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2yr
Antidepressant Use to Treat Menopausal Vasomotor Symptoms

It is estimated that close to 40% of the world's 1.2 billion women will be post-menopausal or menopausal by 2030. That's nearly 50 million women and, among those, ~60-70% are likely to suffer from menopausal symptoms. Although hormone therapy (HT) is suggested for curtailing both vasomotor symptoms and mood disturbances, HT treatment continues to be controversial. Aside from breast cancer and cardiovascular concerns, research shows that HT itself might also increase the risk of depression.

In a recent discussion among OB-GYNs and primary care clinicians, about half stated they treat menopausal vasomotor symptoms with antidepressants such as SSRIs, SNRIs, and bupropion. While there was agreement that the treatment may not address all of the symptoms, research has confirmed that antidepressants are effective in treating both depression and vasomotor symptoms shortly before, during, and after menopause.

Which antidepressant(s) do you find most effective for the treatment of menopause? Have you observed whether these are the same antidepressants that work in younger women for premenstrual dysphoric disorder?

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  • 2yr
    Brisdelle not only helps my patients with their VMS, but I have found it also helps mood improvement as menopause can be difficult emotionally for many. I have patients take it at bedtime as it seems to mitigate side effects. It also appeals to patients who do not wish to have any hormonal medications.
  • 2yr
    Effexor and Prozac are useful too. Many of the SSRIs and SNRIs are effective by helping to reduce hot flashes, night sweats and mood swings.
  • 2yr
    I usually use Effexor,gabapentin at low doses and I have used Paxil and Zoloft as well. I
  • 2yr
    paroxetine, appears to reduce duration and severity of the symptoms.
  • 2yr
    I have used paroxetine at low doses for vasomotor symptoms. This is FDA approved for this indication at 7.5 mg
  • 2yr
    I have used Effexor xr and multiple patients for hot flashes with positive outcomes
  • 2yr
    Effexor, venlaflaxine, paroxetine seem reasonable. Although we dislike it, a substantial portion of patients still smoke, and may benefit from bupropion the most in those cases.
  • 2yr
    Perhaps more than any other issues with which we deal, treating post-reproductive women and those with PMS/PMDD requires a highly individualized approach, and everyone's comments to date are reflective of that type of care. We need lots of tools in our toolbox to successfully take care of our patients. SSRIs and SNRIs are but two. HT is another and NKB-RAs will soon be our newest tool to help patients with VMS. If we begin by taking the time to listen to our patients, then first, suggesting simple lifestyle changes like exercise, maintaining healthy diet and weight, and avoid smoking, they will do well and appreciate the care we offer.
  • 2yr
    Although they do not work as predictably well as estrogen for VMS, I have had moderate success with venlaxafine, paroxetine, sertraline, and gabapentin. I counsel the patients that we may have to try several before finding one that works better for them. I, too, am looking forward to having fezolinetant in my armamentarium. The selective neurokinin 3 receptor antagonist is an exciting new development.
  • 2yr
    I have had good results with Effexor and gabapentin.
  • 3yr
    I use Effexor, fluoxetine or paroxetine. I have not tried patients on Brisdelle
  • 3yr
    I have used paroextine low dose 10mg with good results after attending a conference on this in 2016. I have also used Effexor, Lexapro.
  • 3yr
    I use Lexapro initially and may move on to venlafaxine if needed for improvement in depression. I have used sertraline with modest improvement which works in younger patients with PMDD symptoms
  • 3yr
    Paroxetine, Effexor (although this can be limited by side effects), lexapro if mood also a major issue
  • 3yr
    Zoloft, lexapro, Effexor
  • 3yr
    I have good success with low dosage Venlafaxine. Works for all ages.
  • 3yr
    Paxil.
  • 3yr
    I have used Paxil with good success.
  • 3yr
    My go to is Effexor, does well with depression and hot flashes. Most people
    Tolerate it at the lower dose but you can also titrate up if needed. I see older women so I am not sure about the younger population and Effexor
  • 3yr
    I have had good results with sertraline and effexor and are usually well tolerated
  • 3yr
