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Antidepressants and Ambien May Ease Sleep Problems

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Hot flashes usually cause sleep problems. A study suggests that a combination of an antidepressant medicine and Ambien (chemical name: zolpidem), a sleep medicine, may ease sleep problems caused by hot flashes more effectively than just taking an antidepressant.

The research was presented at the 2008 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium.

Breast cancer treatment can cause hot flashes, sometimes very suddenly. Chemotherapy and hormonal therapy medicines lower estrogen levels in the body or reduce estrogen's effects on the body, which is basically what happens during menopause. Younger women being treated for breast cancer may have to deal with hot flashes and other menopausal symptoms much earlier than usual. Hot flashes are also a symptom of naturally-occurring menopause, which may be happening around the same time as breast cancer diagnosis in older women.

Antidepressants are sometimes used to help women having severe hot flashes. There are two kinds of antidepressant medicines: SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors). Both were used in this study.

SSRIs include Paxil (chemical name: paroxetine), Prozac (chemical name: fluoxetine), and Zoloft (chemical name: sertraline). SNRIs include Effexor (chemical name: venlafaxine), Cymbalta (chemical name: duloxetine), and Pristiq (chemical name: desvenlafaxine).

In this very small study, 53 women diagnosed with breast cancer all had:

  • at least 14 hot flashes during the 2 weeks before starting in the study
  • trouble sleeping for at least a month before starting in the study (waking up 3 or more times each night because of hot flashes)

All of the women were treated with either one of the SSRI antidepressant medicines or the SNRI antidepressant Effexor. About half of the women also took Ambien. The other half of the women took a placebo (sugar pill) along with the antidepressant.

The women kept track of hot flashes, quality of sleep, sleep disruptions, and overall quality of life. The women's sleep and wake times were measured by a sleep monitor (actigraph) attached to the wrist.

Among the women who completed the study:

  • 40% of the women who took Ambien and an antidepressant had some improvement in sleep by the end of the study compared to 14% of the women who took a placebo and an antidepressant
  • time awake at night (measured by the sleep monitor) was reduced by 40% in women who took Ambien and an antidepressant but didn't change at all in women who took a placebo and an antidepressant
  • overall quality of life improved during the study for women taking an antidepressant and Ambien but actually declined in women taking a placebo and an antidepressant

If you're having hot flashes and are considering treatment or have taken an antidepressant that didn't help, you might want to talk to your doctor about the results of this study. Together you and your doctor can decide if adding a sleeping medicine such as Ambien to your treatment plan makes sense for you.

It's important to note that the women in this study had frequent, severe hot flashes that dramatically disrupted their sleep. For many women with less frequent and less severe hot flashes some diet and lifestyle changes can help:

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

You can read more about approaches to help ease hot flashes on the All About Hot Flashes page.

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