Using an antidepressant for hot flashes?

September 22, 2021.

Yes, it may sound obscure, but some providers may prescribe an antidepressant to provide a non-hormonal option for managing those pesky hot flashes. Here’s everything you need to know about using an antidepressant for hot flashes.

Why are hot flashes such a problem in menopause?

Hot flashes are one of the most common menopause symptoms. While little is understood about why menopause causes hot flashes, we know that fluctuating estrogen levels can affect the hypothalamus, our body’s internal thermostat. Hot flashes are extremely disruptive as they cause a cascade of symptoms that are uncomfortable.

Symptoms of a hot flash include:

  • A feeling of intense heat
  • Flushing and redness on the face, neck, and upper chest
  • Excessive perspiration
  • Feelings of anxiety
  • A period of intense heat followed by chilling 

It is hard to predict when a hot flash will happen, and rarely are they at a convenient time. Not only are they uncomfortable and disruptive, but this symptom is hard to conceal and can severely reduce your quality of life.

How does an antidepressant improve hot flashes?

According to the North American Menopause Society, the most effective treatment for menopause hot flashes is hormone replacement therapy. HRT is effective because it balances out your hormones, which improves many other menopause symptoms aside from hot flashes. However, some women prefer not to use HRT or cannot use it, despite having real difficulties managing hot flashes.

In 2013, the FDA approved prescribing an antidepressant to treat hot flashes. Studies found that paroxetine (Paxil) led to a 33%-67% reduction in hot flash frequency compared to patients taking a placebo. Also, the severity of hot flashes improved. Some women use Paxil for hot flashes and weight gain, which is also a common symptom experienced by women in menopause. Paxil is an SSRI (selective serotonin reuptake inhibitor), which means that it works by increasing serotonin levels in the brain. Serotonin is a neurotransmitter that is sometimes referred to as the “feel-good hormone” in your brain. 

Several studies also found that Effexor for hot flashes (also known as venlafaxine) reduced hot flashes. Effexor was approved for treating hot flashes in 2014 by the FDA

The exact mechanism for improving hot flashes with an antidepressant is not well understood. Interestingly, women taking HRT compared to those taking Paxil or Effexor report the same improvement in their hot flashes. Thus, while we do not know exactly how antidepressants for hot flashes work, we do know they are about as effective as HRT.  

Effexor reviews and Paxil reviews: What are women saying

Effexor

Along with improving hot flashes, many women report an improvement in their mood and overall sense of well-being. Because this medication alters your neurotransmitters, it can increase the neurotransmitters that make you feel happy. Thus, some theories suggest that Effexor itself does not reduce hot flashes, but rather women’s perception of their menopause symptoms improves with an increase in mood-boosting neurohormones

Paxil

Women taking Paxil for hot flashes not only have a reduction in the severity and frequency of hot flashes but they also experience improvement in their sleep. Where most medications that help you sleep cause daytime drowsiness, women overwhelmingly reported that they did not experience daytime sedation in a 2015 study

Curious what would be the best anti-depressant for hot flashes for you? Talk with your doctor. Not all women are candidates for antidepressants, especially in treating hot flashes. If you are struggling with this frustrating menopause symptom, meet with your doctor.

Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.

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Julia Walker
perry expert Julia (RN, BSN, BA) is a registered nurse based in Colorado. Julia's nursing background in women’s health has ranged from neonatal and postpartum care to labor and delivery, to outpatient gynecological medicine for both adolescent and adult populations. She specializes in helping women optimize their health during perimenopause and beyond.

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