Last checked September 2026 against 20 sources · Editorial policy
Paroxetine and SSRIs for hot flashes
Low-dose paroxetine, 7.5 mg at bedtime (Brisdelle), is the only antidepressant FDA-approved for moderate to severe hot flashes. It and other SSRIs and SNRIs, such as escitalopram, citalopram, venlafaxine and desvenlafaxine, reduce hot flashes by about 40% to 65%. In trials, paroxetine 7.5 mg didn't cause weight gain or loss of libido. It isn't taken with tamoxifen, because it can reduce tamoxifen's effect.
Low-dose paroxetine (7.5 mg) is FDA-approved for hot flashes. How it compares with HRT and other SSRIs, side effects, and the tamoxifen interaction.
Paroxetine and SSRIs for hot flashes: expectation vs reality
What people often expect
“Taking an antidepressant for hot flashes means you're being treated for depression, with the usual weight gain and sexual side effects”
What the evidence shows
The dose for hot flashes is much lower. Brisdelle's 7.5 mg is below the paroxetine doses used for depression, and its label says it isn't indicated for any psychiatric condition. In pooled trials of 1,174 women, paroxetine 7.5 mg caused no meaningful changes in weight or sexual function compared with placebo.
How SSRIs and paroxetine treat hot flashes
How antidepressants reduce hot flashes
SSRIs act on serotonin signaling, and SNRIs such as venlafaxine on serotonin and norepinephrine, which are involved in the brain's temperature control. Low doses reduce hot flashes: Brisdelle's 7.5 mg is lower than paroxetine doses for depression. In a JAMA meta-analysis, SSRIs and SNRIs reduced daily hot flashes by 1.13 more than placebo; a later review puts the reduction at about 40% to 65% overall.
Learn more →Low-dose paroxetine (Brisdelle) results
In two randomized trials, with 591 women on paroxetine 7.5 mg and 593 on placebo, paroxetine reduced the frequency of moderate to severe hot flashes more than placebo at week 4 and week 12, and the benefit persisted through 24 weeks. It also cut night-time awakenings caused by hot flashes by 39% vs 28% on placebo within 4 weeks and added about 31 minutes of sleep at week 4.
Learn more →Escitalopram and citalopram for hot flashes
In an 8-week trial of healthy menopausal women with about 9.78 hot flashes a day, escitalopram reduced them by 4.60 a day compared with 3.20 on placebo, and more than half of women had at least a 50% reduction, compared with 36% on placebo. Discontinuation for side effects was 4%. Citalopram is also listed among effective options.
Venlafaxine and other SNRIs
Venlafaxine was one of the first non-hormonal hot flash treatments tested. In breast cancer survivors, 75 mg a day cut hot flash scores by 61% after 4 weeks, compared with 27% on placebo; higher doses didn't add benefit but brought more side effects such as dry mouth, nausea and constipation. In MsFLASH, venlafaxine cut hot flashes by 47.6%, close to low-dose estradiol's 52.9%.
Learn more →SSRIs and tamoxifen
Paroxetine is a strong inhibitor of the liver enzyme CYP2D6, which tamoxifen needs to become fully active. Some studies found tamoxifen worked less well, with more breast cancer relapse, in women also taking paroxetine. The Brisdelle label advises weighing this risk and considering avoiding the combination. Venlafaxine and gabapentin were tested in breast cancer survivors and are common alternatives.
Learn more →Paroxetine side effects and cautions
The most common side effects of Brisdelle in trials were headache, fatigue and nausea or vomiting. SSRIs raise bleeding risk, especially with aspirin, NSAIDs or blood thinners, can lower sodium levels, and have been associated with fractures. Serotonin syndrome can occur, particularly with other serotonergic drugs. Brisdelle mustn't be combined with MAO inhibitors, thioridazine or pimozide.
Antidepressants for hot flashes when you also have low mood
If low mood, anxiety or depression come with menopause, the NHS says antidepressants may be offered, and SSRIs and SNRIs can treat hot flashes at the same time. The doses for depression are usually higher than Brisdelle's 7.5 mg, so if both problems need treating, your doctor will choose the dose for your mood and monitor it. Brisdelle isn't a treatment for depression.
