WebMD Medical News
Laura J. Martin, MD
Jan. 18, 2011 -- Low doses of the antidepressantLexapro (escitalopram) cooled off hot flashes better than placebo in about 200 menopausal women, according to a new study.
''We believe escitalopram provides an option for treating moderate to severe hot flashes that are disrupting people's lives and quality of life," says study researcher Ellen Freeman, PhD, a research professor in the department of obstetrics-gynecology and psychiatry at the University of Pennsylvania School of Medicine, Philadelphia.
In the study, Freeman found the antidepressant reduced both the number and severity of hot flashes compared to placebo. Previous studies of other antidepressants have yielded mixed results, according to Freeman.
The new study findings suggest Lexapro can provide an option for women reluctant to take hormone therapy.
The findings are published in TheJournal of the American Medical Association.
Freeman and colleagues assigned 205 women who were experiencing hot flashes either to a group which took 10 to 20 milligrams a day of Lexapro or a placebo for eight weeks.
The women, on average about age 54, did not know whether they were taking the drug or the placebo. The women were asked to keep daily diaries noting the frequency and severity of their hot flashes.
At the study start, the average frequency of hot flashes was nearly 10 per day.
When Freeman's team looked at the seven-day average of hot flash frequency at week eight in those who kept the daily diaries, they found:
The severity of the hot flashes went down more in the Lexapro-treated women than those on placebo. On a 3-point scale, the average overall hot flash severity score at the study start was 2.17. At week eight, those on Lexapro reported an average severity score of 1.63, termed mild to moderate. Those on placebo by week eight had a severity score of 1.89.
While 55% of the women in the Lexapro group had a decrease of at least 50% in hot flash frequency at the eight-week mark, 36% of those in the placebo group did. "A 50% reduction is pretty good," Freeman says.
The researchers followed up three weeks after the study ended and the women had stopped taking the drug or placebo. They found those in the drug group reported a bigger increase in hot flashes than did those in the placebo group.
No serious adverse events were reported in either group, Freeman says.
The study was funded by the National Institute on Aging and other sources. Freeman reports having received research support from Forest Laboratories Inc., and other pharmaceutical companies that make antidepressants. For this study, Forest, which makes escitalopram, provided the drug and placebo pills but no funding.
Exactly how the drug relieves hot flashes is not known, Freeman says. "The cause of hot flashes is not really known," she says. It is thought that the antidepressant works by providing more of the hormone serotonin to the brain, she says.
Lexapro is approved for depression in adults and teens 12 to 17 and for anxiety disorder in adults. Its use for hot flashes is considered ''off-label." Off-label drugs are prescribed for uses that have not been approved by the FDA.
The new study findings are no surprise to Amanda Richards, MD, assistant professor of obstetrics and gynecology at the University of Miami Medical School, who reviewed the study for WebMD.
She has prescribed antidepressants for hot flashes for some of her patients, including some who had cancer and went into surgical menopause after ovary removal, with generally good success, she says.
"It's not that it takes them away completely," she says of the drugs' effects on menopausal symptoms. But she finds, as did the study researchers, that the antidepressants do reduce the number and severity of the hot flashes.
A typical patient prescribed an antidepressant for hot flashes, she says, "will come back a couple weeks later thanking me, saying they can now work, they can manage their hot flashes."
There could be a decline in libido, she tells patients on antidepressants. But some will take that side effect, she says, in return for hot flash relief.
SOURCES:Ellen W. Freeman, PhD, research professor, department of obstetrics-gynecology and psychiatry, University of Pennsylvania School of Medicine, Philadelphia.Freeman, E. TheJournal of the American Medical Association, Jan. 19, 2011; vol 301: pp 267-274.Amanda Richards, MD, assistant professor of obstetrics and gynecology, University of Miami Miller School of Medicine.
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