Hot flashes are one of the most troubling manifestation of menopause, affecting about 80% of women. Due to recent controversies about hormone replacement therapy, many women seek alternative treatments. The use of antidepressants to treat hot flashes and other menopausal symptoms has been an active area of investigation. However, the majority of past research in this area has included women with significant medical or psychiatric histories that may influence treatment response. This was the first study to examine the impact of escitalopram on hot flashes, mood, sleep, and quality of life in a sample of healthy nondepressed menopausal women.
Methods
This study enrolled 25 menopausal women who had no significant psychiatric or medical history. All women were treated with escitalopram (10 to 20 mg flexibly dosed) for 8 weeks. The active treatment phase was preceded by a single-blind placebo lead-in period.
Results
Over the course of the study, women reported significant decreases in both hot flash frequency and severity as well as improvements in dysphoria, anxiety, quality of life, and sleep.
Conclusions
These preliminary findings suggest that escitalopram may be a feasible and effective option for treating hot flashes and other menopausal symptoms in healthy women who might not ordinarily consider antidepressant treatment.
PearceJHawtonKBlakeF.Psychological and sexual symptoms associated with the menopause and the effects of hormone replacement therapy. Br J Psychiatry. 1995;167:163–173.
2.
MontgomeryJCStuddJW. Psychological and sexual aspects of menopause. Br J Hosp Med. 1991;45: 300–302.
3.
DennersteinL.Well-being, symptoms, and the menopause transition. Maturitas. 1996;23:147–157.
4.
NagamaniMKelverMESmithER. Treatment of menopausal hot flashes with transdermal administration of clonidine. Am J Obstet Gynecol. 1987;156: 561–565.
5.
BerendsenHH. The role of serotonin in hot flushes. Maturitas. 2000;36:155–164.
6.
RossouwJEAndersonGLPrenticeRL, and the Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288:321–333.
7.
VickersMRMacLennanAHLawtonB. Main morbidities recorded in the Women's International Study of Long Duration on Oestrogen after Menopause (WISDOM): a randomized controlled trial of hormone replacement therapy in postmenopausal women. BMJ. 2007;335:239.
8.
RodriguezCPatelAVCalleEE. Estrogen replacement therapy and ovarian cancer mortality in a large prospective study of US women. JAMA. 2001;285:1460–1465.
9.
ShumakerSALegaultCRappSR, and the WHIMS Investigators. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial. JAMA. 2003;289:2651–2662.
10.
FletcherSWColditzGA. Failure of estrogen plus progestin therapy for prevention. JAMA. 2002;288: 366–368.
BorazMASimkin-SilvermanLRWingRR. Hormone replacement therapy use and menopausal symptoms among women participating in a behavioral lifestyle intervention. Prev Med. 2001, 33(2 pt 1):108–114.
13.
YoungRLKumarNSGoldzieherJW. Management of menopause when estrogen cannot be used. Drugs. 1990;40:220–230.
14.
GradyDGebretsadikTKerlikowskeK. Hormone replacement therapy and endometrial cancer risk: meta-analysis. Obstet Gynecol. 1995;85:304–313.
15.
ConnellyMTRichardsonMPlattR.Prevalence and duration of postmenopausal hormone replacement therapy use in a managed care organization, 1990-1995. J Gen Intern Med. 2000;15:542–550.
16.
HillDAWeissNSLaCroixAZ. Adherence to postmenopausal hormone therapy during the year after the initial prescription: A population based study. Am J Obstet Gynecol. 2000;182:270–276.
17.
HulleySGradyDBushT. Randomized trial of estrogen plus progestin for secondary prevention of coronary artery disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study Research Group. JAMA. 1998;280:605–613.
18.
NerhoodRC. Making a decision about ERT/HRT. Evidence to consider in initiating and continuing protective therapy. Postgrad Med. 2001;109:167-170, 173–174, 178.
19.
PhilpHA. Hot flashes—a review of the literature on alternative and complementary treatment approaches. Altern Med Review. 2003;8:284–302.
20.
KesselBKronenbergF.The role of complementary and alternative medicine in the management of menopausal symptoms. Endocrinol Metab Clin North Am. 2004;33:717–739.
21.
KronenbergFFugh-BermanA.Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Intern Med. 2002;137:805–813.
22.
NedrowAMillerJWalkerM. Complementary and alternative therapies for the management of menopause-related symptoms: a systematic evidence review. Arch Intern Med. 2006;166:1453–1465.
23.
GradyD.Clinical practice. Management of menopausal symptoms. N Engl J Med. 2006;355:2338–2347.
24.
NelsonHDVescoKKHaneyE. Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis. JAMA. 2006;295:2057–2071.
25.
LoprinziCLPisanskyTMFonsecaR. Pilot evaluation of venlafaxine hydrochloride for the therapy of hot flashes in cancer survivors. J Clin Oncol. 1998;16:2377–2381.
26.
LoprinziCLKuglerJWSloanJA. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomized controlled trial. Lancet. 2000;356:2059–2065.
27.
