Antidepressants (SSRIs) for Menopausal Symptoms (2024)

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Introduction:Selective serotonin reuptake inhibitors (SSRIs) antidepressants and non-SSRI antidepressants have been shown to decrease the frequency and strength of hot flashes, with few side effects.

SSRI antidepressants include:

Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)

Some SSRIs may interfere with tamoxifen. However, it’s not known if this impacts the effectiveness of tamoxifen treatment forbreast cancer [1]. If you’re taking tamoxifen, talkwith your health care provider before taking an SSRI.

Non-SSRI antidepressants include:

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)

Other non-hormone medications

Gabapentin (Neurontin), and pregabalin (Lyrica) and clonidine are under study for the relief of hot flashes.

Learn more about treating menopausal symptoms.

Learn about the strengths and weaknesses of different types of studies.

Study selection criteria: Randomized controlled trials that compared a non-hormone medication to a placebo with at least 100 participants, pooled analyses and meta-analyses. A placebo is an inactive substance sometimes used to have a comparison to a drug in a clinical trial.

Table note: Relative risk above 1 indicates increased risk. Relative risk below 1 indicates decreased risk.

Study	Study Population (number of participants)	Medication Studied	Treatment Duration	Medication Reduced Hot Flashes Better Than Placebo?
Randomized controlled trials
SSRI antidepressants versus placebo
Barton et al. [2]	254 women who’ve had breast cancer and women never diagnosed with cancer	Citalopram	6 weeks	Yes
LaCroix et al. [3]	205 women never diagnosed with cancer	Escitalopram	8 weeks	Yes
Stearns et al. [4]	165 women who’ve had breast cancer and women never diagnosed with cancer	Paroxetine	6 weeks	Yes
Stearns et al. [5]	151 women who’ve had breast cancer and women never diagnosed with cancer	Paroxetine	4 weeks	Yes
Suvanto-Luukkonen et al. [6]	150 women never diagnosed with cancer	Fluoxetine	9 months	No
		Citalopram	9 months	No
Non-SSRI antidepressants versus placebo
Speroff et al. [7]	620 women never diagnosed with cancer	Desvenlafaxine	12 weeks	Yes
Archer et al. [8]	567 women never diagnosed with cancer	Desvenlafaxine	12 weeks	Yes
Bouchard et al. [9]	485 women never diagnosed with cancer	Desvenlafaxine	12 weeks	No
Pinkerton et al. [10]	365 women never diagnosed with cancer	Desvenlafaxine	12 weeks	Yes
Joffe et al. [11]	242 women never diagnosed with cancer	Venlafaxine	8 weeks	Yes
Loprinzi et al. [12]	191 women who’ve had breast cancer and women never diagnosed with cancer	Venlafaxine	4 weeks	Yes
Gabapentin versus placebo
Pinkerton et al. [13]	600 women never diagnosed with cancer	Gabapentin	12 weeks	Yes
Pandya et al. [14]	420 women never diagnosed with cancer	Gabapentin	8 weeks	Yes
Butt et al. [15]	193 women never diagnosed with cancer	Gabapentin	4 weeks	Yes
Loprinzi et al. [16]	163 women who’ve had breast cancer and women never diagnosed with cancer	Pregabalin	6 weeks	Yes
Clonidine versus placebo
Pandya et al. [17]	149 women who’ve had breast cancer	Clonidine	8 weeks	Yes
Pooled and meta-analyses
Loprinzi et al. [18]	748 women who’ve had breast cancer and women never diagnosed with cancer	SSRI and non-SSRI antidepressants*	4-6 weeks	Yes
	550 women who’ve had breast cancer and women never diagnosed with cancer	Gabapentin	4 weeks	Yes
Shams et al. [19]	9 studies of women never diagnosed with cancer	SSRI antidepressants	6-36 weeks	Yes
Nelson et al. [20]	7 studies	SSRI and non-SSRI antidepressants†	4 weeks to 3 months	Yes
	4 studies	Clonidine	4-8 weeks	No
Yoon et al. [21]	7 studies	Gabapentin	1-6 months	Yes
Sun et al. [22]	6 studies	Desvenlafaxine	12 weeks	Yes
Toulis et al. [23]	4 studies	Gabapentin	4-12 weeks	Yes
Riemma et al. [24]	3 studies	Paroxetine	6-16 weeks	Yes

* Pooled analysis included studies of fluoxetine, paroxetine, sertraline and venlafaxine.

† Meta-analysis included studies of citalopram, fluoxetine, paroxetine and venlafaxine.

