While hormone therapy has long been known as the most effective treatment for menopausal hot flashes, night sweats, and the sleepless nights that come with them, a new Brigham and Women’s Hospital study found that a generic antidepressant is nearly as effective at alleviating symptoms — without causing the increased breast cancer risks associated with hormone use.
In the study published earlier this week in JAMA Internal Medicine, 339 menopausal women who had an average of eight episodes a day of hot flashes or night sweats were randomly assigned to receive either estrogen therapy, the antidepressant venlafaxine hydrochloride (Effexor), or a placebo for eight weeks; all of those who took a pill in the study had relief from their symptoms — including those on the placebo.
Those who took estrogen had 3.9 hot flashes or night sweats a day compared to 4.4 episodes in the antidepressant group, and 5.5 in the group that took placebos. About 70 percent of the estrogen users were satisfied with their treatment compared to 51 percent of the venlafaxine users and 38 percent of the placebo takers.
“Estrogen therapy is still the gold standard for alleviating hot flashes and night sweats, but it’s nice to see that alternative treatments can work nearly as well,” said study leader Dr. Hadine Joffe, director of the Women’s Hormone and Aging Research Program at Brigham and Women’s Hospital.
This is the first time estrogen therapy and antidepressants have been compared in a head-to-head trial, which was funded by the National Institutes of Health.
The women were put on the lowest possible doses of treatments — 0.5 milligrams of estradiol (the form of estrogen used) per day or 75 mg of extended-release venlafaxine hydrochloride — that were shown to be effective in previous studies. Increasing the dose of estradiol, however, has been found in studies to provide added relief from hot flash symptoms, while a higher dose of venlafaxine hasn’t been shown to work any better, Joffe said.
That means hormone therapy has an added edge over antidepressants for women with severe hot flashes and night sweats. Doctors, though, frequently don’t want to prescribe the hormones for more than a few years due to concerns about blood clots, breast cancer, and stroke risks.
What’s more, certain women shouldn’t be on hormone therapy at all, such as those who have been diagnosed with breast cancer or who have been treated for blood clots in their legs.
“It’s very reassuring for women who can’t take estrogen or don’t want to stay on hormones for very long to have antidepressants as a treatment option,” Joffe said, that they could theoretically stay on safely for years if their symptoms linger.
Last year, the Food and Drug Administration approved paroxetine — a low-dose version of Paxil called Brisdelle — for the treatment of hot flashes but emphasized that the treatment brings only modest relief from hot flashes compared to relief brought by the placebo. Venlafaxine has not been approved for this purpose, but doctors often prescribe it off-label to treat menopausal symptoms.