Learn more →SSRIs vs HRT for hot flashes
Estrogen is more effective, reducing hot flashes by about 75% vs about 40% to 65% for SSRIs and SNRIs. But in the MsFLASH trials, escitalopram, low-dose estradiol and venlafaxine gave comparable, modest reductions in women with moderate hot flashes. SSRIs don't treat vaginal dryness or protect bone, but they suit women who can't take estrogen.
Learn more →How to take Brisdelle and what happens when you stop
Take one 7.5 mg capsule once a day at bedtime, with or without food. In the trials, no short-term discontinuation symptoms followed stopping treatment, which is different from the withdrawal effects sometimes seen when higher antidepressant doses are stopped abruptly. Talk to your doctor before stopping or switching, especially if you also take the medicine for mood.
Who shouldn’t take paroxetine for hot flashes
The Brisdelle label says it mustn't be used with MAO inhibitors or within 14 days of stopping one, with thioridazine or pimozide, in pregnancy, or by people allergic to paroxetine. It's usually avoided with tamoxifen. Angle-closure glaucoma has occurred with antidepressants in people with untreated narrow angles, so mention any eye problems. Other SSRIs and SNRIs have their own interaction lists.
Learn more →Paroxetine and SSRIs for hot flashes by the numbers
From the studies on this page
reduction in hot flash frequency with SSRIs and SNRIs
40% to 65%
fewer night-time awakenings from hot flashes on paroxetine 7.5 mg vs placebo at 4 weeks
39% vs 28%
reduction in hot flash scores with venlafaxine 75 mg in breast cancer survivors
61%
7.5 mg
Placebo effects in hot flash trials are large, so reductions on placebo of around a quarter are common. The figures above compare treatment with placebo.
SSRI and SNRI options for hot flashes compared
Paroxetine 7.5 mg (Brisdelle)
Strong evidenceFDA-approved for hot flashes, taken once at bedtime, and it improves night-time awakenings. Not for women on tamoxifen, and not with MAO inhibitors, thioridazine or pimozide.
Escitalopram or citalopram
Strong evidenceOff-label SSRIs with trial evidence; escitalopram reduced hot flashes more than placebo in 8 weeks, with low dropout for side effects. Citalopram is a related option.
Venlafaxine or desvenlafaxine
Strong evidenceSNRIs that reduce hot flashes; venlafaxine 75 mg is the dose most studied, including in breast cancer survivors. Dry mouth, nausea and constipation were more common at higher doses.
Gabapentin or neurokinin blockers instead
Strong evidenceIf SSRIs don't suit you, gabapentin, fezolinetant or elinzanetant are other non-hormonal options with good evidence.
Related guide →
When to call a doctor on an SSRI for hot flashes
Urgent: Thoughts of self-harm or suicide
Get help now: call or text 988, or call 911 in an emergency.
Urgent: Agitation, fever, fast heartbeat, muscle twitching or confusion
These can be signs of serotonin syndrome. Stop the medicine and get urgent medical help.
Taking tamoxifen, blood thinners or other antidepressants
Tell your doctor before starting an SSRI; interactions are important.
Unusual bruising or bleeding
See a doctor. SSRIs raise bleeding risk, especially with aspirin or NSAIDs.
Paroxetine for hot flashes: questions women ask
Does paroxetine help hot flashes?
Yes. Low-dose paroxetine, 7.5 mg (Brisdelle), is FDA-approved for moderate to severe hot flashes and reduced them more than placebo from week 4 in two large trials, with benefit lasting 24 weeks.
What is the best antidepressant for hot flashes?
Paroxetine 7.5 mg is the only one FDA-approved for hot flashes. Escitalopram, citalopram, venlafaxine and desvenlafaxine also work. If you take tamoxifen, paroxetine is usually avoided; venlafaxine, which was tested in breast cancer survivors, is a common alternative.
Does Brisdelle cause weight gain?
Not in trials. In pooled data from 1,174 women, paroxetine 7.5 mg caused no meaningful changes in weight or sexual function compared with placebo. Headache, fatigue and nausea were the most common side effects.
How long do SSRIs take to work for hot flashes?
