SSRIs and SNRIs for vasomotor symptoms of menopause

Consider an SNRI or SSRI for individuals with hot flushes and mood symptoms.

Escitalopram is the most effective SSRI for improving vasomotor symptoms, quality of life and sleep, and has the fewest adverse effects (including sexual adverse effects). Fluoxetine and paroxetine inhibit cytochrome P450 and may reduce the active metabolite of tamoxifen; avoid concurrent use.

Note: Do not use fluoxetine and paroxetine in individuals taking tamoxifen; consider an SNRI or an alternative SSRI.

Venlafaxine and desvenlafaxine can also be used for vasomotor symptoms, and can improve sleep, mood and quality of life.

See ../../Psychotropic/ptg/c_ptg8-c68-s1.html#ptg8-c68-s1__tptg8-c68-tbl2 for an overview of adverse effects of SSRIs and SNRIs.

Suitable SSRI regimens include:

1 citalopram 10 mg orally in the morning, increasing if needed every 2 to 4 weeks to a maximum of 20 mg once daily menopause, vasomotor symptoms citalopram    

OR

1 escitalopram 5 mg orally in the morning, increasing if needed every 2 to 4 weeks to a maximum of 20 mg once daily menopause, vasomotor symptoms escitalopram    

OR

1 fluoxetine 10 mg orally, in the morning, increasing if needed every 2 to 4 weeks to a maximum of 30 mg once daily menopause, vasomotor symptoms fluoxetine    

OR

1 paroxetine 10 mg orally, in the morning, increasing if needed every 2 to 4 weeks to a maximum of 20 mg once daily. menopause, vasomotor symptoms paroxetine    

Suitable SNRI regimens include:

1 desvenlafaxine 50 mg orally in the morning, increasing if needed every 2 to 4 weeks to a maximum of 150 mg menopause, vasomotor symptoms desvenlafaxine    

OR

1 venlafaxine 37.5 mg orally, in the morning, increasing if needed every 2 to 4 weeks to a maximum of 75 mg once daily. menopause, vasomotor symptoms venlafaxine    

Some benefit may be expected within 4 weeks of starting therapy, but full effects may take up to 8 weeks. If stopping therapy, reduce doses gradually to avoid withdrawal symptoms. If switching from one SSRI or SNRI to another, see Switching antidepressants.