In the journals: The antidepressant citalopram cuts hot flash severity and frequency
As many of us know firsthand, hot flashes can be a bothersome symptom of declining estrogen levels at menopause as well as a common side effect of breast cancer treatment. For most women, hot flashes are transient and manageable, but for others, they're a daily (and sometimes nightly) burden that can persist for years, disrupting sleep and eroding quality of life. Estrogen therapy provides the most effective relief for hot flashes, but it's recommended only for short-term treatment of menopausal symptoms, and most women who've had breast cancer can't take it at all.
In recent years, randomized trials have shown that certain antidepressants can reduce hot flashes by 50% or more. These include paroxetine (Paxil) and fluoxetine (Prozac), which are selective serotonin reuptake inhibitors (SSRIs), and venlafaxine (Effexor), a serotonin-norepinephrine reuptake inhibitor (SNRI). However, paroxetine and fluoxetine have been found to greatly reduce the effectiveness of tamoxifen (Nolvadex), which is commonly used to reduce the likelihood of recurrence in women being treated for early-stage hormone receptor–positive breast cancer. Now, a randomized controlled trial has shown that citalopram (Celexa), an SSRI with little effect on tamoxifen metabolism, cuts the frequency and severity of hot flashes by at least 50% in postmenopausal women. Results were published in the July 10, 2010, issue of the Journal of Clinical Oncology.
Researchers with the North Central Cancer Treatment Group at the Mayo Clinic in Rochester, Minn., assigned 254 postmenopausal women to receive one of three daily doses of citalopram (10, 20, or 30 mg) or a placebo for six weeks. All of the subjects reported having troublesome hot flashes at least 14 times a week, and none were taking hormone therapy or being treated for active breast cancer. (About 35% had a history of breast cancer. Some of the women were taking tamoxifen; others, an aromatase inhibitor — an anti-estrogen drug that, like tamoxifen, reduces breast cancer recurrence. Both drugs can cause hot flashes.)