Do SSRIs and SNRIs reduce the frequency and/or severity of hot flashes in menopausal women Original paper

What was studied?

This review article focused on the use of SSRIs and SNRIs to reduce the frequency and severity of hot flashes in menopausal women. The study assessed various SSRIs and SNRIs, including paroxetine, escitalopram, venlafaxine, and desvenlafaxine, to determine their effectiveness as alternatives to hormone replacement therapy (HRT) in treating vasomotor symptoms (VMS), particularly hot flashes. It explored the evidence from multiple randomized controlled trials (RCTs) and systematic reviews to evaluate the efficacy, safety, and side effects of these non-hormonal treatments for managing menopausal symptoms in women who either cannot use HRT or prefer non-hormonal options due to health concerns.

Who was studied?

The studies reviewed included menopausal, perimenopausal, and postmenopausal women aged 18 years and older who experienced frequent or severe vasomotor symptoms, such as hot flashes. The review focused on women who were seeking relief from these symptoms using non-hormonal pharmaceutical treatments. It also considered studies that involved women who had contraindications to hormone therapy, such as a history of breast cancer, or those who simply preferred non-hormonal treatments for managing their menopausal symptoms. The review also assessed the use of SSRIs and SNRIs in women with varying baseline health conditions, such as hypertension or a history of breast cancer, to understand their safety and effectiveness in different populations.

Most important findings

The review found that SSRIs and SNRIs, particularly paroxetine, escitalopram, and venlafaxine, were effective in reducing the frequency and severity of hot flashes in menopausal women. Paroxetine (Paxil) was particularly noted for its significant effectiveness at a low dose (7.5 mg), which is the only FDA-approved SSRI for treating hot flashes. Venlafaxine (Effexor XR) was highlighted as a first-line SNRI option, although it was associated with higher rates of side effects, such as nausea and constipation. The review found that SSRIs reduced hot flashes by 10% to 64%, with the greatest effectiveness seen in paroxetine. Escitalopram and citalopram were also effective, although their effects were less pronounced than paroxetine.

The most common side effects included nausea, fatigue, and dry mouth, but these were generally mild and subsided after the first week. The review emphasized that SNRIs, particularly venlafaxine, may increase blood pressure and therefore should be used cautiously in hypertensive patients. The evidence also suggested that SSRIs and SNRIs can be considered a reasonable alternative to HRT for women who wish to avoid estrogen-related risks.

Key implications

The review suggests that SSRIs and SNRIs are viable options for reducing hot flashes in menopausal women who are unable or unwilling to use HRT. Paroxetine, escitalopram, and venlafaxine are particularly effective and should be considered as first-line therapies for managing vasomotor symptoms. The review also highlights the need for careful monitoring of blood pressure in patients using venlafaxine, particularly those with a history of hypertension. Furthermore, the review advises against using SSRIs in women who are taking tamoxifen, as SSRIs can inhibit the CYP2D6 enzyme, which is necessary for tamoxifen metabolism. SNRIs like venlafaxine and desvenlafaxine are safer alternatives for women taking tamoxifen. The findings support the use of SSRIs and SNRIs in clinical practice, particularly in populations where hormone therapy is not recommended or preferred. However, the review also calls for further studies to evaluate the long-term risks, benefits, and dosing regimens of these non-hormonal treatments.