Can You Take Antidepressants for Menopause Symptoms? How SSRIs May Reduce Hot Flashes

Before menopause, the ovaries make most of a woman’s natural estrogen. During menopause, (usually around age 50), the ovaries gradually stop producing estrogen. This lack of estrogen causes both vaginal and full-body symptoms. Examples include vasomotor symptoms, such as hot flashes and night sweats. You might also experience mood changes.

Replacing low estrogen usually relieves menopause symptoms. This is known as menopausal hormone therapy (MHT) — formerly referred to as hormone replacement therapy. But hormone therapy has some risks, including an increased risk of blood clots and breast cancer. So it’s not the right treatment for everyone.

That's where antidepressants come in. Here, we’ll discuss how antidepressants can help ease certain menopause symptoms.

Which antidepressants help treat menopause symptoms?

Brisdelle (paroxetine) is currently the only antidepressant that’s FDA approved for vasomotor symptoms of menopause (VMS). It’s a low-dose version of Paxil, a selective serotonin reuptake inhibitor (SSRI) that treats depression and other mental health conditions.

Other antidepressants are considered off-label when it comes to menopause symptoms. This means they haven’t been approved for this use. But there’s some evidence that they may help with certain menopause symptoms. More on that next.

What menopause symptoms can antidepressants address?

Antidepressants can help treat VMS, including hot flashes and night sweats. They may also help with mood changes that happen during menopause. But antidepressants don't work well for vaginal or urinary menopause symptoms, such as vaginal dryness or a frequent urge to pee.

EXPERT PICKS: WHAT TO READ NEXT

• Symptoms of perimenopause: Night sweats and insomnia can start before menstrual changes show up. Learn about the symptoms of perimenopause and which treatments help most. 

• Curious about menopause hormone therapy (MHT)? Hormone therapy is usually safe for treating perimenopause symptoms, but it’s not recommended for everyone. Find out who benefits most from MHT. 

• Medication and mindfulness for hot flashes: Read about one woman’s experience with hot flashes and what helped her find relief.

Let’s take a closer look at how antidepressants can help with certain menopause symptoms.

Hot flashes

We don’t know exactly why hot flashes happen as estrogen levels drop. But it seems that they’re caused by changes to the part of the brain that controls your body temperature, known as the thermoregulatory center.

Think of the thermoregulatory center as our body’s internal thermostat. Chemical messengers, known as neurotransmitters, regulate this part of the brain. Antidepressants can help balance the levels of these chemical messengers. In turn, this can help improve how your brain regulates your body temperature during menopause.

Research shows Brisdelle can improve the frequency and severity of VMS. It also helps prevent you from waking up during the night due to hot flashes. Brisdelle also isn’t linked to weight gain or lowering your sex drive. These are two side effects associated with other SSRIs, including higher doses of paroxetine.

Other SSRIs and serotonin and norepinephrine reuptake inhibitors (SNRIs) have also been shown effective for VMS in clinical studies. These include:

• Lexapro (escitalopram)

• Celexa (citalopram)

• Pristiq (desvenlafaxine)

• Effexor (venlafaxine)

Anxiety and depression

Mood changes are common during perimenopause and menopause. For most people, this includes mild symptoms such as irritability and low mood. But in some cases, the combination of hormone changes, sleep issues, and stress can develop into a more serious mental health condition, such as an anxiety or depressive disorder. This isn’t common, but the risk of anxiety or depression during menopause goes up if you’ve experienced these conditions before.  

In the event you’re diagnosed with one of these conditions during menopause, SSRIs and SNRIs are first-choice treatment options. Your prescriber can help determine the best option for your needs.

Antidepressants vs. hormone therapy for menopause symptoms

Hormone therapy is generally considered the most effective treatment for menopause symptoms. Unlike antidepressants, hormone therapy can treat more than just VMS. This includes sleep problems, vaginal symptoms, and minor mood changes. 

That being said, the available research suggests that MHT and antidepressants are both effective options for VMS. 

In one study, oral estradiol and Effexor were found similarly effective at improving VMS. 

Another review of three studies compared Lexapro, Effexor XR, and oral estradiol for VMS. These treatments each resulted in similar improvements in the frequency of VMS. The medications were then compared with taking fish oil and exercised-based options, such as yoga and aerobic exercise. In that comparison, the antidepressants all provided more benefits than the other options.

From those studies, it seems that antidepressants are an effective alternative for treating VMS if hormone therapy isn’t an option.

Can antidepressants make menopause symptoms worse?

The side effects of antidepressants may overlap with some menopause symptoms. This can make it seem like your menopause symptoms are getting worse in some cases. Examples include:

• Sleep issues

• Weight changes

• Sexual side effects

Keep in mind that it can take several weeks for antidepressants to start working. Side effects, on the other hand, typically improve over the same time period as your body adjusts to the medication. So it’s best to give antidepressants some time to work. If your symptoms don’t improve after a few weeks, let your prescriber know. But don’t stop taking an antidepressant on your own — this can lead to unpleasant withdrawal symptoms.

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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