Do SSRIs Help With Hot Flashes?
Yes, modestly. Low-dose SSRIs and SNRIs ease hot flashes more than placebo, usually by one or two a day, and the ones left tend to be milder.
By withClaro Editorial · Medically reviewed by Dr. Jason Tan , Consultant Psychiatrist · 2026-11-09 · 13 min read
Key takeaways Low-dose SSRIs and SNRIs beat placebo by about one or two hot flashes a day, and the ones that remain tend to be milder. Paroxetine 7.5 mg, sold as Brisdelle, is the only SSRI the FDA has approved for hot flashes. Venlafaxine and escitalopram have their own trials. Estrogen works somewhat better, so these drugs mainly suit women who can't or don't want to take hormones. If you take tamoxifen, the Brisdelle label says to consider avoiding paroxetine, and your oncologist should be part of the choice. On Reddit, 28 of the 57 people who said how their hot flashes went on an SSRI or SNRI said it clearly helped. On this page
Do SSRIs help with hot flashes? What did a Mayo Clinic menopause expert get right about SSRIs for hot flashes? Do SSRIs help hot flashes, according to people on Reddit? Which antidepressant is best for hot flashes? What dose of an SSRI is used for hot flashes? Can you take an SSRI for hot flashes if you're on tamoxifen? Can SSRIs cause hot flashes? What should you tell your prescriber before starting an SSRI for hot flashes? SSRIs do help with hot flashes, though the effect is modest. In trials, low-dose SSRIs and SNRIs beat placebo by about one or two hot flashes a day. The ones left were milder. You may notice the change within about four weeks.
Dr. Chrisandra Shufelt is a Mayo Clinic internist who led The Menopause Society's 2023 statement on nonhormone treatments. In July 2023 she went through these drugs with gynecologist Dr. Lauren Streicher on Dr. Streicher's Inside Information podcast. We checked what they said against trials and drug labels, and added what people on Reddit say about their own course.
Do SSRIs help with hot flashes?
In trials they do, though placebo alone eases hot flashes by about a quarter to a third. A 2009 analysis of seven trials found paroxetine, venlafaxine and fluoxetine cut hot flashes 13% to 41% more than placebo. So what the drug adds is smaller than the before-and-after drop.
A 2014 US trial of 339 women compared venlafaxine, low-dose estradiol and placebo over eight weeks. Hot flashes dropped by 47.6% on venlafaxine, 52.9% on estradiol and 28.6% on placebo. Against placebo, that meant 1.8 fewer a day on venlafaxine and 2.3 fewer on estradiol.
A 2011 trial of escitalopram in 205 women found 4.6 fewer hot flashes a day on the drug and 3.2 fewer on placebo. Hot flashes halved for 55% of the women on escitalopram and 36% on placebo.
A 2014 review pooled 11 trials of SSRIs in 2,069 women. On average, hot flashes fell by about one a day more than on placebo, and their severity eased a little.
Hormone therapy is still the most effective treatment, and The Menopause Society's 2023 position statement says so. The same statement recommends SSRIs and SNRIs at Level I, its strongest grade of evidence, for women who don't use hormones. Ask your prescriber whether hormones are an option for you before choosing an SSRI or SNRI.
Why would an antidepressant ease hot flashes?
Nobody knows exactly. A 2014 review explains that around menopause the range of body temperature the brain treats as comfortable narrows sharply, partly because estrogen falls. A small rise in core temperature then sets off a hot flash.
Shufelt described it this way:
And the area of the brain that controls your hot and cold perception, your thermostat basically, is based on the serotonin itself.
The thermostat part fits the research. The serotonin part is less certain: the 2014 review says recent work has cast doubt on serotonin's role. The Brisdelle label says how the drug works on hot flashes is unknown.
Whatever the mechanism, here the drug is used for hot flashes, not depression. Only Brisdelle is approved for this. Other SSRIs and SNRIs are used off label, based on trials such as those of venlafaxine and escitalopram. If your prescriber suggests one, ask whether it is Brisdelle or an off-label choice.
