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Harvard Medical School

Citalopram (Celexa) Effective for Treating Hot Flashes

For decades, estrogen has been used to treat menopausal symptoms, including night sweats and hot flushes.  However, after studies reported that estrogen may have an adverse effect on risk for cardiovascular disease and breast cancer, many patients and clinicians have looked into alternative treatments for hot flashes, including selective serotonin reuptake inhibitors (SSRIs).

The North Central Cancer Treatment Group studied the use of the SSRI citalopram (Celexa) to decrease hot flashes in a randomized, placebo-controlled phase III trial as reported in a poster session at the annual meeting of the American Society of Clinical Oncology.  This group found that citalopram performed twice as well as placebo in decreasing the frequency or severity hot flashes.

This study included 254 post-menopausal participants who had a history of breast cancer or who wanted to avoid hormones due to breast cancer risk.  The participants needed to have at least 14 hot flashes per week for at least 1 month and could not be taking any other antidepressants or hot flash therapies.  These participants were divided into 4 separate groups with 57 participants in each of the treatment arms and 83 participants in the placebo group.  For week one, all the participants recorded their hot flashes prior to treatment.  The groups received the following interventions during weeks 2-7:

Group 1:  Citalopram 10mg (per day) during weeks 2-7

Group 2:  Citalopram 10mg during week 2, followed by 20mg during weeks 3-7

Group 3:  Citalopram 10mg for week 2, 20mg for week 3, and 30mg for weeks 4-7

Group 4:  Placebo

This study showed that the participants receiving placebo (Group 4) had a 23% reduction in their mean hot flash score, while groups 1, 2, and 3 had mean reductions of 49%, 50%, and 55%, respectively.  Similarly, the mean reduction in hot flash frequency was noted to be 20% in the placebo group, while groups 1, 2, and 3, had mean reductions of 46%, 43%, and 50%, respectively.  All of the comparisons to placebo noted here were noted to be statistically significant.

Women in all three groups receiving citalopram arms also had greater improvements in the quality of work, leisure, sleep, mood, relationships, enjoyment of life, and overall quality of life that those on placebo on the Hot Flash Related Daily Interference Scale (HFRDIS).

This study further supports the use of citalopram as a possible treatment option for patients looking to reduce hot flashes and is consistent with previous studies documenting the effectiveness of other serotonergic antidepressants, including paroxetine (Paxil) and venlafaxine (Effexor), for the treatment of hot flushes.  These studies also indicate that these antidepressants may be helpful for managing other menopausal symptoms, including mood changes and sleep disturbance.

Betty Wang, MD

Kalay AD, Demir B, Haberal A, Kalay M, Kandemir O. Efficacy of citalopram on climacteric symptoms.  Menopause 14(6):1069-1070, 2007.

Poster session by Debra Barton, PhD and colleagues from the Mayo Clinic in Rochester, MN, at the annual meeting of the American Society of Clinical Oncology, as reported in: Wachter K. Citalopram Appears Effective for Reducing Hot Flashes. Clinical Psychiatry News 36 (7): 48, 2008.

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2 Responses to Citalopram (Celexa) Effective for Treating Hot Flashes

  1. kathleen hewitt April 17, 2010 at 1:42 pm #

    I totally agree with the use of Celexa. My gynecologist was surprised when I told her that if I missed a day or two of Celexa (I only take 10 mg daily), I would have flashes and I would cry. The kind of deep crying associated with sadness. I do not have a history of depression. I started Celexa when I was in treatment for rectal cancer in 2005 and went into menopause secondary to chemotherapy.

    If I take, though, more than 10mg per day, I feel too much anxiety so sometimes, if I’m having a particularly stressful time, I might alternate 10mg with 20mg. every other day, making sure that I take it very early in the morning because I feel that increased dose interferes with sleep.

  2. Jean June 17, 2010 at 3:22 pm #

    I take 20 mg a day before bedtime. Hot flashes and night sweats have been reduced a lot though not eliminated. That’s why I’m taking it. Unfortunately I seem to have the side effect of fatigue and am more tired now than when I woke up every 30 minutes in a sweat. I don’t have any other side effect. I’ve been on it for 3 months. I guess it’s back to the doctor for another consult.

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