A drug marketed for
attention deficit hyperactivity disorder (ADHD) might improve memory and
concentration problems associated with menopause, a new study suggests. Vyvanse
(lisdexamfetamine), a stimulant, is usually prescribed to children and adults
with ADHD. But researchers found it also may help to improve menopausal women's
"executive function" -- brain activities such as memory, reasoning,
multitasking, planning and problem-solving.
According to a new study, women who are experiencing
difficulty with time management, attention, organization, memory, and problem
solving – all the cognitive functions often referred to as executive - related
to menopause may find improvement with a drug already being used to treat
attention deficit hyperactivity disorder (ADHD). The study led by researchers
at the Perelman School of Medicine at the University of Pennsylvania is the
first to show that Vyvanse (lisdexamfetamine, or LDX) improved subjective and
objective measures of cognitive decline commonly experienced in menopausal
women. Results of the study are published online today in the journal
Psychopharmacology.
"Reports of cognitive decline, particularly in
executive functions, are widespread among menopausal women," said lead author, C. Neill Epperson, MD, professor of
Psychiatry and Obstetrics and Gynecology at the Perelman School of Medicine at
the University of Pennsylvania, and director of the Penn Center for Women's
Behavioral Wellness. "There are approximately 90 million post-menopausal
women living in the US alone, and with the average age of onset occurring at
52, the great majority of those women will live in the postmenopausal state for
at least one-third of their lives. Therefore, promoting healthy cognitive aging
among menopausal women should be a major public health goal."
The Penn-led team administered a once-daily dose of LDX
for four weeks to 32 healthy, non-ADHD-diagnosed women between the ages of 45
and 60 experiencing difficulties with executive functions as a result of
mid-life onset menopause, and as measured using the Brown Attention Deficit
Disorder Scale (BADDS). All participants served as their own controls by being
randomly assigned to crossover to a placebo for an additional four weeks.
The researchers found a 41 percent overall improvement in
executive functions for women receiving LDX, compared to a 17 percent
improvement when taking placebo medication. There were also significant
improvements in four out of the five subscales for women taking LDX:
organization and motivation for work; attention and concentration; alertness,
effort, and processing speed; and working memory and accessing recall.
“The low estrogen levels in menopause can cause a drop in
serotonin and dopamine levels, leading to severe mood and cognitive changes,”
explains Sheryl Ross, MD, ob-gyn and women’s health expert at the Obstetrics,
Gynecology and Women's Health Center in Santa Monica, California.
"We need more research before changing our clinical
practice, but it is encouraging that we are looking at other treatments for a
variety of cognitive, mood and physical symptoms that are present during
perimenopause and menopause for women," said Dr. Nicole Cirino, director
of women's mental health and wellness at Oregon Health & Science
University. "It's especially exciting to see this research for women who
cannot tolerate hormone replacement therapy," added Cirino, who was not
involved in the study.
Many women use hormone replacement therapy for menopausal
symptoms, but how much it can help mental functioning is controversial, said
Dr. Kevin Ault, an obstetrician-gynecologist and professor at the University of
Kansas Medical Center. The evidence has not clearly shown that it does or does
not help.
Not every woman is comfortable taking hormone replacement
therapy or cannot take it due to other medical complications, Ross noted.
"Even though this is a small study, it shows that other medications can be
safe and effective in treating annoying cognitive side effects of
menopause," she said.
While the women in the study were taking the medication,
their blood pressure and heart rate increased but stayed in the normal range
overall. The study authors did not report other major side effects.
"One of the problems with having a small study like
this is that you're not going to see the big picture with side effects,"
Ault said.
Known side effects of Vyvanse include trouble sleeping,
nervousness, dizziness, skin numbness, irregular heartbeat, headaches, nausea,
vomiting, weight loss and loss of appetite, said Ross.
There are also individuals who should not take Vyvanse
based on their health history, Cirino said, such as those with a history of
heart conditions or a history of addiction or dependence.
"It is a psychostimulant that is a controlled
substance, so it has to be given to the right candidate," Cirino said.
"These can be addictive substances, especially if not carefully monitored,
and they can worsen certain mood conditions, such as anxiety disorder, bipolar
disorder or psychotic disorder."
Ideally, she said, women would wean off the medication
once past menopause.
A 30-day supply of Vyvanse is estimated to cost between
$200 and $250 without insurance. It is available through major pharmacies but
has not been approved by the Food and Drug Administration for use in menopausal
women.
The best candidates for ADHD drugs are women whose
cognitive menopausal symptoms are getting in the way of their quality of life.
“Menopausal women who do not have any symptoms related to mood or cognitive
function should not take ADHD drugs,” Ross says. This is because using ADHD
drugs during menopause comes with some risks, including addiction and potential
abuse because of their stimulating effects. Other possible side effects include
trouble sleeping, nervousness, dizziness, irregular heartbeat, skin numbness,
headaches, nausea, and vomiting.
If you do not find the prospect of using ADHD drugs in
menopause appealing, there are other things you can do. If you do not have risk
factors such as a family history of breast cancer, short-term hormone
replacement therapy may help boost your attention and memory, Ross says. Other
potential drug treatments include antidepressants, blood pressure medications,
and anti-seizure drugs.
“There are also some non-medication treatments, including
acupuncture, hypnosis, yoga, meditation, regular exercise, and dietary changes,
such as limiting caffeine, alcohol, and spicy foods,” Ross says.
No matter which treatment you choose for improving mental
and emotional symptoms of menopause, make sure it's a good fit. “Dealing with
the symptoms of menopause is an individualized process that has to feel right
for you,” Ross says.
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