What did a Mayo Clinic menopause expert get right about SSRIs for hot flashes?
Most of it, with a few overstatements. Shufelt and Streicher spoke to a general audience, and their main points hold. These drugs help, small doses are used, and stopping should be planned. The size of the benefit, one timeline and one study length were off, and a tamoxifen warning was broader than the data.
What was said What the research found Does it hold up? Shufelt: SSRIs and SNRIs ease hot flash frequency and severity by up to 50%, sometimes up to 70%, over placebo Venlafaxine gave a 61% drop from the starting point, against 27% on placebo. In pooled trials the gain over placebo was 13% to 41%, depending on the drug Overstated. Drops of 50% to 70% are counted from the starting point, with placebo included Shufelt: The brain's thermostat runs on serotonin The comfortable temperature range narrows around menopause, but serotonin's role is in doubt. The Brisdelle label calls the mechanism unknown Partly. The thermostat is right, the serotonin link is unproven Shufelt: They start to work in two to four weeks and need to be taken every day Paroxetine beat placebo by week 4 in both of its trials. Hot flashes came back after escitalopram was stopped Yes Shufelt: Menopause specialists use the starting dose or half of it Brisdelle is 7.5 mg, against a 20 mg starting dose of paroxetine for depression. Venlafaxine 37.5 mg did less than 75 mg, and escitalopram was tested at its usual doses Partly. True for paroxetine, not for every drug Shufelt: Hot flashes are a listed side effect of some of these drugs Lexapro lists hot flushes, and its sweating rate rose with dose. Effexor XR lists flushing and heavy sweating Yes Shufelt: The best response comes at 8 to 12 weeks, and if nothing by then, change the drug or the dose In the Brisdelle trials, the gap over placebo at week 12 was not clearly bigger than at week 4. We found no trials of changing drugs after one failed We couldn't find data for this Streicher: On tamoxifen, take an SNRI, because an SSRI may weaken tamoxifen The added risk was seen with paroxetine, and not with other antidepressants Partly. The study found the risk with paroxetine only Streicher: Paroxetine 7.5 mg is the only SSRI the FDA approved for hot flashes The Brisdelle label confirms approval for moderate to severe hot flashes of menopause Yes Shufelt: Paroxetine 7.5 mg worked for up to 24 months and didn't affect libido Its trials ran 12 and 24 weeks, not months. Weight and sexual function didn't change in a pooled analysis Weeks, not months. The libido part holds Shufelt: Placebo eases hot flashes by about 30% to 40% Placebo groups had 27% and 28.6% fewer hot flashes, and 36% saw them halve Yes, close to the trials Shufelt: Don't stop these drugs abruptly, since stopping can sometimes be more harmful than starting The Effexor XR label warns that a sudden stop can bring new symptoms and advises a gradual change. We found no data comparing the harm of stopping with that of starting Partly. Not stopping abruptly is backed by the label, the rest we couldn't find Streicher: At low doses they don't cause weight gain, lost libido or hot flashes True for paroxetine 7.5 mg. We found no matching data for low doses of other drugs Partly. Shown for one drug only
The biggest gap is in the first row. Shufelt said:
studies have found that they reduce both hot flash frequency as well as severity by up to 50 sometimes up to 70 over placebo
Drops of that size are real, but they are counted from the starting point, and placebo accounts for much of that drop. What the drug adds on top is closer to one or two fewer hot flashes a day.
Both doctors stressed that milder hot flashes matter, not only fewer ones. In the 2014 review of SSRI trials, severity eased a little more than on placebo. So when you judge your own course, rate how bad each one is, not only how many you had.
Do SSRIs help hot flashes, according to people on Reddit?
28 of the 57 people who said how their hot flashes went said the drug clearly helped
We read 68 threads on r/Menopause, r/Perimenopause, r/breastcancer and the subreddits for single drugs, comments included. Between the posts and the replies, 249 people wrote about their own time on an SSRI or SNRI. Of those 249, 192 didn't say how their hot flashes or night sweats went, and the 57 who did are counted here.
