Antidepressant cools hot flashes in study

The antidepressant citalopram may help lessen the severity of menopausal hot flashes, at least in the short term, a new clinical trial suggests.

The findings, from a seven-week study of 254 women, add to evidence that certain antidepressants can offer relief from severe hot flashes.

Studies have found that some antidepressants in the class known as selective serotonin reuptake inhibitors (SSRIs) may help treat hot flashes; those drugs include paroxetine (Paxil), fluoxetine (Prozac) and venlafaxine (Effexor).

But citalopram (Celexa), another SSRI, has an advantage over some of those medications - namely, paroxetine and fluoxetine - in that it can be used by women on tamoxifen. Tamoxifen is a drug prescribed to treat and lower the risk of breast cancer, and hot flashes are a common side effect.

Because paroxetine and fluoxetine inhibit an enzyme needed to metabolize tamoxifen, women on the drug cannot use those antidepressants for hot flashes.

For the new study, published in the Journal of Clinical Oncology, researchers recruited 254 postmenopausal women who said they had at least 14 "bothersome" hot flashes per week.

For the first week of the study, the women recorded their hot-flash frequency and severity. The researchers then randomly assigned them to take one of three doses of citalopram - 10, 20 or 30 milligrams (mg) per day - or a placebo for six weeks.

In general, the study found, women on the antidepressant showed greater reductions in their hot-flash "score" - a measure of the severity and frequency of hot flashes - than those on the placebo: a reduction of 49 percent to 55 percent, depending on the dose, versus 23 percent with the placebo.

The difference among the three citalopram doses was not significant, suggesting that even a low 10-mg dose can ease hot flashes, the researchers say.

However, as a group, women on the 20-mg dose reported additional benefits, including better sleep and improved mood, noted lead researcher Dr. Debra L. Barton, an associate professor of oncology at the Mayo Clinic in Rochester, Minnesota.

The doses used in this study were lower than what is typically used for treating depression, Barton told Reuters Health in an email, and there was no evidence of an increased risk of side effects with the 10- or 20-mg doses, versus placebo.

With the 30-mg dose, there was some evidence of more sexual side effects; the difference, however, was not significant in statistical terms, so it is unclear if the finding was due to chance.

Sexual side effects, such as decreased libido and difficulty reaching orgasm, are among the potential adverse effects of citalopram and other antidepressants - as are sleep problems, drowsiness and weight changes.

Barton said that more research is needed to study both the effectiveness and risk of side effects when citalopram is taken over a longer period to treat hot flashes.