References

Kelly CM, Juurlink DN, Gomes T, et al. Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study. BMJ. 340:c693, 2010.
Barton DL, LaVasseur BI, Sloan JA, et al. Phase III, placebo-controlled trial of three doses of citalopram for the treatment of hot flashes: NCCTG trial N05C9. J Clin Oncol. 28(20):3278-83, 2010.
LaCroix AZ1, Freeman EW, Larson J, et al. Effects of escitalopram on menopause-specific quality of life and pain in healthy menopausal women with hot flashes: a randomized controlled trial. Maturitas. 73(4):361-8, 2012.
Stearns V, Beebe KL, Iyengar M, Dube E. Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. JAMA. 289(21):2827-34, 2003.
Stearns V, Slack R, Greep N, et al. Paroxetine is an effective treatment for hot flashes: results from a prospective randomized clinical trial. J Clin Oncol. 23(28):6919-30, 2005.
Suvanto-Luukkonen E, Koivunen R, Sundström H, et al. Citalopram and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized, 9-month, placebo-controlled, double-blind study. Menopause. 12(1):18-26, 2005.
Speroff L, Gass M, Constantine G, Olivier S for the Study 315 Investigators. Efficacy and tolerability of desvenlafaxine succinate treatment for menopausal vasomotor symptoms: a randomized controlled trial. Obstet Gynecol. 111(1):77-87, 2008.
Archer DF, Dupont CM, Constantine GD, Pickar JH, Olivier S for the Study 319 Investigators. Desvenlafaxine for the treatment of vasomotor symptoms associated with menopause: a double-blind, randomized, placebo-controlled trial of efficacy and safety. Am J Obstet Gynecol. 200(3):238.e1-238.e10, 2009.
Bouchard P, Panay N, de Villiers TJ, et al. Randomized placebo- and active-controlled study of desvenlafaxine for menopausal vasomotor symptoms. Climacteric. 15(1):12-20, 2012.
Pinkerton JV, Constantine G, Hwang E, et al. for the Study 3353 Investigators. Desvenlafaxine compared with placebo for treatment of menopausal vasomotor symptoms: a 12-week, multicenter, parallel-group, randomized, double-blind, placebo-controlled efficacy trial. Menopause. 20(1):28-37, 2013.
Joffe H, Guthrie KA, LaCroix AZ, et al. Low-dose estradiol and the serotonin-norepinephrine reuptake inhibitor venlafaxine for vasomotor symptoms: a randomized clinical trial. JAMA Intern Med. 174(7):1058-66, 2014.
Loprinzi CL, Kugler JW, Sloan JA, et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet. 356(9247):2059-63, 2000.
Pinkerton JV, Kagan R, Portman D, Sathyanarayana R, Sweeney M for the Breeze 3 Investigators. Phase 3 randomized controlled study of gastroretentive gabapentin for the treatment of moderate-to-severe hot flashes in menopause. Menopause. 21(6):567-73, 2014.
Pandya KJ, Morrow GR, Roscoe JA, et al. Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial. Lancet. 366(9488):818-24, 2005.
Butt DA, Lock M, Lewis JE, Ross S, Moineddin R. Gabapentin for the treatment of menopausal hot flashes: a randomized controlled trial. Menopause. 15(2):310-8, 2008.
Loprinzi CL, Qin R, Balcueva EP, et al. Phase III, randomized, double-blind, placebo-controlled evaluation of pregabalin for alleviating hot flashes, N07C1. J Clin Oncol. 28(4):641-7, 2010.
Pandya KJ, Raubertas RF, Flynn PJ, et al. Oral clonidine in postmenopausal patients with breast cancer experiencing tamoxifen-induced hot flashes: a University of Rochester Cancer Center Community Clinical Oncology Program study. Ann Intern Med. 132(10):788-93, 2000.
Loprinzi CL, Sloan J, Stearns V, et al. Newer antidepressants and gabapentin for hot flashes: an individual patient pooled analysis. J Clin Oncol. 27(17):2831-7, 2009.
Shams T, Firwana B, Habib F, et al. SSRIs for hot flashes: a systematic review and meta-analysis of randomized trials. J Gen Intern Med. 29(1):204-13, 2014.
Nelson HD, Vesco KK, Haney E, et al. Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis. JAMA. 295(17):2057-71, 2006.
Yoon SH, Lee JY, Lee C, Lee H, Kim SN. Gabapentin for the treatment of hot flushes in menopause: a meta-analysis. Menopause. 27(4):485-493, 2020.
Sun Z, Hao Y, Zhang M. Efficacy and safety of desvenlafaxine treatment for hot flashes associated with menopause: a meta-analysis of randomized controlled trials. Gynecol Obstet Invest. 75(4):255-62, 2013.
Toulis KA, Tzellos T, Kouvelas D, Goulis DG. Gabapentin for the treatment of hot flashes in women with natural or tamoxifen-induced menopause: a systematic review and meta-analysis. Clin Ther. 31(2):221-35, 2009.
Riemma G, Schiattarella A, La Verde M, et al. Efficacy of low-dose paroxetine for the treatment of hot flushes in surgical and physiological postmenopausal women: systematic review and meta-analysis of randomized trials. Medicina (Kaunas). 55(9):554, 2019.