Usually within 4 weeks. Paroxetine 7.5 mg reduced hot flashes by week 4 in trials, and venlafaxine did so within 4 weeks too. Give it about 12 weeks before deciding. Night-time awakenings from hot flashes also fell within 4 weeks on paroxetine.
Can I take Paxil for menopause?
Paroxetine is the active ingredient in both Paxil and Brisdelle. Brisdelle is the low 7.5 mg dose approved for hot flashes; higher doses are used for depression and anxiety. Don't take paroxetine with tamoxifen, MAO inhibitors, thioridazine or pimozide.
What are the side effects of low-dose paroxetine?
The most common were headache, fatigue and nausea or vomiting. Less common risks include bleeding, low sodium and, rarely, serotonin syndrome. In trials, it didn't cause weight gain or reduce libido.
Are antidepressants better than HRT for hot flashes?
No. Estrogen is more effective, cutting hot flashes by about 75% vs about 40% to 65% for SSRIs and SNRIs. Antidepressants are a good alternative for women who can't or don't want to take estrogen. SSRIs don't treat vaginal dryness or protect bone.
Can SSRIs help night sweats and sleep in menopause?
Yes. Paroxetine 7.5 mg reduced night-time awakenings caused by hot flashes by 39% vs 28% on placebo within 4 weeks, and increased sleep time by about 31 minutes at week 4. If insomnia persists once night sweats improve, CBT for insomnia is the next step.
Related →Can I take an SSRI for hot flashes with HRT?
Sometimes doctors combine them, for example when low mood persists on HRT. Both are prescription medicines, so your doctor will check for interactions. For hot flashes alone, estrogen is more effective than an SSRI, so combining isn't usually needed.
Sources
- Prescribing information: Brisdelle (paroxetine 7.5 mg capsules). Legacy Pharma, 2025. DailyMed, US National Library of Medicine.
- Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405-420.
- Portman DJ, Kaunitz AM, Kazempour K, 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;21(10):1082-90.
- Nelson HD, Vesco KK, Haney E, et al. Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis. JAMA. 2006;295(17):2057-71.
- Simon JA, Portman DJ, Kaunitz AM, et al. Low-dose paroxetine 7.5 mg for menopausal vasomotor symptoms: two randomized controlled trials. Menopause. 2013;20(10):1027-35.
- Pinkerton JV, Joffe H, Kazempour K, et al. Low-dose paroxetine (7.5 mg) improves sleep in women with vasomotor symptoms associated with menopause. Menopause. 2015;22(1):50-8.
- Freeman EW, Guthrie KA, Caan B, et al. Efficacy of escitalopram for hot flashes in healthy menopausal women: a randomized controlled trial. JAMA. 2011;305(3):267-74.
- Loprinzi CL, Kugler JW, Sloan JA, et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet. 2000;356(9247):2059-63.
- Joffe H, Guthrie KA, LaCroix AZ, et al. Low-dose estradiol and the serotonin-norepinephrine reuptake inhibitor venlafaxine for vasomotor symptoms: a randomized clinical trial. JAMA Intern Med. 2014;174(7):1058-66.
- Pandya KJ, Morrow GR, Roscoe JA, et al. Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial. Lancet. 2005;366(9488):818-24.
- NHS. Treatment for menopause and perimenopause.
- Guthrie KA, LaCroix AZ, Ensrud KE, et al. Pooled Analysis of Six Pharmacologic and Nonpharmacologic Interventions for Vasomotor Symptoms. Obstet Gynecol. 2015;126(2):413-422.
- The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
- The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
- Prescribing information: Veozah (fezolinetant tablets). Astellas Pharma, 2026. DailyMed, US National Library of Medicine.
- Prescribing information: Lynkuet (elinzanetant capsules). Bayer HealthCare, 2026. DailyMed, US National Library of Medicine.
- Federal Communications Commission. 988 Suicide & Crisis Lifeline.
- National 911 Program. 911.gov.
- NHS. Paroxetine.
- McCurry SM, Guthrie KA, Morin CM, et al. Telephone-Based Cognitive Behavioral Therapy for Insomnia in Perimenopausal and Postmenopausal Women With Vasomotor Symptoms: A MsFLASH Randomized Clinical Trial. JAMA Intern Med. 2016;176(7):913-20.
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