SSRI Reduces Severity of Menopausal Hot Flashes

Menopausal women may find some relief from hot flashes with escitalopram, a selective serotonin reuptake inhibitor (SSRI) that reduced the severity of hot flashes in healthy women (Freeman EW, et al. Efficacy of escitalopram for hot flashes in healthy menopausal women. JAMA. 2011;305:267-274).

With the growing concern for potential risks associated with estrogen/ progesterone therapy for menopausal symptoms, researchers are looking at nonhormonal alternatives. Studies involving serotonin and norepinephrine reuptake inhibitors and SSRIs have yielded varied results; 2 pilot studies on escitalopram showed reductions in hot flashes with minimal toxicity, but both had small populations and unblinded treatment.

This current double-blind study compared the efficacy of escitalopram and placebo for hot flashes in 205 women (95 black, 102 white, and 8 other) who were randomized to 10 to 20 mg daily of escitalopram or matching placebo for 8 weeks. Women receiving escitalopram were started on 10 mg/day, which was increased to 20 mg/day if they did not report a reduction in the frequency of hot flashes after 4 weeks. Primary (frequency and severity of hot flashes) and secondary (hot flash bother) outcomes were evaluated by daily diaries completed by the women.

Baseline mean frequency of hot flashes was 9.78/day, which at week 8 was significantly reduced with escitalopram (47%; 5.26/day) compared with placebo (6.43 per day). Hot flashes frequency decreased by ≥50% in 55% of those receiving escitalopram versus 36% of the placebo group.

The mean decrease in hot flashes severity score was 24% in the escitalopram group and 14% in the placebo group.

A 3-week postintervention followup after cessation of escitalopram and placebo showed increased hot flashes in the escitalopram group but not in the placebo group, an observation that the researchers took as further proof of the drug’s effectiveness