Escitalopram (Lexapro) for Treatment of Hot Flashes in Menopausal Women

In a well-done placebo controlled study published in this week’s JAMA, use of Escitalopram (Lexapro) reduced hot flashes in post-menopausal women.

Investigators enrolled 205 women, randomizing them to either Lexapro 10 mg or placebo, with instructions to increase to two pills a day if needed after 4 weeks.

Lexapro users experienced about a 60% reduction in hot flash frequency over the 8 week study. About half ended up on the larger 20 mg daily dose by study’s end. The drug’s effect was apparent at about one week of use, and it was well-tolerated.

As in almost studies of menopausal treatments, the placebo group also experienced a significant reduction in symptoms – about 40% – but the difference between placebo and drug groups was significant. Compared to placebo users, Lexapro users had a bigger rebound of symptoms when stopping their treatment, were more satisfied and more likely to want to continue study drug, another validation of the drug’s efficacy.

Add another SSRI to the List of Drugs Proven to Treat Hot Flashes

The results of this study are not surprising. This class of anti-depressant medications (SSRI’s and SNRI’s) seem to have a modest but consistently shown impact on the vasomotor symptoms of menopause. All of the SSRI’s studied to date seem to have a similar efficacy – about a 60% reduction in hot flash frequency. None work quite as well as estrogen does, but in women concerned about breast cancer risks, SSRI’s may be preferable to hormone replacement, especially if mood issues are also significant symptoms.

Unlike their use in depression, where effects may not become apparent for 6 weeks or more, SSRI’s begin to work within the first 1-2 weeks when used to treat hot flashes (and, by the way, PMS…).

One advantage of citalopram is that, unlike some SSRI”s ( Paxil and Prozac),  it does not appear to impair the efficacy of tamoxifen. These other drugs interfere with the conversion of Tamoxifen to its active metabolites. Effexor is probably the safest to use with Tamoxifen, and has similar efficacy against hot flashes.  Other SSRIs that are considered safer than Paxil and Prozac are Zoloft and Celexa.  Since hot flashes are a side effect of Tamoxifen use, it’s nice to have yet another option to treat them.   (In order of interference with tamoxifen, from highest to lowest interference, the SSRIs are Paxil, Prozac, Zoloft, Celexa, and Effexor. Maybe I’ll do a post on this later…)

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1/19/11 Note – I updated and clarified the SSRI Tamoxifen interaction data for those interested.