Selective serotonin reuptake inhibitors (SSRIs) are a common class of antidepressants. Beyond depression, they may offer relief for other conditions—including menopause. 

The use of SSRIs for menopause care didn’t actually start from menopause research. In the 1990s, cancer researchers found that SSRI usage helped patients’ hot flashes. Since then, SSRIs have been a solid option for menopausal symptom relief. In fact, the FDA approved paroxetine (Brisdelle®) for vasomotor symptoms in 2013. 

Wondering if they might be right for you? Let’s explore SSRIs for menopause symptoms.

Why are antidepressants (SSRIs) used for menopause symptoms?

Menopause is a season of change. In the years leading up to it, also known as perimenopause, estrogen and progesterone fluctuate. Then, as you reach menopause, these hormones rest at a lower baseline. These changes take a toll on your body and mind. SSRIs can help regulate your mood and offer some relief. 

But serotonin-norepinephrine reuptake inhibitors (SNRIs), which are another type of antidepressant, can also be helpful. Here’s how they compare with SSRIs:

• SSRIs block the brain’s reabsorption (reuptake) of serotonin. That means more of this “feel-good” chemical stays in your brain. 
• SNRIs block the reabsorption of serotonin and another chemical, called norepinephrine. Norepinephrine is a stress hormone, but it’s actually good for your mood because it gives you energy. SNRIs are common, but not as common as SSRIs. 

Neither of these antidepressants are primary menopausal treatments. They don’t address the root causes of your symptoms (the underlying hormonal changes). Instead, they make some symptoms, like hot flashes and mood swings, easier to manage. They do help some people, but only as part of a broader care plan.

When are antidepressants helpful, and when does HRT fit better?

SSRIs (and other antidepressants) aren’t for everyone. Here’s a quick guide to different menopausal and perimenopausal treatment options and when they work best.

When SSRIs may be right for you

Your doctor may prescribe SSRIs if you experience the following: 

• Vasomotor symptoms: These common symptoms, like hot flashes and night sweats, come from temperature dysregulation. SSRIs help by stabilizing hormones in the hypothalamus, which regulates your body temperature.
• Sleep disturbances: In menopause, poor sleep usually happens because of other menopause symptoms, like the vasomotor ones we just mentioned. SSRIs make it easier for your body to regulate temperature, which also helps you sleep.
• Mental health disorders: Menopause-related hormonal changes can affect your mental health, contributing to depression and anxiety. SSRIs can be a natural fit for managing these symptoms. 

When SSRIs aren’t the ideal choice

Your doctor may advise against SSRIs in these contexts:

• Medical history: Your medical history affects which SSRIs are best for you. For example, some options may worsen symptoms in people with bipolar disorder. 
• Medication conflicts: SSRIs don’t mix well with certain medications. Your doctor should review your current medications and spot any conflicts before prescribing. 
• Treatment intolerance: SSRIs aren’t front-line menopausal treatments. Your doctor might try another option, like hormone replacement therapy (HRT), first. If that doesn’t work, SSRIs may enter the conversation. 

This isn’t an exhaustive list. Your doctor will assess your full health picture to decide if SSRIs fit in your care plan or if another route makes more sense for you. Everyone’s menopause journey is unique. Your care plan should be, too. 

HRT and SSRIs: Can they be used together? 

HRT is a treatment that doctors often prescribe to relieve menopausal symptoms. It works by supplementing your hormones, bringing your body back to the levels it’s used to.

There are two main types:

1. Estrogen therapy (ET), which only supplements estrogen* 
2. Combined estrogen-progesterone therapy (EPT), which supplements progesterone and estrogen

In most cases, you can be on HRT and SSRIs at the same time. But suitability varies case by case. Your doctor will weigh all factors to determine if both are right for you. 

*Without progesterone, estrogen can increase the risk of endometrial hyperplasia (abnormal thickening of the uterine lining). For this reason, doctors typically only prescribe ET to women who’ve had a hysterectomy. 

