Multiple studies have shown that gabapentin (Neurontin) at 600-2400 mg/day in divided doses is effective for treating hot flashes in menopausal women. This study examines the efficacy of an extended release preparation.
For decades, estrogen has been used to treat menopausal symptoms, including night sweats and hot flashes. However, after studies reported that estrogen increases the risk of cardiovascular disease and breast cancer, many patients and clinicians have looked into alternative treatments for hot flashes, including selective serotonin reuptake inhibitors (SSRIs).
Selective serotonin and serotonin-norepinephrine inhibitors (SSRIs and SNRIs) have been shown to be effective for the treatment of hot flashes. However, these agents may carry certain side effects, including sexual side effects and sleep disturbance. These two side effects may be particularly concerning to peri- and postmenopausal women who, in addition to having vasomotor symptoms, are more likely to experience sexual dysfunction and sleep disruption than premenopausal women.
Women with bipolar disorder or history of postpartum psychosis are at high risk for postpartum psychosis; appropriate interventions significantly decrease this risk.
Escitalopram, when used in the treatment of menopausal vasomotor symptoms, did not worsen overall sexual function among non-depressed midlife women.
Part 4:Â The Postpartum Period
Part 3: Planning for the Postpartum Period
Part 1:Â Pre-Pregnancy Planning
Ms. T is a 33 year old woman with a history of recurrent depression who is 32 weeks   pregnant with her first pregnancy. She has remained on her citalopram (Celexa) throughout pregnancy and has been well. Her gynecologist has encouraged her to enquire about coming off the Celexa prior to delivery in order to avoid symptoms of neonatal distress. What should she do?
