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.