Nonhormonal treatment of postmenopausal symptoms is a subject of great interest today. The results of studies on selective serotonin reuptake inhibitors (SSRIs) are promising, but long-term results do not exist. The objective of this study was to evaluate the efficacy of citalopram and fluoxetine in the treatment of physical and psychological menopausal symptoms and their effects on psychosocial and sexual well being in symptomatic postmenopausal women.
One hundred fifty healthy women suffering from menopausal symptoms were recruited to this placebo-controlled double-blind study with a follow-up period of 9 months. They were randomized into three groups receiving placebo, fluoxetine, or citalopram. The initial dose was 10 mg of both fluoxetine and citalopram, and it was increased to 20 mg at 1 month and to 30 mg at the 6-month visit. The main outcome measures were hot flushes and Kupperman index. The RAND-36 Quality of Life questionnaire, Beck's Depression Scale, and the McCoy Female Sexuality Questionnaire were used at every control visit.
There were no statistically significant differences between the groups in respect to number of hot flushes, Kupperman index, or Beck's Depression Scale, although there was a tendency in all these parameters in favor of SSRIs versus placebo. Insomnia improved significantly in the citalopram group versus placebo. Discontinuation rates at nine months were 40% in the placebo group, 34% in the fluoxetine group and 34% in the citalopram group.
Compared with placebo, citalopram and fluoxetine have little effect on hot flushes and cannot therefore be recommended for the treatment of menopausal symptoms, if vasomotor symptoms are the main complaint. Whether the improvement of insomnia by means of citalopram affects the quality of sleep needs further investigation.
The effects of fluoxetine and citalopram on menopausal hot flushes were not significantly better than that of placebo, and therefore, these agents cannot be recommended for the treatment of menopausal symptoms, if hot flushes are the main complaint.
From the 1Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland; 2Family Federation of Finland, Kiviharjuntie, Oulu, Finland; 3Department of Obstetrics and Gynecology, Jyväskylä Central Hospital, Jyväskylä, Finland; 4Faculty of Medicine, Oulu University, Oulu, Finland; and 5Department of Obstetrics and Gynecology, Kainuu Central Hospital, Kajaani, Finland.
Received April 21, 2003; revised and accepted July 13, 2004.
This study was supported by grants from the Academy of Finland, the Sigrid Jusélius Foundation, the Eli-Lilly Foundation, the Lundbeck Foundation, and Oulu University Hospital.
Address correspondence to: Eila Suvanto-Luukkonen, MD, PhD, Department of Obstetrics and Gynecology, Oulu University Hospital, PL 24, 90029 OYS, Oulu, Finland. E-mail: Eila.Suvanto-Luukkonen@oulu.fi.