From the Guidelines
Selective serotonin reuptake inhibitors (SSRIs) are a viable treatment option for managing menopausal symptoms, particularly hot flashes and mood disturbances, as evidenced by the most recent study in 2017 1. When considering SSRI treatment for menopause, it's essential to weigh the benefits and risks. The 2017 study published in the Journal of the National Comprehensive Cancer Network found that low-dose antidepressants, such as SSRIs, can improve vasomotor symptoms in the general population and in female cancer survivors 1. Some key points to consider when prescribing SSRIs for menopause include:
- Starting with a low dose and adjusting based on symptom response
- Using consistent dosing, typically in the morning to avoid sleep disturbances
- Monitoring for side effects, such as nausea, headache, insomnia, and decreased libido
- Gradually tapering the medication when discontinuing to minimize withdrawal symptoms
- Using alternative therapy if available, especially in women taking tamoxifen, due to potential interactions with CYP2D6 inhibition 1. Common SSRIs used for menopause include paroxetine (7.5-25mg daily), fluoxetine (20mg daily), sertraline (50-100mg daily), and escitalopram (10-20mg daily), as well as venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), at 37.5-150mg daily 1. It's crucial to consult with a healthcare provider before starting or stopping these medications to ensure safe and effective treatment.
From the Research
SSRIs for Menopause
- SSRIs (Selective Serotonin Reuptake Inhibitors) have been shown to reduce the frequency and severity of hot flashes in menopausal women 2, 3, 4, 5.
- Studies have demonstrated that paroxetine, citalopram, and escitalopram are effective SSRIs for treating hot flashes in menopausal women 2, 3, 4, 5.
- SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) such as venlafaxine and desvenlafaxine have also been found to be effective in reducing hot flashes in menopausal women 2, 3.
- The most common side effects of SSRIs and SNRIs are nausea and constipation, which typically resolve within the first week of treatment 2.
- Women with a history of breast cancer and taking tamoxifen should avoid SSRIs, as they can interfere with tamoxifen metabolism 2, 6.
- SSRIs and SNRIs are recommended as non-hormonal treatment options for vasomotor symptoms in menopausal women 3, 6.
Treatment Considerations
- Treatment choice should be patient-specific and begin with the lowest dose available 2.
- Women with hypertension should use SNRIs with caution, as they can increase blood pressure 2.
- Cognitive behavior therapy and clinical hypnosis may also be effective for short-term reduction of vasomotor symptoms and associated sleep disturbances 6.
- Hormone-free vaginal moisturizers are a non-inferior option to estrogen-based therapies for treating genitourinary syndrome of menopause 6.