD coverage at least mentioned the possibility that this drug could cause adverse effects, this blog post does not acknowledge any potential downsides of treatment. We have a lot of good data on the adverse effects of antidepressants, and the story could easily have brought in summary data from other studies, rather than relying simply on 8 week data from a relatively small number of women. Giving results from a single study, while ignoring data from hundreds of other relevant studies involving thousands of patients, is a frequent problem in reporting. See the WebMD review for a more thorough discussion of why this is important.
The description of the study was accurate and detailed enough to satisfy this criterion. As with the competing WebMD story, there could have been more emphasis on the short length of the study and the lack of data on longer-term outcomes. Menopausal symptoms can last for years, and an 8-week study doesn’t really tell us much about the durability of the treatment in this context. Also, while it’s useful to know the drug’s effect on frequency and severity of hot flashes, it would have been valuable to have data on the drug’s impact on health-related quality of life.
The story didn’t state that the study discussed here was restricted to women with moderate to severe symptoms, as the competing WebMD coverage did. Also, the story would have been more informative if it had reported the proportion of menopausal women who have moderate to severe symptoms. By our read, a reader could misconstrue the study to mean that all menopausal women with hot flashes are appropriate candidates for treatment.
There were no independent sources referenced in this post. In addition, while the story notes that the study was federally funded, it should have pointed out that at least one of the study researchers receives research funding and is a consultant for Forest Laboratories, which makes Lexapro.
Although the story mentions hormone replacement, it gives readers the impression that this approach is no longer used for the treatment of hot flashes because the risks outweigh the benefits. In fact, women with more bothersome menopausal symptoms may still use hormones for short-term relief, concluding that the benefits for them individually still outweigh the risks. This story should have spent some more time putting the benefits and risks of antidepressants in context with those of hormone replacement. Also, many women try complementary and alternative medicine treatments.
The story did not comment on the availability of Lexapro to treat hot flashes. Although many readers may be aware that this drug is approved to treat depression and may therefore be used to treat other conditions off-label, the story should have spelled this out as the competing WebMD coverage did.
The story notes that other antidepressants have been tested in small studies for the treatment of hot flashes. It doesn’t oversell the novelty of this approach.
This blog post did not include any external perspective on the study, so we can’t be sure to what extent it may have relied on a press release.