January 31, 2011

Antidepressant Effective For Hot Flashes

Photo of a smiling older woman.

Women taking a low dose of the antidepressant escitalopram had fewer and less severe hot flashes than those taking a placebo, a new clinical trial reports.

Menopause is a transition that affects many women as they approach age 50. It marks the end of menstrual periods and fertility. It can also bring hot flashes, trouble sleeping, mood changes and other symptoms.

Menopausal hormone therapy has long been the predominant treatment for menopausal symptoms. However, its use has greatly declined since 2002, when a large NIH-funded study concluded that the overall risks of menopausal hormone therapy likely outweigh the benefits. The therapy increases the risk in some women of heart disease, stroke, blood clots and breast cancer.

No other treatments for menopausal hot flashes currently have FDA approval. Recent studies suggest that certain anti-depressant medications may be effective for relieving hot flashes, but the results have been inconclusive.

Dr. Ellen W. Freeman at the University of Pennsylvania School of Medicine and her colleagues enrolled over 200 healthy menopausal or postmenopausal women. The women were given either a daily dose of escitalopram or a placebo for 8 weeks. The researchers tracked the number, severity and irritation of their hot flashes. The trial was funded by NIH’s National Institute on Aging (NIA) and several other NIH components.

As described in the January 19, 2011, issue of the Journal of the American Medical Association the researchers found that women taking escitalopram had an average of nearly 50% fewer hot flashes after 4 weeks. In comparison, women taking the placebo had on average of 26% fewer hot flashes. The escitalopram treatment led to even further reductions in hot flashes after 8 weeks. Women taking the medication also reported a reduction in the severity and bother of their hot flashes.

An equal number of white and African American women participated in the study. Race had no significant effect on the treatment results.

While it is not clear exactly why antidepressants like escitalopram are effective for treating hot flashes, the study shows that these drugs could be a safe alternative to hormone therapy. Women taking escitalopram reported few adverse side effects during or after the clinical trial. Furthermore, a majority of the women said they were satisfied with the treatment and would like to continue taking escitalopram.

"Our findings suggest that among healthy women who were not depressed or anxious, a 10 to 20 milligram dose of escitalopram provides a non-hormonal, off-label option that is effective and well-tolerated in the management of menopausal hot flashes," Freeman says.

— by Amy Alabaster

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