The efficacy and tolerability of SSRI/SNRIs in the treatment of vasomotor symptoms in menopausal women: A systematic review

Abstract

Purpose To systematically review the evidence related to the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) used for the treatment of vasomotor symptoms in perimenopausal and postmenopausal women. Data sources Medline, CINAHL, and the Cochrane Library databases were searched to identify randomized controlled trials (RCTs). Eighteen trials met the criteria for review. Conclusions Results from these trials indicate that paroxetine, citalopram, escitalopram, venlafaxine, and desvenlafaxine are effective in reducing the frequency and severity of hot flashes. Fluoxetine and sertraline appear to be less effective and should be considered second‐line options for treatment. Implications for practice The SSRIs and SNRIs can reduce hot flashes by 65% and begin working within the first week. Patient response is variable and if one drug does not improve hot flashes, another can be tried after a 1‐ to 2‐week drug trial. Paroxetine, citalopram, and escitalopram appear to have the fewest adverse effects. Considering cost, paroxetine and citalopram are the most cost‐efficient.

Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial

“…55 A recent systematic review concluded that although venlafaxine was shown to provide beneficial effects on reducing VMS, trials have also reported significant adverse effects. 56 In the present study, only three women reported adverse effects: two reported pain during treatment and one reported a feeling of numbness. Another review concluded that paroxetine, which is the only SSRI approved by the FDA for VMS, had the highest probability for reducing VMS.…”

Comparative Efficacy of Newer Antidepressants in Combination with Pregabalin for Fibromyalgia Syndrome: A Controlled, Randomized Study

“…As discussed above, the present investigation showed higher tolerability and fewer adverse effects with the use of pregabalin in combination with paroxetine (a SSRI) rather than amitriptyline (a tricyclic antidepressant) or venlafaxine (a SNRI). This could be attributed to the favorable pharmacological profile of SSRIs, which possess high selectivity for the serotonin receptor and low or null affinity for other types of receptors, including α‐adrenergic, muscarinic, cholinergic, and histaminic receptors . Many antidepressant medications provoke numerous adverse effects due to their actions at these receptors, obligating some patients to discontinue their treatment regimen.…”

Anxiogenic CO2 stimulus elicits exacerbated hot flash-like responses in a rat menopause model and hot flashes in postmenopausal women

“…Despite this indication, SSRIs do not fully alleviate hot flashes and treatment switching is common due to tolerability issues (62). Some of this variability in response and side effects may be due to differences in SERT genotype, as persons with the s/s genotype have been shown to have a poor response to SSRIs (for treating anxiety disorders) (63).…”