    I agree with many of the above comments. My experience has been good with Cymbalta, but also with Paxil, Celexa, Lexapro, Wellbutrin, and Zoloft. As mentioned you have to find the right fit for each individual patient and that’s different for all!
  • 3yr
    Tatsiana Halkova FM
    Based on my patient's response to treatment Effexor, Clonidine and Bupropion work more reliably than other non HRT brands, For PMDD any SSRI or SNRI has a fair chance.
  • 3yr
    Effexor has the best track record of what I prescribe for patients.
  • 3yr
    I think Effexor works well but I find that patients really struggle to wean off of this (more so than other meds.) Paroxetine and Lexapro seem to contribute to some already unwanted weight gain. If there is truly anxiety a/o depression, fluoxetine is still my go to med.
  • 3yr
    For non-hormonal therapy, I typically use paroxetine: 7.5 mg/day (avoiding this in women on tamoxifen). I also use citalopram and occasionally venlafaxine. I don't use sertaline or fluoxetine - since data does not suggest that they are effective on hot flashes. For women with only nighttime hotflashes, I discuss gabapentin
    With PMDD - my first step is to discuss hormonal contraception; if they don't want this, or if 3 months of hormonal contraception does not improve symptoms, then I add either citalopram or escitalopram as treatment
  • 3yr
    Effexor, Prozac, Wellbutrin, Zoloft, Paxil. They all work for PMDD as well.
  • 3yr
    Use the tools we have to treat the problems that arise, indicated or off label
    but use them!
  • 3yr
    Not sure we know why SSRIs help w vms but effexor (off label) and brisdelle may help. Nonhormonal Rx for VMS has room to grow .
  • 3yr
    The benefits of SSRIs and SNRIs exceed just menopausal symptoms but also sleep cycle, diet and overall mood. Better side effect profile than HT. No one SSRI/SNRI is universal for all patients, the point is to find the right drug for the right patient.
  • 3yr
    For patients that are a candidate for HRT, I will start with that. If not fully effective usually add SSRI. For patients that are not good candidates or decline, I will start with Paxil or Lexapro. Response to therapy is different that pre-menopausal dysphoric group. Sertraline also a good choice for most.
  • 3yr
    I have heard women do well on Effexor. Fluoxetine and bupropion, not so much for VMS. As an aside, I have also heard some success with neurontin treating night sweats.
  • 3yr
    Depression related to Menopause may or may not be related to the Vasomotor Sympotms , We need better medicine to manage the VMS other than the HRT and Neuroknin Receptor Antagonists are the new very promising class which should be available soon , Regarding depression that needs to be evaluated on its own merit considering if there is anxiety component or not or has more dysthymia features , Brisdelle ( Paroxeitine ) which is approved for VMS that can be used as will kill two brids with a stone , Other wise i use Sertraline and Fluoxitine as my to go meds when i see strong component of anxiety and use Wellbutrin when there is more of dysthymia feautres in depression and depending on how they respond or not move on to the New branded name meds like Trintellix and Viibryd , Use these meds with or with out HRT as needed , For PMDD I just use the Fluoxitine arond the menstrual flow phase for a week or so and works well
  • 3yr
    I recommend Effexor, Bupropion, clonidine in certain cases. Most common VMS are night sweats and Hot flashes
  • 3yr
    Brisdelle is FDA approved for VMS but many cannot tolerate the side effects. There is no one antidepressant that works for everyone. I am successful with Effexor, Pristiq, Gabapentin, Clonidine, Zoloft, Lexapro. Depends on which menopausal symptom is causing the most issue. I look forward to trying Fezolinetant by Astellas when it gets to market. Tend to use more Prozac and Zoloft for PMDD.
  • 3yr
    venlafaxine, clonidine, hydroxyzine, or taking people off of SSRI if they think it is making hot flashes or night sweats worse. i think it is important also to do labs like tsh to confirm not missing electrolyte or hormonal imbalance.
  • 3yr
    venlafaxine
  • 3yr
    Treating VMS with antidepressants like venlafaxine, escitalopram, sertraline can reduce symptoms like 60%, usually they are well tolerated .
  • 3yr
    I find Desvenlafaxine to be a good medication for VMS, as reported by my patients. Although Paroxetine--Brisdelle has been FDA approved for the VMS indication, my patients do not report as good symptomatic relief with it as with Desvenlafaxine. Yes, this medication works for PMDD too.

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