Antidepressant May Help Ease Hot Flashes

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A study suggests that the antidepressant medicine Celexa (chemical name: citalopram) can lower the number and severity of hot flashes in postmenopausal women.

In this study, 254 postmenopausal women -- none of whom had been diagnosed with breast cancer -- who were having at least 14 hot flashes per week for a month or longer were split into four groups:

  • the first group got 10 milligrams of Celexa each day
  • the second group got 20 milligrams of Celexa each day
  • the third group got 30 milligrams of Celexa each day
  • the fourth group got a placebo (sugar pill) each day

All of the women recorded the frequency and severity of their hot flashes before treatment and 6 weeks after the study started.

The women who were taking Celexa had a greater decrease in the frequency and the severity of hot flashes after 6 weeks of treatment compared to women taking the placebo.

All the women were having about eight or nine hot flashes each day before the study started. The number of hot flashes decreased between 43% and 55% in women who took Celexa for 6 weeks. Women who were taking the highest dose of Celexa (30 milligrams) had the largest decrease in hot flashes. The number of hot flashes also decreased in women taking the placebo, but by only 20%.

Before the study started, the women rated the severity of the hot flashes using a hot flash score. The average hot flash score was:

  • about 14 to 17 among the women who would get a dose of Celexa
  • 12 among the women who would get the placebo

After taking Celexa for 6 weeks, hot flash scores decreased an average of 49% to 55%. The decrease in hot flash scores was greater for women who were taking the highest dose of Celexa. Hot flash scores dropped by an average of 23% in women who took the placebo for 6 weeks.

Although this study looked at women who weren't diagnosed with breast cancer, many postmenopausal women who have been diagnosed with breast cancer have hot flashes, particularly as a hormonal therapy side effect. For some of these women, the hot flashes may be affecting their quality of life so much that they and their doctors are considering medicine to treat the hot flashes.

Research has shown that other antidepressant medicines can help ease hot flashes, including:

  • SSRI (serotonin-specific reuptake inhibitor) antidepressants
    • Prozac (chemical name: fluoxetine)
    • Paxil (chemical name: paroxitene)
  • SNRI (serotonin-norepinephrine reuptake inhibitor) antidepressants
    • Effexor (chemical name: venlafaxine)

Still, taking one of these medicines while you're taking tamoxifen can interfere with the benefits of tamoxifen. Tamoxifen often causes bothersome hot flashes as a treatment side effect.

Tamoxifen is used to:

  • reduce breast cancer risk in women who haven't been diagnosed but are at higher-than-average risk for disease
  • lower the risk of breast cancer coming back (recurrence) in women diagnosed with early-stage, hormone-receptor-positive breast cancer
  • treat advanced-stage, hormone-receptor-positive breast cancer

An enzyme called CYP2D6 helps tamoxifen work in the body. Some research has shown that women with an abnormal gene that blocks their bodies' ability to produce CYP2D6 don't get the same benefits from tamoxifen as women who produce CYP2D6. Other research has shown that some medicines, including the antidepressants listed above, interfere with how CYP2D6 works and reduce tamoxifen's effectiveness against breast cancer.

Celexa is an SSRI antidepressant, but unlike other SSRIs such as Prozac and Paxil, Celexa does NOT interfere with CYP2D6 and may be a better choice to treat hot flashes in women taking tamoxifen. Celexa also seems to have two other advantages over other possible antidepressant treatments for hot flashes:

  • Celexa only has to be taken once a day (by mouth).
  • Celexa is available as a generic medicine, which could mean lower cost.

If you're a postmenopausal woman having troublesome hot flashes because of breast cancer treatment, you might want to ask your doctor about hot flash treatment options and if a medicine such as Celexa makes sense for you. There are other non-prescription techniques you can try to help avoid and ease hot flashes. Visit the Breastcancer.org Hot Flashes page in the Treatment Side Effects section to learn more about hot flashes and how to manage them.

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