The antidepressant Lexapro (escitalopram) may reduce the frequency and severity of hot flashes, the bouts of sweating and overheating that are an uncomfortable fact of life for many menopausal women, a new government-funded study suggests.
The study, which appears in the Journal of the American Medical Association, included more than 200 middle-aged women who were experiencing an average of 10 hot flashes per day. After eight weeks, women who took Lexapro every day were having about 5.25 hot flashes per day, while those who took placebo were averaging roughly 6.5.
“The women on escitalopram were much more likely to [think] their treatment was helpful,” says the lead researcher, Ellen W. Freeman, PhD, a professor of ob-gyn at the University of Pennsylvania School of Medicine, in Philadelphia. “Many of them said they wanted to continue their medication.”
Women with menopause-related hot flashes don’t have many options. The most effective treatment for hot flashes, night sweats, and other menopausal symptoms is generally believed to be hormone therapy, which entails taking estrogen, sometimes in combination with progestin, to counteract the hormonal changes associated with menopause.
But hormone therapy is no longer recommended for long-term use because of the risk of heart disease, breast cancer, and other health problems associated with the combination of estrogen and progestin. (Because estrogen alone can increase the risk of endometrial cancer, or cancer of the lining of the womb, women who have not had a hysterectomy take progestin in addition to estrogen.)
Currently, hormone therapy is the only prescription treatment for hot flashes approved by the Food and Drug Administration (FDA), and the effectiveness of herbal remedies such as black cohosh and evening primrose oil is disputed.
Antidepressants such as Prozac and Celexa have been shown to be better than placebo at treating hot flashes, and doctors sometimes prescribe these and other antidepressants for hot flashes “off-label” (i.e., without the FDA’s official OK). The antiseizure medication gabapentin and the hypertension drug clonidine are sometimes used off-label for hot flashes as well.
Lexapro, which is in the same class of drugs as Prozac, appeared to be a promising treatment for hot flashes in previous studies, but the results were inconclusive. The new findings “just further substantiate what we know about this class of drugs,” says Charles Loprinzi, MD, a professor of oncology at the Mayo Clinic, in Rochester, Minn.
These drugs, known as selective serotonin reuptake inhibitors (SSRIs), are thought to help treat depression by increasing levels of serotonin in the brain. It’s not clear how they might help reduce hot flashes, but it may be unrelated to how they fight depression.
Although a depressed person needs to take an SSRI for weeks or even months to see results, women who take the drugs for hot flashes notice a difference within a week or even right away, says Dr. Loprinzi, who has conducted several studies on antidepressant drugs for hot flashes but was not involved in the new research.
The National Institutes of Health funded the new study. Forest Pharmaceuticals, the maker of Lexapro, provided the pills used in the study, and Freeman and several of her coauthors reported a financial relationship with the company, including receiving research funding and consulting fees.
Although Lexapro did not eliminate hot flashes altogether, it did appear to reduce their severity. The study participants who took the drug rated their hot flashes as being about 24% less severe than they were at the beginning of the study, compared to just 14% less severe in the placebo group.
And after the women stopped taking Lexapro, the number of hot flashes they experienced bounced back, more so than in the placebo group. “It looks like the women who had escitalopram really noticed a difference when they didn’t take it anymore,” Freeman says.
Lexapro may not be the best antidepressant alternative to hormone therapy for all menopausal women, Dr. Loprinzi says. For instance, the antidepressant Effexor may be a better choice for women taking tamoxifen because it appears to interact the least with this hormone-blocking drug, he says.
However, Dr. Loprinzi adds, there haven’t been any studies directly comparing different antidepressants for hot flashes, so it’s impossible to say which drug is the most effective for any given patient.