Jaffe, S.L. (2000) Neurology and psychiatry: Closing the great divide. Neurology, 55, 603-604.
AUTHORS: S. L. Jaffe
ABSTRACT: The “menopause” (not menopause, the cessation of menses) mechanism responsible for its symptom complex (Menopausal Symptom Complex) (or, Climacteric Syndrome) including chronic fatigue, fibromyalgia, depression, tension headache, cervical vertigo, sleep disturbances, irritability, anxiety/panic attacks, cognitive changes (decreased concentration to obsessional/delusional thought), decreased libido, and vasomotor dysfunction remains elusive. And MSC, other than vasomotor dysfunction, is not significantly altered by treatment with sex hormones (estrogen/progesterone), which have major neoplastic and vascular side effects. Thus at present, there are minimal indications for treatment with these compounds. Confusion between menopause and “menopause” (MSC) as well as research money made available by pharma advocating ERT/HRT (estrogen replacement therapy/hormone replacement therapy) has produced both therapeutic and research inertia. Presently, there would appear to be mismanagement of a symptom complex which infers primary brainlimbic system dysfunction and for which there is no correlation with falling sex hormone levels. Pharmacological modification of the proposed aberrant limbic circuitry responsible for the MSC has been successfully accomplished using specific NT/MMs (neurotransmission/modulation modifiers) i.e. a combination of alpha-1 and norepinephrine reuptake blockers, and thus providing initial elucidation of this particular brain pathophysiology as well as an efficient treatment of a problem affecting up to 60% of women ages 35 to 55. Specific NT/MMs capable of affecting a number of neurotransmitter/receptor types within limbic circuitry appear to reverse the MSC which includes chronic fatigue and fibromyalgia, pointing to aberrant limbic circuitry as their etiology as well.