From the Guidelines
The best SSRI for menopause symptoms is typically Paroxetine (Paxil), which is FDA-approved specifically for treating hot flashes at a lower dose of 7.5 mg daily (brand name Brisdelle). When considering the treatment of menopause symptoms, it's essential to prioritize medications that have the most significant impact on reducing morbidity, mortality, and improving quality of life.
Key Considerations
- The use of SSRIs, such as Paroxetine, has been shown to decrease the intensity and severity of vasomotor symptoms in menopausal women, as noted in studies 1.
- However, it's crucial to consider the potential interaction between SSRIs and tamoxifen, as some SSRIs, like paroxetine, may inhibit the conversion of tamoxifen to its active metabolites through the inhibition of cytochrome P450 2D6 (CYP2D6) 1.
- Despite this potential interaction, a large database analysis found no evidence of an increased risk of cancer recurrence in women taking concurrent tamoxifen and antidepressants, including paroxetine 1.
Treatment Options
- Other effective SSRI options for menopause symptoms include Escitalopram (Lexapro) at 10-20 mg daily and Citalopram (Celexa) at 10-20 mg daily.
- Venlafaxine (Effexor, an SNRI) at 37.5-150 mg daily is also an effective option for reducing hot flashes.
- Treatment should continue as long as symptoms persist, typically for several months to years, with the goal of minimizing morbidity and improving quality of life.
Important Considerations for Treatment
- Side effects of SSRIs may include nausea, headache, insomnia, and sexual dysfunction, which often improve after 2-4 weeks 1.
- It's essential to start with the lowest effective dose and take the medication at the same time each day.
- If one SSRI doesn't work well or causes intolerable side effects, switching to another may be beneficial, as individual responses vary.
From the Research
Best SSRI for Menopause
The following SSRIs have been found to be effective in reducing the frequency and severity of hot flashes in menopausal women:
- Paroxetine 2, 3, 4, 5
- Escitalopram 3, 5
- Citalopram 2, 3, 4, 5
- Venlafaxine 2, 3, 4, 5
- Desvenlafaxine 3, 4, 5
Efficacy of SSRIs
These SSRIs can reduce hot flashes by approximately 40% to 65% 2, 5 and begin working within the first week 5.
Comparison of SSRIs
Some studies suggest that paroxetine, citalopram, and escitalopram have the fewest adverse effects 5 and are cost-efficient 5.
Treatment Approach
Hormonal therapy with estrogen is the first-line therapy for bothersome vasomotor symptoms and GSM symptoms, but nonhormonal medications (such as paroxetine and venlafaxine) also can be effective 2.
Patient Response
Patient response to SSRIs is variable, and if one drug does not improve hot flashes, another can be tried after a 1- to 2-week drug trial 5.