Updated 05/03/24

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FAQs

What is the best SSRI for menopause symptoms? ›

A form of paroxetine (sample brand name: Brisdelle) is an SSRI and is the only nonhormonal therapy that is specifically approved for hot flashes in the United States. This medication has been used for many years for treating depression, but it can be taken at a lower dose for hot flashes.

Discover More Details ›

Can antidepressants mask menopause symptoms? ›

For some women, these medications can help to reduce these symptoms, but they are not usually effective in helping their mood related changes or other menopausal symptoms such as vagin*l dryness, headaches and joint pains as these are due to fluctuating or lowered levels of estrogen and testosterone.

See Details ›

What antidepressants are good for vasomotor symptoms of menopause? ›

Studies suggest that low doses of SSRIs or SNRIs may help reduce vasomotor symptoms, especially hot flashes and night sweats. For example, a 2014 clinical trial found that a low dose of the SNRI venlafaxine (Effexor) worked almost as well as traditional hormone therapy for reducing hot flashes.

Learn More Now ›

Does Zoloft help with menopause symptoms? ›

Medications Without Hormones

There are three types of medications for menopause symptoms that are not hormonal. One of these might be better for you. SSRI antidepressants like Paxil, Zoloft, Lexapro, and Prozac can help reduce hot flashes and night sweats along with any depression you may be experiencing.

Read The Full Story ›

What SSRI is FDA approved for menopause? ›

They're prescribed at lower dosages, and they have different effects (more on that shortly). The only SSRI or SNRI currently FDA-approved for menopause treatment is paroxetine (brand name Brisdelle). Many similar medications, however, are prescribed by doctors on an “off-label” basis for menopause treatment.

Show Me More ›

Does Lexapro help with menopause? ›

The study found that escitalopram resulted in a significant reduction in the frequency, severity, and bothersomeness of hot flashes as compared to placebo. At baseline, the mean frequency of hot flashes for all subjects was 9.8 per day.

Show Me More ›

What is the best medication for menopause symptoms? ›

Estrogen therapy is the most effective treatment option for relieving menopausal hot flashes. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose and the shortest time frame needed to provide symptom relief for you.

Learn More ›

What antidepressants are good for energy and weight loss? ›

Most antidepressants might cause weight gain, but only one is known for not causing weight gain—bupropion (Wellbutrin). In one study, participants taking Wellbutrin lost as much as seven pounds. Sometimes people lose weight when going on any antidepressant because they become much more active again when feeling better.

What is the drug of choice for postmenopausal hot flashes? ›

Fezolinetant (Veozah). Veozah is a medicine for treating menopause hot flashes.

Tell Me More ›

What is the new drug for menopause? ›

Last year, the FDA greenlighted the Astellas drug fezolinetant, sold as Veozah. It targets NK-3, the receptor that controls body temperature. Ongoing research recently found that it can reduce hot flashes for nearly six months.

Keep Reading ›

What SSRI is best for menopause symptoms? ›

SSRIs escitalopram and paroxetine ER and SNRI venlafaxine XR were shown to be the most effective. Although less effective than HRT, SSRIs/SNRIs are demonstrated to reduce hot flashes and may be recommended for women who wish to avoid the risks of HRT.

Read On ›

What is the best mood stabilizer for menopause? ›

What is the best antidepressant for menopause? Brisdelle (paroxetine mesylate) is a low-dose SSRI. It's currently the only antidepressant that's FDA-approved for VMS due to menopause. Research shows Brisdelle can improve the frequency and severity of VMS.

Explore More ›

Does Cymbalta help with menopause symptoms? ›

FOCUS ON WOMEN'S MENTAL HEALTH

In the current study, we found that duloxetine therapy improved depression, vasomotor symptoms, and other menopause-related symptoms in postmenopausal women.

See Details ›

What is an alternative SSRI for HRT? ›

SSRI (SSRIs) in the menopause

SSRIs as an alternative to HRT - general principles. in general baseline effectiveness 20-50% ...
SSRI's such as paroxetine (12.5-25mg daily) has shown to reduce flushes in 50%, while fluoxetine (20mg daily) has also been reported to reduce in 60% (2) (1) paroxetine.

Feb 11, 2020

Get More Info ›

Is venlafaxine or citalopram better for menopause? ›

Conclusions: Although citalopram was associated with more adverse effects, including constipation, it was more effective in reducing the frequency of hot flashes when compared to venlafaxine or placebo.

See Details ›