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). According to a new study published in the Journal of the American Medical Association, treatment with the selective serotonin reuptake inhibitor (SSRI) escitalopram (Lexapro) significantly reduces the frequency and severity of menopausal hot flashes compared with placebo.

This multicenter, randomized, double-blind, placebo-controlled trial included 205 women (ages 40 to 62 years) who were either peri- or postmenopausal women.  Women were eligible for the study if they had at least 28 hot flashes or night sweats per week rated as bothersome or severe for 4 or more days per week.  Women with a history of bipolar disorder or psychosis, current major depressive episode, or drug or alcohol abuse in the past year were excluded.

Women were randomly assigned to receive either escitalopram (10 mg) or placebo. After 4 weeks, if the hot flash frequency was reduced by less than 50% and there was no decrease in severity, the dose was increased to 20 mg.

The study found that escitalopram resulted in a significant reduction in the frequency, severity, and bothersomeness of hot flashes as compared to placebo.  At baseline, the mean frequency of hot flashes for all subjects was 9.8 per day. At 8 weeks, the mean daily frequency decreased to 5.3 in the treatment group versus 6.4 in the placebo group.  This represented a mean reduction of 4.6 hot flashes (47%) per day in the escitalopram group versus a mean reduction of 3.2 (33%) hot flashes per day in the placebo group.

Treatment response was rapid, with women in the escitalopram group already showing some improvement in hot flash frequency and severity within 1 week of starting treatment.  After 8 weeks of treatment, participants stopped their treatment. Three weeks after treatment ended, the frequency of hot flashes increased more in the women who stopped the escitalopram than in those who stopped placebo, indicating that hot flashes recurred after the SSRI was discontinued.  At the end of treatment, 64% of the women taking escitalopram said they would have liked to have continued taking their assigned medication, compared with only 42% of those in the placebo group.

Consistent with previous trials of other SSRIs and SNRIs, escitalopram at doses of 10 or 20 mg/d significantly reduced hot flash frequency and severity.  While earlier studies using estrogen for the treatment of hot flashes have indicated that estrogen may have a more robust effect on reduction of hot flashes, the impact of escitalopram on hot flash frequency and severity is clinically meaningful and escitalopram was well-tolerated. Although women treated with the SSRI continued to have some hot flashes, the amount of improvement that they experienced on escitalopram had an important positive impact on their quality of life.

This study was funded by the NIH/NIA and is part of a series of clinical trials that is supported by funding from NIH through the MsFLASH network (Menopause Strategies: Finding Lasting Answers for Symptoms and Health). The Center for Women’s Mental Health is one of 6 research centers that comprise the MsFLASH network.

Ruta Nonacs, MD PhD

Hadine Joffe, MD MSc

Freeman EW, Guthrie KA, Caan B, Sternfeld B, Cohen LS, Joffe H, et al.  Efficacy of Escitalopram for Hot Flashes in Healthy Menopausal Women: A Randomized Controlled Trial. JAMA. 2011;305:267-274.

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