SSRIs for Hot Flashes: A Systematic Review and Meta-Analysis of Randomized Trials

• Published in: Journal of general internal medicine : JGIM 2014-01, Vol.29 (1), p.204-213
• Main Authors: Shams, Taghreed, Firwana, Belal, Habib, Farida, Alshahrani, Abeer, AlNouh, Badria, Murad, Mohammad Hassan, Ferwana, Mazen
• Format: Article
• Language: English
• Subjects: Antidepressants; Biological and medical sciences; Dermatology; Female; General aspects; Hot Flashes - drug therapy; Humans; Internal Medicine; Medical sciences; Medicine; Medicine & Public Health; Menopause; Randomized Controlled Trials as Topic; Review; Review Aritcle; Serotonin Uptake Inhibitors - adverse effects; Serotonin Uptake Inhibitors - therapeutic use; Severity of Illness Index; Side effects; Skin involvement in other diseases. Miscellaneous. General aspects; Systematic review; Treatment Outcome; Vascular disorders of the skin
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-013-2535-9

ABSTRACT Background Hot flashes are the most commonly reported vasomotor symptom during the peri- and early post-menopausal period. Objectives To systematically review, appraise and summarize the evidence of the impact of different SSRIs on peri-menopausal hot flashes in healthy women in randomized, controlled trials. Methods A comprehensive literature search was conducted of MEDLINE™, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Scopus through March 2013. Two independent reviewers selected studies and extracted data. Random effects meta-analysis was used to pool outcomes across studies, and Bayesian mixed treatment methods were used to rank SSRIs in terms of effectiveness. Results We included a total of 11 randomized controlled trials with good methodological quality enrolling 2,069 menopausal and post-menopausal women (follow-up 1–9 months, mean age 36–76 years, mean time since menopause 2.3–6.6 years). Compared with placebo, SSRIs were associated with a statistically significant decrease in hot flash frequency (difference in means −0.93; 95 % CI −1.46 to −0.37; I 2 = 21 %) and severity assessed by various scales (standardized difference in means −0.34; 95 % CI −0.59 to −0.10; I 2 = 47 %). Adverse events did not differ from placebo. Mixed treatment comparison analysis demonstrated the superiority of escitalopram compared to other SSRIs in terms of efficacy. Conclusion SSRI use is associated with modest improvement in the severity and frequency of hot flashes but can also be associated with the typical profile of SSRI adverse effects.