Effexor Seems Just as Good as HRT in Easing Hot Flashes

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A study has found that the antidepressant Effexor (chemical name: venlafaxine) eased hot flashes just as well as hormone replacement therapy (HRT).

There are two types of antidepressant medicines: SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors). Effexor is an SNRI.

The research was published online on May 26, 2014 by JAMA Internal Medicine. Read the abstract of “Low-Dose Estradiol and the Serotonin-Norepinephrine Reuptake Inhibitor Venlafaxine for Vasomotor Symptoms: A Randomized Clinical Trial.”

Menopausal symptoms such as hot flashes and night sweats can dramatically reduce quality of life for some women. Hot flashes also are a known side effect of hormonal therapy medicines used to treat breast cancer. Doctors call hot flashes and night sweats “vasomotor symptoms.”

Some women use hormone replacement therapy (HRT) to ease these symptoms. But research has shown that HRT increases breast cancer risk in women who haven’t been diagnosed. HRT also increases the risk of breast cancer coming back (recurrence) in women who have been diagnosed with the disease. HRT is not recommended for women who’ve been diagnosed with breast cancer. Undiagnosed women who have severe menopausal symptoms need to weigh the benefits of HRT against its risks.

It’s not clear if any of the 339 women in this study had been diagnosed with breast cancer or were at high risk for the disease. The women were having at least two hot flashes per day and most were having about eight.

The women were randomly assigned to receive one of three treatments daily for 8 weeks:

  • low-dose (0.5 mg) estrogen-only HRT (97 women)
  • 75 mg Effexor (96 women)
  • placebo (sugar pill) (146 women)

After 8 weeks, the number of hot flashes per day most women were having dropped from eight to four -- a 50% decrease.

The researchers found that:

  • HRT reduced hot flashes by 52.9%.
  • Effexor reduced hot flashes by 47.6%.
  • Placebo reduced hot flashes by 28.6%.

The difference in hot flash reduction between HRT and Effexor wasn’t significant, which means that it could have happened by chance and wasn’t necessarily because of the difference in medicine.

In 2013, the U.S. Food and Drug Administration (FDA) approved a low-dose formula of another antidepressant, Paxil (chemical name: paroxetine), under the brand name Brisdelle, to treat hot flashes. Paxil is an SSRI. The FDA approval was based on research comparing Paxil to a placebo pill. The study reviewed here is the first time researchers have compared an antidepressant to HRT to treat hot flashes.

Other research has suggested that other antidepressants may help ease hot flashes, including the SSRIs:

  • Prozac (chemical name: fluoxetine)
  • Lexapro (chemical name: escitalopram)
  • Celexa (chemical name: citalopram)

Some of these antidepressants may cause problems for women taking tamoxifen. 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 Paxil and Prozac -- can interfere with how CYP2D6 works and might reduce tamoxifen’s effectiveness against breast cancer. Still, the subject is controversial and not all experts agree that a lack of CYP2D6 or taking an antidepressant reduces tamoxifen’s effectiveness.

If you’re having troublesome hot flashes because of menopause or breast cancer treatment, talk to your doctor about all your options to ease them and ask whether a medicine such as Effexor makes sense for you. There are also non-medicinal treatments that have helped many women ease hot flashes, including:

  • yoga
  • massage
  • meditation
  • avoiding caffeine, alcohol, and cigarettes
  • eating a low-fat diet
  • acupuncture

Visit the Breastcancer.org All About Hot Flashes page to learn more about hot flashes and how to manage them.



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