Menopause and Escitalopram

Selective serotonin reuptake inhibitors (SSRIs) are used for depression, anxiety, and personality disorders. This may be useful for depression associated with perimenopause and menopause. SSRIs are also are being studied for their effectiveness beyond their conventional uses for depression and anxiety. They have shown mixed results in treating menopausal symptoms including but not limited to hot flashes, night sweats, and insomnia.

In a study on 205 ethnically diverse menopausal women studied the effect of 10-20 mg per day for 8 weeks. The outcomes being studied were frequency and severity of hot flashes, as well as degree of bother.

• There was a 47% decrease in daily hot flashes in the escitalopram group compared with 33% in placebo.
• Improvements began after 1 week of treatment.
• There was a slightly smaller reduction of hot flash symptoms in African American women taking escitalopram.
• Women did experience withdrawal symptoms, and 64% of participants wanted to continue the treatment after the study was over. Withdrawal symptoms included
  • lightheadedness (14%)
  • vivid dreams (13%)
  • nausea (11%)
  • excessive sweating (11%)
• Other than the withdrawal effects, escitalopram was shown to have no significant adverse effects compared with placebo. ²

Another study examined the effect of 10-20 mg per day of escitalopram on insomnia in women who were having an average of 9.78 hot flashes per day. Outcomes were measured using two insomnia scales - the insomnia severity index (ISI) and the Pittsburgh Quality of Sleep Index (PQSI).

• The average ISI after treatment was reduced from 11.4 at baseline to 6.75. The highest possible score on the ISI is 28, indicating severe insomnia.
• PQSI was reduced by 1.3 points after eight weeks.
• The effect of escitalopram was consistent across all groups, regardless of how severe insomnia was at baseline.
• When used for depression, insomnia has been reported as a side effect. This study shows that when used by women without anxiety or depression, it can have the opposite effect.
• Participants reported no adverse events such as insomnia, fatigue, or drowsiness. ¹

What are the precautions when taking this medicine?

• If you are 65 or older, use this medicine with caution. You could have more side effects.

• If you have bleeding problems, talk with healthcare provider.

• If you have kidney disease, talk with healthcare provider.

• If you have liver disease, talk with healthcare provider.

• If you have seizures or are on seizure medicine, talk with healthcare provider.

• If you have had an ulcer or bleeding from your stomach or intestines, talk with healthcare provider.

• If you have been taking this medicine for several weeks, talk with healthcare provider before stopping. You may want to gradually withdraw this medicine.

• Check medicines with healthcare provider. This medicine may not mix well with other medicines.

• You may not be alert. Avoid driving, doing other tasks or activities until you see how this medicine affects you.

• Avoid alcohol (includes wine, beer, and liquor) or other medicines and natural products that slow your actions and reactions.

• Talk with healthcare provider before using aspirin, aspirin-containing products, other pain medicines, blood thinners, garlic, ginseng, ginkgo, or vitamin E.

• If you are taking any natural products, talk with healthcare provider.

• Tell healthcare provider if you are pregnant or plan on getting pregnant.

What are some possible side effects of this medicine?

• Feeling lightheaded, sleepy, having blurred vision, or a change in thinking clearly. Avoid driving, doing other tasks or activities that require you to be alert or have clear vision until you see how this medicine affects you.

• Headache.

• Nausea or vomiting. Small frequent meals, frequent mouth care, sucking hard, sugar-free candy, or chewing sugar-free gum may help.

• Dry mouth. Frequent mouth care, sucking hard, sugar-free candy, or chewing sugar-free gum may help.

• Diarrhea.

• Change in sexual ability or desire. This is usually reversible.

• Inability to sleep.

Reasons to call healthcare provider immediately

• If you suspect an overdose, call your local poison control center or emergency department immediately.

• Signs of a life-threatening reaction. These include wheezing; chest tightness; fever; itching; bad cough; blue skin color; fits; or swelling of face, lips, tongue, or throat.

• If you are planning to harm yourself or the desire to harm yourself increases.

• Significant change in thinking clearly and logically.

• Significant change in balance.

• Agitation, twitching, sweating, or muscle stiffness.

• Very nervous and excitable.

• Fast heartbeat.

• Severe nausea or vomiting.

• Unusual bruising or bleeding.

• Any rash.

• No improvement in condition or feeling worse.

¹Ensrud, Kristine et al. “Effect of escitalopram on insomnia symptoms and subjective sleep quality in healthy perimenopausal and postmenopausal women with hot flashes: a randomized controlled trial,” Menopause 19, no 8 (2012).

²Freeman, Ellen W. et al. Efficacy of Escitalopram for Hot Flashes in Healthy Menopausal Women: A Randomized Controlled Trial”, JAMA 305, no 3 (2011): 267-274.