How It Works
Selective serotonin reuptake inhibitors
(SSRIs) affect the brain's use of a
neurotransmitter chemical called serotonin, which is
thought to have a role in regulating body heat.1
Increased serotonin use by the brain can also improve
perimenopausal mood swings and irritability.
Venlafaxine affects the brain's serotonin and norepinephrine levels. How
it affects hot flashes is not known. Mood may also improve with venlafaxine
Why It Is Used
Select antidepressants are used to
hot flashes affecting menopausal women. They may
also help with irritability, depression, and moodiness. They can be used before
and after menopause as a symptom treatment alternative to hormones (birth
control pills or
hormone replacement therapy [HRT]).
Antidepressant therapy helps many men and women who have hot flashes from cancer treatment. But if you take tamoxifen to treat your cancer, you need to avoid certain antidepressants. Talk to your doctor about what medicines for hot flashes are right for you.
Do not take venlafaxine
How Well It Works
Studies have shown that certain
antidepressants may help relieve hot flashes.2
- In a randomized, controlled trial of paroxetine
(such as Paxil) for postmenopausal women having at least 14 bothersome hot flashes a
week, researchers report that about 60% of women had at least a 50% reduction
in the severity and number of hot flashes a day after 6 weeks of
- Venlafaxine (Effexor) lowers
the number and severity of hot flashes for most women. This includes women with
severe hot flashes from tamoxifen, a cancer-fighting hormone drug. In several
studies, venlafaxine was most effective for hot flashes when used at a lower
dose than is normal for treating depression.3
Possible SSRI side effects include:
- Loss of appetite.
- Anxiety or
of ability to reach orgasm during sexual activity.
- Dizziness or
- High blood pressure.
Rare SSRI side effects include:
- Urination problems.
Time-released formulations and lower doses reduce the risk
of side effects.
Possible venlafaxine (Effexor) side effects are similar to
those of SSRIs. Venlafaxine can also cause:
- Weight loss.
- A slight increase in cholesterol.
Other more serious side effects are rare but can include
allergic reaction, fast heart rate, nausea, dizziness, anxiety, blurred vision,
insomnia, increased blood pressure, and seizures. Because venlafaxine
can increase blood pressure, it is used with caution in women with
high blood pressure,
heart failure, or
See Drug Reference for a full
list of side effects. (Drug Reference is not available in all systems.)
FDA Advisory. The U.S. Food and
Drug Administration (FDA) has issued an
advisory on antidepressant medicines and the risk of
suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for
warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
What To Think About
Using antidepressants to treat
menopause symptoms is considered an
off-label use for these medicines.
side effects most commonly reported with paroxetine (such as Paxil) use for hot flashes
were headache, nausea, and insomnia. About 58% of women reported side effects.
(Interestingly, of women who were taking a
placebo, about 53% also reported side effects.
Similarly, about 43% of women taking a placebo reported a 50% or better
improvement in hot flashes.)1
research is needed to determine the risks and benefits of long-term
antidepressant treatment. But many people have used these medicines for
long-term treatment of depression.
Never stop taking antidepressants abruptly. The use of any antidepressant should be
tapered off slowly and only under the supervision of a doctor. Abruptly
stopping these medicines can cause headaches, nervousness, anxiety, or
Studies have found that daily use of SSRIs may increase
the risk of bone fracture in adults over age 50. Before you take an SSRI, talk
to your doctor about this risk.4
venlafaxine make bleeding more likely in the upper gastrointestinal tract
(stomach and esophagus). Taking SSRIs or venlafaxine with NSAIDs (such as Aleve
or Advil) makes bleeding even more likely. Taking medicines that control acid
in the stomach may help.5
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Stearns V, et al. (2003). Paroxetine controlled
release in the treatment of menopausal hot flashes: A randomized controlled
trial. JAMA, 289(21): 2827-2834.
Cedars MI, Evans M (2008). Menopause. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 725-741. Philadelphia: Lippincott Williams and Wilkins.
Brigitte L, et al. (2004). Nonhormonal alternatives for the treatment of hot flashes. Pharmacotherapy, 24(1): 79-93.
Richards JB, et al. (2007). Effect of selective
serotonin reuptake inhibitors on the risk of fracture. Archives of Internal Medicine, 167(2): 188-194.
Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper
gastrointestinal tract bleeding associated with selective serotonin reuptake
inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795-803.