Best SSRI for hot flashes with fewest side effects?

November 13, 2014 4:50 PM

Paroxetine has recently been FDA-approved for the treatment of hot flashes, but other SSRIs have been used for this purpose for years now.

Any thoughts, studies, and/or experiences with SSRIs to treat hot flashes (and anxiety)?

Looking for fewest side effects, most notably looking to avoid weight gain and dry mouth.

Thank you.

posted by DMelanogaster to Health & Fitness (1 answer total)

Best answer: You actually don't need to solicit anecdotes to answer this question - it's been researched.

Comparisons of weight gain in SSRIs (fluoxetine best, then sertraline, citalopram, then paroxetine).
As far as dry mouth, paroxetine is the most likely to cause that - fluoxetine is the least.

There was a Cochrane systematic review (a meta-analysis) on the use of SSRIs for hot flashes. The meta-analysis showed that escitalopram was superior to the other SSRIs for hot flashes. Unfortunately, fluoxetine did not fare well in the analysis and is unlikely to be better treatment for hot flashes (the table shows escitalopram > paroxetine > sertraline > citalopram > fluoxetine, but the difference in effectiveness between even #1 and #2 is huge - I can send you the PDF if you want the nitty gritty).
There have also been recent reviews of therapy for generalized anxiety disorder. Looking at just the SSRIs, this review found that: "fluoxetine was ranked first for response and remission [of generalized anxiety disorder] (probability of 62.9% and 60.6%, respectively) and sertraline was ranked first for tolerability (49.3%)" - in this case the paper is free full text if you want the details - figure 4 is the best summary and you will see that fluoxetine and sertraline were far ahead of the other drugs in the categories noted.

I suggest you talk to your doctor about which is the best drug for you- they are also better equipped to interpret this research than you are (with no offense meant, I think it's good you're trying to be well informed).
posted by treehorn+bunny at 6:15 PM on November 13, 2014