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Antidepressants for Hot Flashes

Examples

Generic NameBrand Name
escitalopramLexapro
fluoxetineProzac
paroxetinePaxil
venlafaxineEffexor

How It Works

Selective serotonin reuptake inhibitors (SSRIs) affect the brain's use of a neurotransmitter chemical called serotonin, which is thought to have a role in regulating body heat. Increased serotonin use by the brain can also improve perimenopausal mood swings and irritability.

Venlafaxine affects the brain's serotonin and norepinephrine levels. How it affects hot flashes is not known. Mood may also improve with venlafaxine use.

Why It Is Used

Select antidepressants are used to treat hot flashes affecting menopausal women. They may also help with irritability, depression, and moodiness. They can be used before and after menopause as a symptom treatment alternative to hormones (birth control pills or hormone therapy [HT]).

Antidepressant therapy helps many men and women who have hot flashes from cancer treatment. But if you take tamoxifen to treat your cancer, you need to avoid certain antidepressants. Talk to your doctor about what medicines for hot flashes are right for you.

Do not take venlafaxine if you:

  • Have had an allergic reaction to this medicine in the past.
  • Are currently taking an MAOI (monoamine oxidase inhibitor). This is an antidepressant and antianxiety medicine. Examples include isocarboxazid (Marplan), phenelzine sulfate (Nardil), and tranylcypromine (Parnate).

How Well It Works

Studies have shown that certain antidepressants may help relieve hot flashes.1

  • In a randomized, controlled trial of escitalopram (Lexapro), researchers report that menopausal women had at least a 50% reduction in the severity and number of hot flashes a day after 8 weeks of treatment.2
  • Venlafaxine (Effexor) lowers the number and severity of hot flashes for most women. This includes women with severe hot flashes from tamoxifen, a cancer-fighting hormone drug. In several studies, venlafaxine was most effective for hot flashes when used at a lower dose than is normal for treating depression.3

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor right away if you have:

  • Hives.
  • Thoughts of suicide.
  • Agitation and restlessness.
  • Seizures.
  • Fast heartbeat
  • Nausea and vomiting.

Common side effects of these medicines include:

  • Loss of sexual desire or ability.
  • Irritability.
  • Trouble sleeping or drowsiness.
  • Headache.
  • Changes in appetite.

The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Never suddenly stop taking antidepressants. The use of any antidepressant should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medicines can cause negative side effects or a relapse of your condition.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

  1. Burbos N, Morris EP (2011). Menopausal symptoms, search date June 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  2. Freeman EW, et al. (2011). Efficacy of escitalopram for hot flashes in healthy menopausal women. JAMA, 305(3): 267–274.
  3. Fritz MA, Speroff L (2011). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 749–857. Philadelphia: Lippincott Williams and Wilkins.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Carla J. Herman, MD, MPH - Geriatric Medicine
Specialist Medical Reviewer Carla J. Herman, MD, MPH - Geriatric Medicine
Last Revised April 26, 2012

Last Revised: April 26, 2012

Author: Healthwise Staff

Medical Review: Kathleen Romito, MD - Family Medicine & Anne C. Poinier, MD - Internal Medicine & Carla J. Herman, MD, MPH - Geriatric Medicine & Carla J. Herman, MD, MPH - Geriatric Medicine

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