June 19, 2014

The efficacy and tolerability of SSRI/SNRIs in the treatment of vasomotor symptoms in menopausal women: A systematic review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Vasomotor symptoms in perimenopausal and postmenopausal women. Intervention: SSRIs and SNRIs. Primary outcome: Frequency and severity of hot flashes.

Key Result

SSRIs and SNRIs, particularly paroxetine, citalopram, escitalopram, venlafaxine, and desvenlafaxine, can reduce hot flashes by 65% in perimenopausal and postmenopausal women.

Study Design

Type

Systematic Review

Structured PICO

Do SSRIs and SNRIs reduce the frequency and severity of hot flashes in perimenopausal and postmenopausal women?

Population

Systematic review of 18 randomized controlled trials evaluating the efficacy and tolerability of SSRIs and SNRIs for vasomotor symptoms in perimenopausal and postmenopausal women.

Intervention

Selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) including paroxetine, citalopram, escitalopram, venlafaxine, desvenlafaxine, fluoxetine, and sertraline

Outcome

Frequency and severity of hot flashespatient reported

SSRIs and SNRIs are effective non-hormonal options for reducing vasomotor symptoms in menopausal women, with paroxetine, citalopram, and escitalopram offering the best balance of efficacy and tolerability.

Abstract

PURPOSE: To systematically review the evidence related to the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) and serotonin/norepinephrine reuptake inhibitors (SNRIs) used for the treatment of vasomotor symptoms in perimenopausal and postmenopausal women. DATA SOURCES: Medline, CINAHL, and the Cochrane Library databases were searched to identify randomized controlled trials (RCTs). Eighteen trials met the criteria for review. CONCLUSIONS: Results from these trials indicate that paroxetine, citalopram, escitalopram, venlafaxine, and desvenlafaxine are effective in reducing the frequency and severity of hot flashes. Fluoxetine and sertraline appear to be less effective and should be considered second-line options for treatment. IMPLICATIONS FOR PRACTICE: The SSRIs and SNRIs can reduce hot flashes by 65% and begin working within the first week. Patient response is variable and if one drug does not improve hot flashes, another can be tried after a 1- to 2-week drug trial. Paroxetine, citalopram, and escitalopram appear to have the fewest adverse effects. Considering cost, paroxetine and citalopram are the most cost-efficient.

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