Comparison of Fluoxetine Versus Citalopram Therapy to Control Postmenopausal Vasomotor Syndrome

NCT05346445 | Completed DMC

• 1 other identifier: 122.2021
• Study Type: interventional
• Target: 91
• Locations: 1 country
• Sites: 1

Brief Summary

This study determined the efficacy of non-hormonal therapy with citalopram compared to fluoxetine, for the treatment of menopausal symptoms in Mexican women with vasomotor syndrome (VMS) and urogenital syndrome.

Conditions

Postmenopause; Hot Flashes

Keywords

Postmenopause; Fluoxetine; Menopause Rating Scale; Vasomotor syndrome; Urogenital syndrome; Citalopram; Non hormonal therapy; Non-hormonal therapies; Serotonin reuptake inhibitors

Outcome Measures

Primary Outcomes (10)

• Change from baseline Menopause Rating Scale (MRS) total score at 3 months

  Menopause Rating Scale measures the severity of ageing symptoms and their impact on Health-Related Quality of Life. It considers the score of the somatic, urogenital, and psychological domains. A score of 0-4 was considered minimal severity, 5-8 mild, 9-16 moderate, and greater than 17 severe.

  3 months

• Change from baseline Menopause Rating Scale (MRS) total score at 6 months

  Menopause Rating Scale measures the severity of ageing symptoms and their impact on Health-Related Quality of Life. It considers the score of the somatic, urogenital, and psychological domains. A score of 0-4 was considered minimal severity, 5-8 mild, 9-16 moderate, and greater than 17 severe.

  6 months

• Change from baseline Menopause Rating Scale (MRS) somatic domain score at 3 months

  It considers the score obtained from the somatic dimension, which includes hot flashes, heart problems, sleep problems, and muscle and joint pain. A score of 0-2 was considered minimal severity, 3-4 mild, 5-8 moderate, and greater than 9 severe.

  3 months

• Change from baseline Menopause Rating Scale (MRS) somatic domain score at 6 months

  It considers the score obtained from the somatic dimension, which includes hot flashes, heart problems, sleep problems, and muscle and joint pain. A score of 0-2 was considered minimal severity, 3-4 mild, 5-8 moderate, and greater than 9 severe.

  6 months

• Change from baseline Menopause Rating Scale (MRS) urogenital domain score at 3 months

  It considers the score obtained from the urogenital dimension, which includes sexual problems, bladder problems and vaginal dryness. A score of 0 was considered minimal severity, 1 mild, 2-3 moderate, and greater than 4 severe.

  3 months

• Change from baseline Menopause Rating Scale (MRS) urogenital domain score at 6 months

  It considers the score obtained from the urogenital dimension, which includes sexual problems, bladder problems and vaginal dryness. A score of 0 was considered minimal severity, 1 mild, 2-3 moderate, and greater than 4 severe.

  6 months

• Change from baseline Menopause Rating Scale (MRS) psychological domain score at 3 months

  It considers the score obtained from the psychological dimension, which includes depression, irritability, anxiety and tiredness. A score of 0-1 was considered minimal severity, 2-3 mild, 4-6 moderate, and greater than 7 severe.

  3 months

• Change from baseline Menopause Rating Scale (MRS) psychological domain score at 6 months

  It considers the score obtained from the psychological dimension, which includes depression, irritability, anxiety and tiredness. A score of 0-1 was considered minimal severity, 2-3 mild, 4-6 moderate, and greater than 7 severe.

  6 months

• Change from baseline score in Item 1 of the Menopause Rating Scale (MRS) at 3 months

  Item 1 considers the score obtained from hot flashes on the MRS scale. 0 points were assigned if the participants reported no symptoms, 1 point if they reported mild symptoms, 2 points if they reported moderate symptoms, 3 points if they reported severe symptoms, and 4 points if they reported extremely severe symptoms.

  3 months

• Change from baseline score in Item 1 of the Menopause Rating Scale (MRS) at 6 months

  Item 1 considers the score obtained from hot flashes on the MRS scale. 0 points were assigned if the participants reported no symptoms, 1 point if they reported mild symptoms, 2 points if they reported moderate symptoms, 3 points if they reported severe symptoms, and 4 points if they reported extremely severe symptoms.

  3 months

Secondary Outcomes (1)

• Change from the severity of individual Menopause Rating Scale (MRS) items at 6 months

  6 months

Study Arms (2)

Fluoxetine group

ACTIVE COMPARATOR

Participants received fluoxetine, 20 mg tablets, once a day for six months.

Drug: Fluoxetine 20 MG

Citalopram group

EXPERIMENTAL

Participants received citalopram, 20 mg tablets, once a day for six months.

Drug: Citalopram 20mg

Interventions

Fluoxetine 20 MG DRUG

Participants received non-hormonal treatment with fluoxetine.

Also known as: Generic PISA®

Fluoxetine group

Citalopram 20mg DRUG

Participants received non-hormonal treatment with citalopram.

Also known as: PREPRAM®

Citalopram group

Eligibility Criteria

• Sex: female
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Participants who attended the climacteric consultation for the first time, without prior treatment of menopausal symptoms, and who met postmenopausal criteria.
• Participants who met the criteria for vasomotor syndrome and score greater than 17 points in total MRS.
• Participants without psychiatric pathology (psychiatric illnesses such as major depression, generalized anxiety disorder, among others).
• Participants who agreed to participate and gave their written informed consent.

