SSRIs for Hot Flashes: A Systematic Review and Meta-Analysis of Randomized Trials

Abstract

BACKGROUND: Hot flashes are the most commonly reported vasomotor symptom during the peri-and early post-menopausal period. OBJECTIVES: To systematically review, appraise and summarize the evidence of the impact of different SSRIs on peri-menopausal hot flashes in healthy women in randomized, controlled trials. METHODS: A comprehensive literature search was conducted of MEDLINE™, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Scopus through March 2013. Two independent reviewers selected studies and extracted data. Random effects meta-analysis was used to pool outcomes across studies, and Bayesian mixed treatment methods were used to rank SSRIs in terms of effectiveness. RESULTS: We included a total of 11 randomized controlled trials with good methodological quality enrolling 2,069 menopausal and post-menopausal women (follow-up 1-9 months, mean age 36-76 years, mean time since menopause 2.3-6.6 years). Compared with placebo, SSRIs were associated with a statistically significant decrease in hot flash frequency (difference in means −0.93; 95 % CI −1.46 to −0.37; I 2 = 21 %) and severity assessed by various scales (standardized difference in means −0.34; 95 % CI −0.59 to −0.10; I 2 = 47 %). Adverse events did not differ from placebo. Mixed treatment comparison analysis demonstrated the superiority of escitalopram compared to other SSRIs in terms of efficacy. CONCLUSION: SSRI use is associated with modest improvement in the severity and frequency of hot flashes but can also be associated with the typical profile of SSRI adverse effects.

Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline

“…In a randomized trial of 187 symptomatic menopausal women, clinical hypnosis was associated with a 74.2% reduction in hot flashes compared with a 17.1% reduction in women randomized to structured attention control (P Ͻ .001) (247). The phytoestrogens are nonsteroidal compounds that have both estrogenic and anti- (226). Hypersensitivity or prior adverse drug reactions to each of these agents represent contraindications.…”

EMAS position statement: Non-hormonal management of menopausal vasomotor symptoms

“…SSRIs, such as paroxetine, escitalopram, citalopram and sertraline have been studied and are effective in decreasing both frequency and severity of hot flushes [22]. Of the SSRIs, paroxetine seems to have the best evidence base of efficacy [23][24][25] and was recently approved by Food and Drug Administration (FDA) for the treatment of menopausal hot flushes [26].…”

Low use of effective and safe therapies for moderate to severe menopausal symptoms

“…9,10 Several prescription nonhormone therapies have proven efficacy for alleviating VMS. These include selective serotonin reuptake inhibitors/serotonin norepinephrine reuptake inhibitors, 11 gabapentin, 12 and clonidine. 13,14 Low-dose topical vaginal estrogen is indicated for the treatment of urogenital atrophy (as primary symptom).…”