How their hot flashes went People Clearly better 28 Some relief, or relief that faded 6 Too early to tell 6 Gave it time, and it didn't help 17
Each person counts in one row only. The group is mixed: some people took their drug for mood or anxiety as well. People tend to post when something goes wrong, so threads like these lean toward the hard cases.
Some had near-complete relief. One person on r/breastcancer wrote:
I love Effexor. It nearly stopped all of my hot flashes- I get maybe ONE a day and it’s more of a slight warm flash.
For others the benefit faded with time. One person on r/Menopause wrote:
It helped a lot then slowly became less effective.
And some saw no change in their night sweats at all. Another person on r/Menopause wrote:
Yeah, I’m on 150mg and it doesn’t help my night sweats at all. It may help my mood but I’m also had to add hormones to feel somewhat normal.
Side effects in the first weeks came up for 32 people. Trouble sleeping was the one named most often, by 10 of them. If you are starting, note how you sleep in the first weeks.
Which antidepressant is best for hot flashes?
No single one is best for everyone, and head-to-head trials are rare. A 2009 analysis pooled seven trials of paroxetine, venlafaxine, fluoxetine and sertraline. Paroxetine and venlafaxine did best against placebo, and fluoxetine and sertraline did little. Escitalopram has its own trial, and tamoxifen, sleep and mood also shape the choice.
Drug Dose in the trial What the trial found Paroxetine (Brisdelle) 7.5 mg at bedtime Fewer hot flashes than placebo by week 4, still at week 24 Venlafaxine (Effexor) 37.5, 75 or 150 mg 61% fewer at 75 and 150 mg, 37% at 37.5 mg, 27% on placebo Venlafaxine (Effexor) 75 mg 1.8 fewer a day than placebo, against 2.3 for estradiol Escitalopram (Lexapro) 10 to 20 mg 1.41 fewer a day than placebo; halved for 55%, against 36% Fluoxetine, sertraline varied 13% for fluoxetine and 3% to 18% for sertraline over placebo
The 2023 position statement also recommends gabapentin, oxybutynin and fezolinetant, a newer non-hormonal drug, for women who don't use hormones.
Venlafaxine (Effexor) for hot flashes
Venlafaxine is an SNRI with two solid trials for hot flashes. A 2000 trial enrolled 221 women, many with past breast cancer. In it, 75 mg worked better than 37.5 mg, and 150 mg did no better than 75 mg. Dry mouth, nausea, poor appetite and constipation were more common at 75 and 150 mg than on placebo.
The Effexor XR label lists raised blood pressure among its warnings, so ask how yours will be checked. For how the drug is used beyond hot flashes, see what Effexor is and what it treats .
Paroxetine 7.5 mg (Brisdelle) vs regular Paxil
Brisdelle is paroxetine at 7.5 mg, taken once at bedtime, and it is approved only for hot flashes. Its label says it is not approved for any psychiatric condition. Paroxetine for depression usually starts at 20 mg.
In two trials of 1,184 women, 7.5 mg beat placebo by week 4, and the benefit held to week 24. A pooled analysis of those trials found no meaningful change in weight or sexual function. Both papers had authors from the company that made the drug at the time. If you have taken paroxetine before for mood, tell your prescriber how it went.
Escitalopram (Lexapro) for hot flashes
Escitalopram has one main trial for hot flashes, at 10 to 20 mg, the range used for depression. In 205 women over eight weeks, it brought 1.41 fewer hot flashes a day than placebo.
Three weeks after the trial ended, women who had been on escitalopram had 1.59 more hot flashes a day than the placebo group. So the benefit lasts only while you take it. If night sweats bother you more than daytime flashes, tell your prescriber.
What dose of an SSRI is used for hot flashes?
For paroxetine, the hot flash dose is much smaller than the depression dose. For venlafaxine and escitalopram, the trials used doses close to the usual ones for depression, and the smallest venlafaxine dose was weaker. So the dose depends on the drug, and your prescriber picks it from the label and the trials.