StearnsVIsaacsCRowlandJ. A pilot trial assessing the efficacy of paroxetine hydrochloride (Paxil) in controlling hot flashes in breast cancer survivors. Ann Oncol. 2000;11:17–22.
28.
WaldingerMDBerendsenHHSchweitzerDH. Treatment of hot flushes with mirtazapine: four case reports. Maturitas. 2000;36:165–168.
29.
LoprinziCLSloanJAPerezEA. Phase III evaluation of fluoxetine for treatment of hot flashes. J Clin Oncol. 2002;20:1578–1583.
30.
OishiAMochizukiYOtsuR. Pilot study of fluvoxamine treatment for climacteric symptoms in Japanese women. Biopsychosoc Med. 2007;1:12.
31.
WeitznerMAMoncelloJJacobsenPB. A pilot trial of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer. J Pain Symptom Manage. 2002;23:337–345.
32.
StearnsVBeebeKLIyengarM. Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. JAMA. 2003;289:2827–2834.
33.
StearnsVSlackRGreepN. Paroxetine is an effective treatment for hot flashes: results from a prospective randomized clinical trial. J Clin Oncol. 2005;23:6919–6930.
34.
Suvanto-LuukkonenEKoivunenRSundstromH. Citalopram and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized, 9-month, placebo-controlled, double-blind study. Menopause. 2005;12:18–26.
35.
GradyDCohenBTiceJ. Ineffectiveness of sertraline for treatment of menopausal hot flashes: a randomized controlled trial. Obstet Gynecol. 2007;109: 823–830.
36.
SperoffLGassMConstantineG, and the Study 315 Investigators. Efficacy and tolerability of desvenlafaxine succinate treatment for menopausal vasomotor symptoms: a randomized controlled trial. Obstet Gynecol. 2008;111:77–87.
37.
Diagnostic and statistical manual of mental disorders. 4th edition. Washington, DC: American Psychiatric Association; 1994.
38.
FirstMBSpitzerRLGibbonM. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Washington, DC: American Psychiatric Publishing, Inc.; 1997.
39.
HamiltonM.Hamilton depression scale. In: GuyW, ed. ECDEU Assessment manual for psychopharmacology. Rev ed. Washington, DC: US Department of Health, Education, and Welfare; 1976.
40.
BuysseDJReynoldsCF3rd, MonkTH, . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.
41.
SloanJALoprinziCLNovotnyPJ. Methodologic lessons learned from hot flash studies. J Clin Oncol. 2001;19:4280–4290.
42.
HamiltonM.Hamilton anxiety scale. In: GuyW, ed. ECDEU Assessment manual for psychopharmacology. Rev ed. Washington, DC: US Department of Health, Education, and Welfare; 1976:193–198.
43.
HilditchJRLewisJPeterA. A menopausespecific quality of life questionnaire: development and psychometric properties. Maturitas. 1996;24:161–175.
44.
GreeneJG. Constructing a standard climacteric scale. Maturitas. 1998;29:25–31.
45.
MontgomerySAKasperS.Comparison of compliance between serotonin reuptake inhibitors and tricyclic antidepressants: a meta-analysis. Int Clin Psychopharmacol. 1995, 9(suppl 4):33–40.
46.
WaughJGoaKL. Escitalopram: a review of its use in the management of major depressive and anxiety disorders. CNS Drugs. 2003;17:343–362.
47.
BurkeWJGergelIBoseA.Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients. J Clin Psychiatry. 2002;63:331–336.
48.
WadeAMichael Lemming O, Bang Hedegaard K. Escitalopram 10 mg/day is effective and well tolerated in a placebo-controlled study in depression in primary care. Int Clin Psychopharmacol. 2002;17:95–102.
49.
AlbertazziP.Noradrenergic and serotonergic modulation to treat vasomotor symptoms. J Br Menopause Soc. 2006;12:7–11.
50.
SoaresCNArsenioHJoffeH. Escitalopram versus ethinyl estradiol and norethindrone acetate for symptomatic peri- and postmenopausal women: impact on depression, vasomotor symptoms, sleep and quality of life. Menopause. 2006;13:780–786.
51.
SecretoGChiechiLMAmadoriA. Soy isoflavones and melatonin for the relief of climacteric symptoms: a multicenter, double-blind randomized study. Maturitas. 2004;47:11–20.
52.
SimonJAStevensREAyresSA. Perimeno-pausal women in estrogen vasomotor trials: contribution to placebo effect and efficacy outcome. Climacteric. 2001;4:19–27.
53.
CummingGPHeraldJMoncurR. Women's attitudes to hormone replacement therapy, alternative therapy and sexual health: a web-based survey. Menopause Int. 2007;13:79–83.
54.
FarrellE.Medical choices available for management of menopause. Best Pract Res Clin Endocrinol Metab. 2003;17:1–16.
55.
ReynoldsRFObermeyerCMWalkerAM. The role of treatment intentions and concerns about side effects in women's decision to discontinue postmenopausal hormone therapy. Maturitas. 2002;43:183–194.
