Women who suffer from hot flashes may get some relief from their symptoms by taking a particular antidepressant, according to a new study.
The antidepressant escitalopram reduced the frequency and severity of hot flashes in menopausal and postmenopausal women during an eight-week study comparing the use of escitalopram against a placebo treatment.
The only treatments currently approved by the Food and Drug Administration for hot flashes are hormone therapies, such as those that use estrogen and progesterone, but long-term use of these hormones has been linked to an increased risk of breast cancer, among other adverse effects, the researchers said.
Researchers were seeking an alternative drug that could confer the benefits of hormone therapy without the risks.
“It provides an option, or another treatment for hot flashes,” study researcher Ellen Freeman, of the University of Pennsylvania School of Medicine, said of escitalopram.
However, other experts said more research is needed before it can be used by women. The new study was too brief, and it did not compare escitalopram with estrogen, the current “gold standard” treatment for hot flashes, some said.
The study appears in the Jan. 19 edition of the Journal of the American Medical Association.
Antidepressants and hot flashes
Antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which are normally prescribed for conditions such as depression and anxiety, have already been investigated for treating hot flashes. However, those studies showed mixed results and involved very small numbers of patients.
Freeman and colleagues examined the effectives of escitalopram, an SSRI, in 205 women who, ranging in age from 42 through 60, either were going through menopause or were postmenopausal. To be included in the study, the women had to have experienced at least 28 hot flashes per week for three weeks.
The participants were randomly prescribed either the antidepressant or the placebo, and not even the doctors knew who received which treatment. The participants kept diaries to track the frequency of their hot flashes and rated them as 1, 2 or 3 for mild, moderate or severe.
Before the study, the women reported an average of 9.78 hot flashes per day. After the eight weeks of the study, the women who took escitalopram had a daily average of 5.26, while those who unknowingly took the placebo reported a daily average of 6.43.
The drug also significantly decreased hot flash severity. Initially, the average rating for severity was 2.17 out of 3. After eight weeks, those who received escitalopram gave their hot flash severity an average rating of 1.63, while those on the placebo gave it a rating of 1.89.
Women who took the drug also sounded more satisfied with their treatment than women who took the placebo, and they were more likely to want to continue with the medication.
Three weeks after the participants stopped their treatment, those in the escitalopram group reported that the frequency of their hot flashes had increased, while those in the placebo group reported no change.
The drug is believed to increase the availability of the neurotransmitter serotonin at receptors in the brain, Freeman said. The findings suggest serotonin plays some role in hot flashes, she said.
What's good enough?
Drugs for hot flashes should be evaluated for at least 12 weeks to gauge their effectiveness, said Dr. Anne Nedrow of the Oregon Health and Science University, who was not involved in the study.
Nedrow helped review alternative treatments for hot flashes in 2006 for the National Institutes of Health, and she said studies were included in the review only if they were at least 12 weeks long.
“The reason for that is because menopausal symptoms wax and wane so much, day to day, week to week, month to month,” Nedrow said. “And unless it was at least 12 weeks long, we felt that any improvement was too likely just to be coincidence.”
In addition, future studies might want to compare the effectiveness of escitalopram with that of estrogen, Nedrow said.
Another important question to answer when conducting these studies is whether the women themselves consider the reduction in their symptoms to be enough to keep them off estrogen therapy, Nedrow said.
“If it's not good enough to keep women off estrogen, it doesn’t matter,” she said.
Future studies will investigate the effectiveness of other treatments for hot flashes, including yoga, physical exercise and supplementation with omega-3 fatty acids, Freeman said.
Pass it on: The antidepressant escitalopram might relieve symptoms of hot flashes.
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