Escitalopram reduces number and severity of menopausal hot flashes

Escitalopram, a selective serotonin reuptake inhibitor, at doses of 10 or 20 mg/d significantly reduced hot flash frequency and severity compared with placebo, according to a recent multicenter, double-blind study.

Women aged 40 to 62 were included in the study. Of the 205 women in the study, 95 were African American; 102 white; and 8 other.

The study, which was published in JAMA, determined that among women receiving escitalopram, 55% reported that hot flash frequency decreased >50% from baseline compared to 36% in the placebo group at the 8-week follow-up. At the starting dose of 10 mg/d, 44% of women improved at 4 weeks; another 11% who were unimproved after 4 weeks improved with a single-dose increase to 20 mg/d. In addition, reduction in hot flash severity scores was significantly greater in those receiving the drug. Race did not significantly affect the response to escitalopram.

Satisfaction with treatment was significantly greater in patients taking escitalopram than those taking placebo. Among those in the placebo group, 46% indicated that their treatment had no benefit compared with 16% in the escitalopram group. There were no serious adverse events that required medical intervention or study withdrawal. Newly emergent (withdrawal) symptoms that were reported by more than 10% of those taking escitalopram were dizziness or lightheadedness (14%), vivid dreams (13%), nausea (11%), and excessive sweating (11%).

Women in the escitalopram group reported a mean 1.59 more hot flashes per day than women in the placebo group 3 weeks after the end of treatment. From weeks 8 to 11 (approximately 3 weeks after treatment cessation), ratings of severity and bother worsened in the escitalopram group but were unchanged in the placebo group.

The authors report that the present study supports previous clinical trials that found selective serotonin and serotonin norepinephrine reuptake inhibitors (SSRIs and SNRIs) are effective in treating hot flashes. They also believe that their study is the first clinical trial to examine the relationship between race and response to SSRI treatment for hot flashes.