Shufelt described how menopause specialists start:
we prescribe the lowest doses, starting doses or half the starting dose.
That fits Brisdelle at 7.5 mg once at bedtime, against 20 mg of paroxetine for depression. For venlafaxine, 75 mg did better than 37.5 mg in the 2000 trial. The Brisdelle label is the only one here with a set time of day. We found no trial data on morning or evening venlafaxine for hot flashes.
Whether a dose is low or high depends on the medication's usual range and on you.
The same dose can be a starting dose for one person and a full dose for another. Age, individual conditions, other medications and how your body processes the drug all play a part.
Doses usually start low and rise in steps, to keep early side effects manageable. A dose goes up when there has been time to judge the response and the benefit is not enough.
Going above the maximum in the prescribing information is a specialist decision. Changing your dose on your own, or taking extra on a bad day, can bring side effects or withdrawal.
Medical review Medically reviewed by Dr. Jason Tan, Consultant Psychiatrist, on 27 October 2026, this section only. Next review: 27 October 2027.
Write down your dose and the date you started it. Any change in your hot flashes can then be judged against that date.
Can you take an SSRI for hot flashes if you're on tamoxifen?
Whether an SSRI fits alongside tamoxifen is a choice to make with your oncologist. The clearest evidence of harm is for paroxetine. Tamoxifen needs the liver enzyme CYP2D6 to work fully, and paroxetine blocks that enzyme strongly. The Brisdelle label says to consider avoiding the pair.
Streicher put the warning more broadly:
if someone is on tamoxifen, then that's someone who should take an SNRI as opposed to an SSRI. An SSRI might make the tamoxifen not work as well.
A 2010 Canadian study followed 2,430 women aged 66 and over who took tamoxifen with a single SSRI. The longer paroxetine overlapped with tamoxifen, the higher the risk of dying from breast cancer. It was 24%, 54% and 91% higher at a quarter, half and three quarters of the time. No such risk showed up with other antidepressants.
The Brisdelle label notes that some studies found tamoxifen weakened by paroxetine and others did not. Bring a full list of your medications to both your oncologist and whoever prescribes the antidepressant.
Can SSRIs cause hot flashes?
Yes. Sweating and flushing are listed side effects of some antidepressants, mostly at the doses used for depression. That sounds like a contradiction. But on average hot flashes drop on these drugs, while extra sweating shows up in a minority, even at usual doses. If sweating gets worse after you start, tell your prescriber.
In the Lexapro trials for depression, more sweating came up in 3% of people on 10 mg and 8% on 20 mg. On placebo it was under 1%. Hot flushes also appear in its list of other reactions seen before approval. On Effexor XR, sweating, including night sweats, affected 11.4% of people, against 2.9% on placebo.
In perimenopause, sweating from the drug and your own hot flashes can be hard to tell apart. Note the date of each dose change and when the sweating started, and bring both to your prescriber. For more on how escitalopram affects women, see Lexapro side effects in women .
What should you tell your prescriber before starting an SSRI for hot flashes?
Tell them anything that changes which drug or dose fits you. Tamoxifen, blood pressure, other medications and your mood all matter here. A short written list saves time at the appointment and makes the choice safer, because some of these points rule a drug out.
It helps to tell them:
Whether you have had breast cancer, and whether you take tamoxifen. Your blood pressure history, if venlafaxine is an option. Every medication and supplement, including triptans for migraine, tramadol and St. John's wort, since these also act on serotonin. Any depression or anxiety now. How you sleep, and whether night sweats or daytime hot flashes bother you more. What worries you most: weight, libido or coming off it later. Antidepressants you have taken before and how they went. Ask at the start how you would stop if you needed to. Shufelt made the same point:
you don't want to abruptly stop those medications.
The Effexor XR label warns that stopping suddenly can bring new symptoms and advises a gradual change instead. The Brisdelle label lists unusual dreams, muscle cramps, headache, anxiety and trouble sleeping after stopping, which usually pass on their own.
A count of your hot flashes before you start and another at around four weeks shows whether the drug is helping. Note how many you have each day and rate each one as mild, moderate or severe. Add how you slept, any side effects and your dose.
