Harvard Mental Health Letter

In Brief: Antidepressant may help ease hot flashes

When the Women's Health Initiative concluded in 2004 that hormone therapy increased the risk of stroke and other health problems, millions of women abandoned estrogen pills. Unfortunately, women bedeviled by menopause-related hot flashes were left with few treatment options. No other drugs have FDA approval for the treatment of hot flashes, and studies testing the effectiveness of alternative therapies have been disappointing.

Researchers have begun to examine the use of antidepressants to ease hot flashes, but studies have had mixed results. Some participants had medical or psychiatric problems, making it difficult for researchers to tease out the effect of the drug on hot flashes. Also, different antidepressants — and varied definitions and measures of hot flashes — were used.

Two small but encouraging studies prompted Philadelphia researchers to launch a randomized, double-blind, placebo-controlled trial of the selective serotonin reuptake inhibitor (SSRI) escitalopram (Lexapro) to see if it might reduce the frequency, severity, and discomfort of hot flashes. They randomly assigned 205 healthy menopausal women experiencing at least 28 troubling or severe episodes per week to receive either one 10-mg escitalopram pill or a placebo daily. If the frequency of a woman's hot flashes didn't drop by at least half after four weeks, or if there was no decrease in their severity, the dose was doubled. Treatment stopped after eight weeks.

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