Sertraline Does Not Cause Hot Flashes—It Treats Them
Sertraline is used as a treatment for hot flashes, not a cause of them, though the FDA label does list "hot flushes" as a rare reason for discontinuation in PMDD trials. 1
Sertraline as Treatment for Hot Flashes
Sertraline (50-100 mg daily) reduces hot flashes in menopausal women, though with mixed results and substantial individual variability. 2
Evidence for Efficacy
In tamoxifen users specifically, sertraline 50 mg was superior to placebo in reducing hot flashes, though it did not affect quality of life measures. 2
A randomized controlled crossover trial in the general population showed women experienced five fewer hot flashes per week on sertraline compared to placebo (p=0.002), with significant improvement in hot flash scores. 3
In breast cancer survivors taking tamoxifen, sertraline decreased hot flash frequency by 50% in 36% of patients versus 27% on placebo, with 48% of women preferring the sertraline period over placebo (p=0.006). 4
Important Caveat: Variable Response
A critical limitation is the marked variability in individual response—some women experience vigorous improvement, others have modest or no benefit, and some actually worsen. 2, 5
In one study analyzing response patterns: 31% had clinically significant reduction (≥30%), 32% had nonsignificant reduction, and 37% experienced an increase in hot flashes. 5
Vigorous response to sertraline was related to activity level, education, and menopausal status. 5
FDA Label Information
The FDA label for sertraline lists "hot flushes" under adverse events, but only as a reason for discontinuation in 1% of patients in the PMDD luteal phase dosing trial—notably, this was not seen in other indications. 1
Hot flushes do not appear in the common adverse events tables (≥2% incidence) for any indication including major depressive disorder, OCD, panic disorder, PTSD, or social anxiety disorder. 1
The 10-20% treatment withdrawal rate with SSRIs is primarily due to other side effects including nausea, dizziness, sexual dysfunction, and insomnia—not hot flashes. 1, 6
Clinical Positioning
Current guidelines from the American College of Obstetricians and Gynecologists and North American Menopause Society recommend sertraline as an option for women with moderate to severe hot flashes who have concerns or contraindications to estrogen therapy. 6
Advantages in Specific Populations
Sertraline has weak or no effects on CYP2D6, making it preferable to paroxetine or fluoxetine in breast cancer patients taking tamoxifen, where strong CYP2D6 inhibition could interfere with tamoxifen metabolism to its active metabolite endoxifen. 2
SSRIs/SNRIs reduce hot flashes by 50-60% in placebo-controlled trials, though this is less effective than estrogen therapy. 6
Practical Considerations
The optimal dose appears to be 50 mg daily based on the available evidence. 2, 3, 4
Sertraline should be stopped gradually to prevent discontinuation symptoms. 2
Given the substantial placebo response (up to 70% in some studies) and individual variability, a trial period is warranted to assess individual response. 2, 5