Use of antidepressant associated with hot flash reduction

Antidepressant escitalopram may provide a viable nonhormonal alternative to relieving menopausal hot flashes
Dr. Andrea La Croix
Public Health Sciences Division's Dr. Andrea La Croix was among researchers in a multicenter trial evaluating the efficacy of escitalopram versus placebo to reduce the frequency and severity of hot flashes. Photo by Dean Forbes

The antidepressant drug escitalopram effectively reduces the frequency and severity of hot flashes in menopausal and postmenopausal women, which suggests that the drug provides a viable nonhormonal option for the management of hot flashes, according to a study in the Jan. 19 issue of JAMA.

Previous results from the Women’s Health Initiative raised concerns about the risks associated with estrogen and progesterone to manage menopausal symptoms. Those worries led to declining use of hormone therapy and increased interest in nonhormonal treatments for hot flashes.
In this clinical trial, Dr. Ellen Freeman of the University of Pennsylvania School of Medicine in Philadelphia, and colleagues including the Public Health Sciences Division’s Dr. Andrea La Croix, evaluated the efficacy of escitalopram versus placebo to reduce the frequency and severity of hot flashes in healthy women, and examined whether race, menopausal status, depressed mood, and anxiety were important modifiers of any observed effect.

Selective serotonin and serotonin norepinephrine reuptake inhibitors were previously studied for hot flash treatment with mixed results. The SSRI escitalopram reduced hot flashes with minimal toxicities in two pilot investigations, but conclusions were limited by small study populations and unblinded treatment.
The multicenter, randomized trial enrolled 205 women who took escitalopram or a placebo for eight weeks and recorded the frequency and severity of their hot flashes at weeks four and eight.

Hot flashes among escritalopram users decrease 47 percent
Escitalopram was associated with a significant reduction in the frequency of hot flashes relative to placebo, adjusted for race, site, and baseline hot flash frequency. The average frequency of hot flashes at the beginning of the study was 9.8 per day. In the escitalopram group, average hot flash frequency at week eight decreased to 5.26 hot flashes per day, a 47 percent decrease. In the placebo group, hot flash frequency decreased to 6.43 hot flashes per day, a 33 percent decrease or an average of 3.2.
“The three-week postintervention follow-up demonstrated that hot flashes increased after cessation of escitalopram but not after cessation of placebo, providing further evidence of escitalopram's effects,” the authors wrote.
The researchers note that although the decreases in hot flash frequency and severity appear modest, the study participants perceived these improvements as meaningful, as indicated by their reported satisfaction with treatment and desire to continue the treatment.
“Our findings suggest that among healthy women, 10 to 20 milligrams a day of escitalopram provides a nonhormonal, off-label option that is effective and well-tolerated in the management of menopausal hot flashes,” the researchers said.

The MsFLASH Network (Menopause Strategies: Finding Lasting Answers for Symptoms and Health), a multicenter research initiative launched by the National Institutes of Health in 2008 to test new treatment options for menopause-related hot flashes and night sweats, conducted the research. As the data coordinating center, the Hutchinson Center coordinates all aspects of trial planning, implementation, statistical analysis and reporting. Other interventions like relaxation breathing, yoga, exercise programs and low-dose estrogen therapy are under evaluation.

[Adapted from a JAMA news release]

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