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Selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs) reduce menopausal hot flushes by 65 per cent, according to a systematic review of 18 studies.

The review suggests that paroxetine, citalopram, escitalopram, venlafaxine and desvenlafaxine reduce the frequency and severity of hot flushes. For example, paroxetine, which the authors regard as “an effective first-line drug among the SSRIs” reduces hot flushes by up to 64 per cent and is well tolerated. Fluoxetine and sertraline “appear to be less effective” and are second-line treatments.

Women’s responses to antidepressants vary so the authors suggest trying an alternative if the first drug does not improve hot flushes after between one and two weeks. SSRIs and SNRIs do not appear to be as effective reducing hot flushes as hormone therapy.

However, no studies compare hormone therapy and SSRIs or SNRIs and only one trial compares two antidepressants. Studies have assessed some antidepressants, including duloxetine and fluvoxamine, in menopausal people with major depression but not healthy women.

The authors suggest that “further research could focus on these areas”. (J Am Ass Nurse Pract)