Antidepressant may reduce severity, frequency of menopausal hot flashes

Women who took the antidepressant escitalopram during the menopausal transition or postmenopause had less frequent and severe hot flashes than women who received a placebo, a new study reports.

The multicenter, 8-week, double-blind trial randomized 205 healthy women (95 African American, 102 Caucasian, 8 other) to receive a daily dose of escitalopram 10 mg or a placebo for 4 weeks. If at the end of 4 weeks the women did not report at least a 50% reduction in hot flashes or a decrease in severity, their dosage was increased to 20 mg of the study drug or matched placebo. Frequency and severity of hot flashes at weeks 4 and 8 were evaluated using prospective daily diaries.

Researchers observed a significant drop in frequency and severity of hot flashes in the escitalopram group compared with the placebo group, adjusted for race, site, and baseline hot flash frequency.

“Our findings suggest that among healthy women, 10 to 20 mg per day of escitalopram provides a nonhormonal, off-label option that is effective and well-tolerated in the management of menopause hot flashes,” the authors write. The average frequency of hot flashes at the beginning of the study was 9.8 per day. It decreased by 47% to an average of 5.26 per day at week 8 in the escitalopram group, compared with a 33% decrease to 6.43 hot flashes per day in the placebo group. The severity also decreased significantly (P<.001) in the escitalopram group compared with placebo. Four percent of participants (7 taking escitalopram, 2 receiving placebo) dropped out of the study because of adverse effects.

Women taking escitalopram showed markedly greater clinical improvement-defined as a decrease in hot flash frequency of 50% or more from baseline frequency-at week 8 than women taking placebo (55% vs 36%, respectively). Race didn’t significantly alter the treatment effect, although the reduction in daily frequency of hot flashes among African American women in the escitalopram cohort was smaller than for women of other races.

“The 3-week postintervention follow-up demonstrated that hot flashes increased after cessation of escitalopram but not after cessation of placebo, providing further evidence of escitalopram’s effects,” the authors write.

The study was published in the Journal of the American Medical Association (2011;305[3]267-274).