Use of Antidepressants for Management of Hot Flashes

Abstract

A growing body of evidence suggests that antidepressant therapies, particularly selective serotonin reuptake inhibitors and venlafaxine, are effective in the management of hot flash symptoms. Several of these agents have the support of the American College of Obstetricians and Gynecologists and the North American Menopause Society. To review the literature on antidepressants for the treatment of hot flashes in women, we searched the PubMed, International Pharmaceutical Abstracts, and MEDLINE databases from inception through May 2009. All publication types that included human participants and that were published in English were eligible for review. These articles, relevant abstracts, and additional references were used to collect pertinent data. Although initial small pilot trials were conducted solely in breast cancer survivors, additional studies have been conducted both in breast cancer survivors and in relatively healthy menopausal women. Data on the benefits with many of these agents are conflicting. Venlafaxine and paroxetine have been studied more extensively than any of the other antidepressants and are more consistent in effectively reducing the frequency and severity of hot flashes, based on these study results. Desvenlafaxine, sertraline, fluoxetine, and citalopram should be considered second- or third-line options if patients fail therapy with or cannot tolerate venlafaxine or paroxetine, based on the current published data. Duloxetine, escitalopram, fluvoxamine, and mirtazapine should be reserved as last-line therapy until more rigorous studies are conducted assessing their use in the management of hot flashes.

Concurrent use of tamoxifen with CYP2D6 inhibitors and the risk of breast cancer recurrence

“…Finally, it was of interest to conduct a separate analysis on antidepressants, as these represent the most frequently prescribed drug class in this population, often used to treat tamoxifen-related side effects, such as hot flashes [29]. Thus, concurrent users were categorized into three mutually exclusive groups: those who used moderate/strong CYP2D6 antidepressants (bupropion, doxepin, duloxetine, fluoxetine, maprotiline, paroxetine, and sertraline), weak CYP2D6 antidepressants (citalopram, escitalopram, fluvoxamine, mirtazapine, and venlafaxine), and combinations of moderate/ strong and weak antidepressants.…”

Progesterone for treatment of symptomatic menopausal women

“…A clinically important portion of women treated for VMS with estrogen-based therapy will experience a withdrawal-related VMS rebound to become worse than before starting therapy 21 ; the same will also occur for some stopping selective serotonin reuptake inhibitors 59 and serotonin-norepinephrine reuptake inhibitors 60 . Therefore, it was important to know whether or not stopping oP4 would cause withdrawal-related increased VMS.…”

Hot flushes still occur in a population of 85-year-old Swedish women

“…Therefore it is not surprising that the women who reported being troubled by hot flushes were more likely to use nitroglycerin than were those who were not troubled by hot flushes. Other types of medications may also interfere with the occurrence of hot flushes, for example antihypertensive medicines and antidepressants [12,13]. We have included these categories of medicines in our logistic regression analyses.…”