The withClaro app lets you log mood, energy, sleep and appetite each day. It links side effects to your dose and turns the record into a report for your prescriber.
Download on the App Store Whether a low-dose SSRI or SNRI is easing your hot flashes shows up over weeks, in your sleep as much as in the flashes. The withClaro app lets you log mood, energy, sleep and appetite each day, track side effects against your dose and share a report with your doctor.
Frequently asked questions How long does it take for Paxil to start working for hot flashes? In the Brisdelle trials, paroxetine 7.5 mg beat placebo by week 4, so many women notice fewer hot flashes within about a month. Ask your prescriber when to check in about how it is going.
When is the best time to take paroxetine for hot flashes? The Brisdelle label says to take it once a day at bedtime. If you take a different dose or form of paroxetine, ask your prescriber which time of day suits it.
What is the drug of choice for hot flashes? Hormone therapy works best and stays the first choice for women who can safely take it, according to The Menopause Society. For women who can't or don't want to, SSRIs, SNRIs, gabapentin and fezolinetant are recommended options. Ask your prescriber which of your health conditions rule hormones in or out.
Do SSRIs help night sweats too? Night sweats are hot flashes that happen at night. If night sweats are your main problem, tell your prescriber and note how many nights a week they wake you.
Does Brisdelle cause weight gain? In a pooled analysis of its two main trials, women on Brisdelle had no meaningful change in weight. That finding covers 7.5 mg, not the doses of paroxetine used for depression. Mention any past weight change on an antidepressant to your prescriber.
Can venlafaxine be used to treat menopausal symptoms? Yes, for hot flashes and night sweats, though it is used off label, without FDA approval for this. Trials showed fewer hot flashes than placebo, and The Menopause Society recommends SNRIs at its strongest level of evidence. Bring your list of medications to the appointment.
Related articles
Sources Chrisandra Shufelt on Dr. Streicher's Inside Information: Menopause, Midlife, and More with Dr. Lauren Streicher. Non-Hormonal Prescription Drugs to Treat Hot Flashes, July 13, 2023 Loprinzi CL, et al. Newer antidepressants and gabapentin for hot flashes: an individual patient pooled analysis. Journal of Clinical Oncology, 2009 Joffe H, et al. Low-dose estradiol and the serotonin-norepinephrine reuptake inhibitor venlafaxine for vasomotor symptoms: a randomized clinical trial. JAMA Internal Medicine, 2014 Freeman EW, et al. Efficacy of escitalopram for hot flashes in healthy menopausal women: a randomized controlled trial. JAMA, 2011 Shams T, et al. SSRIs for hot flashes: a systematic review and meta-analysis of randomized trials. Journal of General Internal Medicine, 2014 The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause, 2023 Freedman RR. Menopausal hot flashes: mechanisms, endocrinology, treatment. Journal of Steroid Biochemistry and Molecular Biology, 2014 Brisdelle (paroxetine) capsules, prescribing information, FDA label via DailyMed, 2025 Loprinzi CL, et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet, 2000 Simon JA, et al. Low-dose paroxetine 7.5 mg for menopausal vasomotor symptoms: two randomized controlled trials. Menopause, 2013 Paroxetine hydrochloride tablets, prescribing information, FDA label via DailyMed, 2026 Lexapro (escitalopram), prescribing information, FDA label via DailyMed, 2023 Effexor XR (venlafaxine extended-release), prescribing information, FDA label via DailyMed, 2023 Kelly CM, et al. Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study. BMJ, 2010 Portman DJ, et al. Effects of low-dose paroxetine 7.5 mg on weight and sexual function during treatment of vasomotor symptoms associated with menopause. Menopause, 2014 Claro articles are for self-monitoring and educational purposes only. They are not a medical device, therapist, or diagnostic tool, and do not replace care from your prescribing clinician. If you are in crisis, contact your care team, emergency services, the Samaritans (UK: 116 123), or the Crisis Text Line (US: text HOME to 741741).
