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June 3, 2003 — Menopausal hot flash symptoms may be reduced by taking a selective serotonin reuptake inhibitor (SSRI) antidepressant medication as an alternative to hormone replacement and other therapies, according to a study in the June 4 issue of The Journal of the American Medical Association (JAMA).
According to background information in the article, "for many years, hormone replacement therapy (HRT) with combined estrogen/progestin has been the standard therapy for women experiencing menopausal symptoms," the authors write. "However, increased risks of long-term adverse clinical outcomes in a recent prospective study conducted by the Women's Health Initiative (WHI) on long-term HRT use, are likely to change clinical practice significantly."
The authors write that alternative treatments are now needed. They report that hot flashes are the most common complaint among women entering menopause and may continue for five years or longer. About 75 percent women will experience some hot flashes around the time of menopause. This translates into more than 25 million women in the United States.
Vered Stearns, M.D., from the Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins School of Medicine, Baltimore, and colleagues evaluated a SSRI (paroxetine controlled release [CR]) in treating menopausal hot flash symptoms. A total of 165 menopausal women aged 18 years or older, who were experiencing two to three daily hot flashes participated in the study. The participants had to have discontinued any hormone therapy for at least six weeks and women were excluded if they had any signs of active cancer of were undergoing chemotherapy or radiation therapy.
The participants were randomly assigned to receive a placebo or the SSRI. Fifty-one women were assigned to receive 12.5 mg/daily of paroxetine CR; 58 were assigned to received 25.0 mg/daily of paroxetine CR and 56 women were assigned to receive the placebo. The participants were evaluated at baseline, and at one, three, and six weeks.
They kept daily hot flash diaries to document the frequency and severity of hot flashes. A number was assigned to the severity of the hot flash and that number was multiplied by the daily number of hot flashes experienced at that severity level to reach a composite score.
The most common adverse effects experienced by women receiving paroxetine CR were headache, dizziness and nausea, with fewer reports of such effects from women receiving the lower dose. "At study end, 63 (60.5 percent) of 104 women who received paroxetine CR achieved a 50 percent or greater reduction in their hot flash composite scores," the authors note. "Taken together with the findings of the WHI, these data suggest that paroxetine CR may have a place in the treatment armamentarium for women experiencing hot flashes."