Using antidepressants in menopause: What to expect

If your care team thinks SSRIs might work for you, they’ll help you weigh the pros and cons. Here’s what they might discuss with you.

Side effects

SSRIs affect serotonin throughout your body, not just in your brain, so they can carry side effects. These include:

• Nausea
• Sexual dysfunction
• Headache
• Sleep disturbances
• Weight changes

It’s worth noting that some SSRI side effects mirror common menopause symptoms, like weight gain. And SSRIs may exacerbate certain menopausal experiences in some people. 

Timeline

SSRIs typically start on a low dosage for the first week or two of treatment before increasing to the regular dose. As the dose increases, the medication’s therapeutic effect tends to strengthen, too. Patients usually start noticing results within the first two weeks of treatment. 

Ongoing management

Your body will naturally evolve as you navigate through menopause. Its response to SSRIs may change over time. This is normal, and your care plan should keep pace and adapt with you. Keep your doctor in the loop about any evolving concerns you have. 

Discontinuation

Just as the adjustment period ramps up slowly, the same happens if you decide to stop SSRIs. This process typically involves multiple moving parts, from gradual dose tapering to lifestyle support. Your doctor will proactively monitor your response to mitigate withdrawal and any symptom rebound. Don’t make any adjustments to your care plan (discontinuation included) without your doctor’s input.

Find the right approach with Maven Clinic

SSRIs can offer real relief, but they’re not right for everyone. You have to look at your full health picture to determine if they’re safe and appropriate for you. That’s what we offer at Maven Clinic: whole-person care, built around how your body works.

Millions of people trust us with the most demanding stages of their lives, including menopause. This season requires a care team that will be with you each step of the way.

Discover Maven Clinic’s approach to hormone care. 

FAQ

Can SSRIs alleviate hot flashes? 

Yes, in some cases. Specific medications have varying levels of efficacy. According to a 2015 systematic review of 18 randomized controlled trials:

• Escitalopram (Lexapro®): 47% reduction in hot flash frequency
• Paroxetine (Paxil®): 51% reduction in hot flash frequency (greatest overall reduction)
• Fluoxetine (Prozac®): 24% reduction in vasomotor symptom scores (a measure that factors in both frequency and severity)

Other medications, like sertraline (Zoloft®), show mixed results. 

Is HRT or SSRI better for menopause?

Starting HRT is typically a first-line menopause treatment, as it addresses more menopause symptoms than SSRIs. Paroxetine (Brisdelle®) is a nonhormonal SSRI approved for controlling vasomotor symptoms like hot flashes and night sweats. 

Can SSRIs help with hot flashes if I’m not depressed?

Yes. Doctors may prescribe SSRIs off-label to help alleviate hot flashes, even without a depression diagnosis. Your physician will determine if SSRIs make sense for your care plan. 

How long do SSRIs take to work for hot flashes?

Patients typically see results within two weeks, but experiences vary. 

What is the best SSRI for menopause symptoms?

There’s no single best antidepressant for menopause symptoms. It depends on your unique health profile. Currently, paroxetine (Brisdelle®) is the only SSRI that is FDA-approved for menopausal symptom relief. It’s specifically approved to treat hot flashes. 

Other common ones include escitalopram (Lexapro®), citalopram (Celexa®), and fluoxetine (Prozac®). Your doctor may prescribe these off-label, depending on your needs. 

Will SSRIs affect my libido during menopause?

Yes, they can. SSRIs increase serotonin activity, which can inhibit dopamine. Dopamine and libido are closely linked, which means lower dopamine can lower your libido.

Outcomes may be dose-dependent. One study found that low-dose paroxetine (an SSRI) didn’t impair sexual function. Discuss concerns with your doctor, who can factor this into your care plan. 

Which antidepressant is most commonly used?

SSRIs are the most common type of antidepressant for menopause. These include:

• Fluoxetine (Prozac®)
• Paroxetine (Paxil®, Pexeva®)
• Sertraline (Zoloft®)
• Citalopram (Celexa®)
• Escitalopram (Lexapro®)