When hormones are not an option, nonhormonal prescription therapies such as antidepressants have shown some effectiveness in relieving hot flashes.

Certain antidepressants known as SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors) allow more serotonin and norepinephrine to reach the appropriate receptors in the brain. Serotonin is thought to play a part in regulating body temperature; norepinephrine is an initiator of the body’s stress response. Therefore, these medications could lessen the fluctuations in body heat, better known as hot flashes.

If there are no contraindications (reasons a drug or therapy should not be used, past allergic reactions, etc), the following antidepressants can be considered for the relief of hot flashes in women who are not candidates for hormone therapy, including breast cancer survivors and those who do not wish to use hormone products:

• venlafaxine (Effexor)
• paroxetine (Paxil)
• fluoxetine (Prozac)
• sertraline  (Zoloft)  

Research on antidepressant use by women experiencing hot flashes has been promising. In a clinical trial involving 229 women who experienced at least 14 hot flashes per week, the women taking venlafaxine reported 37% to 60% reductions in hot flashes, based on their dosages. In a study involving paroxetine use by 165 women who experienced two to three hot flashes per day, incidence of hot flashes went down 62.2% and 64.6%, based on varied dosages. And, in an 81-woman study of fluoxetine, those taking the antidepressant reported a 20% decrease in the frequency of hot flashes. Other studies are ongoing.

To minimize side effects, low doses of these antidepressants are typically used when starting therapy. Side effects, especially nausea and sexual dysfunction, should be monitored. Women who experience drowsiness may find it beneficial to take these drugs at night. If hot flashes are not relieved after 1 week of treatment, the dose can be increased. These medications should not be stopped abruptly, as sudden withdrawal has been associated with headaches and anxiety. Women who have been using an antidepressant for at least 1 week should gradually taper off the drug. Tapering may require up to 2 weeks, depending on the initial dose.

Women should discuss using antidepressants for hot flashes with their healthcare provider to ensure that the benefits of a particular medication outweigh the risks. Regardless of the therapy, treatment should be periodically reevaluated to determine if it is still necessary, as menopause-related vasomotor symptoms (hot flashes) will diminish over time for most women.

For more information on treating hot flashes, visit: Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society.