Your face and chest feel intensely hot, your skin reddens, and you're soaked in sweat. A cold chill follows. At night you wake up drenched and shivering.
Hot flashes—whether debilitating, embarrassing, or merely annoying—are inevitable for most menopausal women, with about 70 percent experiencing some symptoms. How much they interfere with a woman's quality of life varies greatly, and most of them will have only mild to moderate ones. But they will be more severe for about 20 percent of women.
Until recently, menopausal hot flashes were routinely and successfully treated with medicines containing various forms of the female hormones estrogen and progestin. But in 2002 a large clinical trial found that those hormones increased the risk of heart disease, stroke, blood clots, breast cancer, urinary incontinence, and dementia. The increased risks were small but noteworthy on all accounts. (Although more recent research has found that women ages 50 to 59 who have a low risk of heart disease or breast cancer and who started menopause within the past five years might be candidates for low-dose hormone therapy if their symptoms are severe. They might not have a greater risk of heart disease but still face a risk of breast cancer, blood clots, and strokes.)
Fear of such risks has sent many women and their physicians in search of nonhormonal remedies. Fortunately, a growing body of evidence suggests that some newer antidepressants might be an effective alternative, according to new analysis of the published evidence by the American Society of Health-System Pharmacists.
Known as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) these drugs are approved by the Food and Drug Administration for the treatment of major depression and in some cases anxiety or other psychiatric disorders. But they're also used off-label for the treatment of hot flashes, which occur when changing hormone levels throw off the part of the brain that controls body temperature. SSRIs and SNRIs are thought to work by modifying the amounts of certain brain chemicals-serotonin and norepinephrine-that are involved in temperature regulation.
"Newer antidepressants decrease hot flashes more than placebo, and are reasonable options," says Charles Loprinzi, M.D., Regis Professor of Breast Cancer Research at the Mayo Clinic in Minnesota. "They have side effects, and some people don't like the way the drugs change their mood, while others like that component."