Antidepressants ease hot flashes: study

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The antidepressant citalopram reduces the severity of hot flashes during menopause, at least in the short term, said a team of researchers who followed 254 women for seven weeks.

Previous studies have shown that certain antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil), fluoxetine (Prozac) and venlafaxine (Effexor), can treat hot flashes.

But citalopram (Celexa), another SSRI, has an advantage over the others, mainly paroxetine and fluoxetine: It can be used in women receiving tamoxifen, a drug to reduce the risk of breast cancer, which causes frequent hot flashes as a side effect.

Because paroxetine and fluoxetine inhibit an enzyme needed to metabolize tamoxifen, patients should not take these antidepressants to relieve hot flashes.

A new study published in the Journal of Clinical Oncology involved 254 postmenopausal women who said they had at least 14 "bothersome" Fever flushes per week.

During the first week, participants recorded the frequency and severity of their symptoms. The group then randomly assigned them to take one of three doses of citalopram (10, 20, or 30 milligrams per day) or placebo for six weeks.

Overall, women who took an antidepressant had a greater reduction in "scores" of hot flashes, a measure of severity and frequency, compared with those taking placebo: 49% to 55% fewer episodes, depending on the dose, compared with 23% when taking placebo.

The difference between the three doses was not significant, suggesting that even a low dose of 10 mg provides symptom relief.

However, women who took the 20 mg reported additional benefits, such as improved sleep quality and mood, says Dr. Debra L. (Debra L.). Barton, assistant professor of oncology at the Mayo Clinic, Rochester, Minn.

The doses used in the study were lower than those used to treat depression, and there was no evidence of increased risk of side effects when using doses of 10 mg or 20 mg compared to placebo.

At the 30 mg dose, there was an increase in sexual side effects, although the difference was not statistically significant.

People taking citalopram and other antidepressants may experience decreased libido and difficulty with orgasm, as well as sleep problems, dizziness and weight changes.

Barton believes more research is needed on the efficacy and side effects of long-term use of citalopram for relief of hot flashes. So far, she said, the results suggest that the antidepressant may be useful in women with prolonged and bothersome hot flashes.

For some women, menopausal hot flashes are fairly tolerable and disappear within a few years. For others, they are more persistent and severe. The most effective therapy for these hot flashes is hormone replacement therapy (HRT).

But given the potential risks of HRT, including a high risk of heart attack, stroke and breast cancer, experts recommend using it in the lowest doses and for as short a time as possible.