Can antidepressants help menopausal symptoms?

Antidepressants such as SSRIs (fluoxetine, citalopram, sertraline) and SNRIs (venlafaxine) are not licensed for use in controlling menopausal symptoms and they are not recommended as a first line treatment. HRT is much more effective at treating all menopausal symptoms and, if there are no contraindications to taking it, this should be the treatment recommended first.

However, for women who can’t, or don’t wish to take HRT, antidepressants are sometimes prescribed to offer help with hot flushes. Unfortunately the evidence to support their use is not great! The best available evidence is for venlafaxine – taking 37.5mg-75mg twice daily – where some improvement of symptoms was seen. The down side is all these drugs can cause unpleasant side effects, particularly nausea and reduced libido, so the benefit is often outweighed by these effects. They may, however, be worth a try if symptoms are really troublesome – but this is done on an ‘off-licence’ basis.

Of note, the drugs are not actually being used as an ‘anti-depressant’. Symptoms of low mood can be common around the time of the menopause, but there is no evidence to support the use of these medications to treat this and they should not be prescribed for this reason. If you develop mood changes around the time of the menopause and have never had problems with depression before, HRT is much more likely to help your symptoms.