| Objective:To review,appraise and summarize the evidence of impact of different SSRIs and SNRIs on menopausal vasomotor syndrome in healthy postmenopausal women in randomized controlled trials studies.Materials and methods:Evidence were collected about SSRIs and SNRIs in treatment of menopausal vasomotor syndrome using Pub Med,Dynamed,Medline,Web of science etc.as retrospective and prospective studies from different country,randomized controlled trial.We did a search of report published in English language using keywords hot flushes,hot flashes,menopause,vasomotor symptoms therapies and serotonin.We found many more papers through the website but only seven studies could able to meet our criteria.Results:Almost all women encounter with hot flashes in their lifetime.Hormone replacement therapy was the most effective management option for postmenopausal vasomotor syndrome but after the WHI’s report was published all the health practioners and the consumers(postmenopausal women)aware of the life threatening adverse effects of hormone replacement therapy.This publication change the entire scenario in the management of hot flashes.Among the alternative therapy research,antidepressant(SSRI/SNRI)are the most widely conducted and proved to be the most effective after hormone replacement therapy.The reduction rate of hot flashes frequency and severity by hormone replacement therapy in average is 75% and the reduction rate for SSRI/SNRI in average is 55%.So,SSRI and SNRI proved to be effective as well as tolerable for VMS treatment.Between SSRI and SNRI,SNRI(desvenlafaxine)is seem to be more appropriate and effective.This review include three RCT trials on desvenlafaxine and all three trails show >50% reduction on frequency and severity of hot flashes unfortunately one study by Bouchard et al.didn’t able to make the statistical significant results.The other good thing about desvenlafaxine is that,it can be used in women taking tamoxifen.The four trials on SSRIs,all reported to be statistically significant.However,not all SSRI/SNRI are highly effective.The paroxetine and escitalopram are moderately effective and sertaline is mildly effective.Therefore,the desvenlafaxine,paroxetine and escitalopram are effective for the reduction of hot flashes frequency and severity and can use as first line therapy and sertaline being expensive and mildly effective can used as second line therapy.Conclusion:SSRI and SNRI are effective as well as tolerable drug for the management of postmenopausal vasomotor syndrome.The desvenlafaxine is the most effective for hot flashes treatment and paroxetine and escitalopram are moderate and mild effective ones.The SNRI group of drug desvenlafaxine is useful in women with breast cancer taking tamoxifen.Both the adverse events and the dropout rate are minimal.Proper patient selection and choice of drug is the best way to avoid unnecessary adverse events.These agents may be used together with HT and can be offered to women in menopause with depression.Although after the report published by WHI,the use of HRT was dramatically decline and the use of serotonergic antidepressants were increased,but none of these agents are as effective as HT.Similarly,one recent report shows that the mortality rate of American women are greatly increase than American male after declination in the use of HRT,because unlike HT,SSRI/SNRI only treat VMS and depression.The literature review by Martin(2017)clearly said the gold standard for the relief of menopausal symptoms is estrogen therapy. |
