Newer Antidepressants for Hot Flashes--should Their Efficacy Still Be Up for Debate?

Objective: Newer antidepressants have been shown in clinical trials to reduce hot flashes, although not as well as do hormones. Nonetheless, a recently published meta-analysis and subsequent editorial raised doubts with regard to the utility of newer antidepressants for treating hot flashes. Concerns about the lack of efficacy of newer antidepressants on hot flashes were based in large part on results of two placebo-controlled, double-blind trials, one evaluating venlafaxine and the other individually evaluating both fluoxetine and citalopram. These two studies have repeatedly been put forward as evidence that newer antidepressants are not definitively proven to reduce hot flashes.

Design: Raw data from these two randomized, placebo-controlled trials evaluating second-generation antidepressants for hot flashes were obtained. These data and subsequent study conclusions are evaluated and discussed in the context of other published trial data regarding the use of newer antidepressants for treating hot flashes.

Results: Examination of the raw data from these two trials revealed that neither employed a baseline period of hot flash determination against which to calculate changes over time from baseline.

Conclusions: Recognition that these two trials cannot be used to look at hot flash frequency or score changes from baseline limits their ability to inform the efficacy literature about the use of newer antidepressants for hot flash reduction.