You may not qualify if:

• Participants who had contraindications to receive serotonin reuptake inhibitors (SSRIs).
• Participants who were receiving prior treatment for the postmenopausal or vasomotor syndrome.
• Participants who did not agree to participate or sign the informed consent.

Sponsors & Collaborators

• Hospital Regional 1o de Octubre: lead
• Universidad Nacional Autonoma de Mexico: collaborator
• National Polytechnic Institute, Mexico: collaborator

Study Sites (1)

Peri-postmenopause and bone metabolism clinic. Regional Hospital October 1st ISSSTE

Mexico City, 07300, Mexico

Location

Related Publications (41)

• El Khoudary SR, McClure CK, VoPham T, Karvonen-Gutierrez CA, Sternfeld B, Cauley JA, Khalil N, Sutton-Tyrrell K. Longitudinal assessment of the menopausal transition, endogenous sex hormones, and perception of physical functioning: the Study of Women's Health Across the Nation. J Gerontol A Biol Sci Med Sci. 2014 Aug;69(8):1011-7. doi: 10.1093/gerona/glt285. Epub 2014 Jan 24.

  PMID: 24465026 BACKGROUND

• Jones CM, Boelaert K. The Endocrinology of Ageing: A Mini-Review. Gerontology. 2015;61(4):291-300. doi: 10.1159/000367692. Epub 2014 Nov 27.

  PMID: 25471682 BACKGROUND

• Blumel JE, Lavin P, Vallejo MS, Sarra S. Menopause or climacteric, just a semantic discussion or has it clinical implications? Climacteric. 2014 Jun;17(3):235-41. doi: 10.3109/13697137.2013.838948. Epub 2013 Nov 7.

  PMID: 23998690 BACKGROUND

• Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause - global prevalence, physiology and implications. Nat Rev Endocrinol. 2018 Apr;14(4):199-215. doi: 10.1038/nrendo.2017.180. Epub 2018 Feb 2.

  PMID: 29393299 BACKGROUND

• Kim MJ, Yim G, Park HY. Vasomotor and physical menopausal symptoms are associated with sleep quality. PLoS One. 2018 Feb 20;13(2):e0192934. doi: 10.1371/journal.pone.0192934. eCollection 2018.

  PMID: 29462162 BACKGROUND

• Sarrel P, Portman D, Lefebvre P, Lafeuille MH, Grittner AM, Fortier J, Gravel J, Duh MS, Aupperle PM. Incremental direct and indirect costs of untreated vasomotor symptoms. Menopause. 2015 Mar;22(3):260-6. doi: 10.1097/GME.0000000000000320.

  PMID: 25714236 BACKGROUND

• Avis NE, Crawford SL, Green R. Vasomotor Symptoms Across the Menopause Transition: Differences Among Women. Obstet Gynecol Clin North Am. 2018 Dec;45(4):629-640. doi: 10.1016/j.ogc.2018.07.005. Epub 2018 Oct 25.

  PMID: 30401547 BACKGROUND

• Langer RD, Hodis HN, Lobo RA, Allison MA. Hormone replacement therapy - where are we now? Climacteric. 2021 Feb;24(1):3-10. doi: 10.1080/13697137.2020.1851183. Epub 2021 Jan 6.

  PMID: 33403881 BACKGROUND

• Deecher DC, Dorries K. Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages. Arch Womens Ment Health. 2007;10(6):247-57. doi: 10.1007/s00737-007-0209-5. Epub 2007 Dec 12.

  PMID: 18074100 BACKGROUND

• De Franciscis P, Cobellis L, Fornaro F, Sepe E, Torella M, Colacurci N. Low-dose hormone therapy in the perimenopause. Int J Gynaecol Obstet. 2007 Aug;98(2):138-42. doi: 10.1016/j.ijgo.2007.04.008. Epub 2007 Jun 18.

  PMID: 17572422 BACKGROUND

• Stubbs C, Mattingly L, Crawford SA, Wickersham EA, Brockhaus JL, McCarthy LH. Do SSRIs and SNRIs reduce the frequency and/or severity of hot flashes in menopausal women. J Okla State Med Assoc. 2017 May;110(5):272-274.

  PMID: 28649145 BACKGROUND

• Kapoor E, Faubion S, Hurt RT, Fischer K, Schroeder D, Fokken S, Croghan IT. A selective serotonin receptor agonist for weight loss and management of menopausal vasomotor symptoms in overweight midlife women: a pilot study. Menopause. 2020 Nov;27(11):1228-1235. doi: 10.1097/GME.0000000000001599.

  PMID: 33110038 BACKGROUND

• Ensrud KE, Joffe H, Guthrie KA, Larson JC, Reed SD, Newton KM, Sternfeld B, Lacroix AZ, Landis CA, Woods NF, Freeman EW. Effect of escitalopram on insomnia symptoms and subjective sleep quality in healthy perimenopausal and postmenopausal women with hot flashes: a randomized controlled trial. Menopause. 2012 Aug;19(8):848-55. doi: 10.1097/gme.0b013e3182476099.

  PMID: 22433978 BACKGROUND

• Wroolie TE, Williams KE, Keller J, Zappert LN, Shelton SD, Kenna HA, Reynolds MF, Rasgon NL. Mood and neuropsychological changes in women with midlife depression treated with escitalopram. J Clin Psychopharmacol. 2006 Aug;26(4):361-6. doi: 10.1097/01.jcp.0000227699.26375.f8.

  PMID: 16855452 BACKGROUND

• Shams T, Firwana B, Habib F, Alshahrani A, Alnouh B, Murad MH, Ferwana M. SSRIs for hot flashes: a systematic review and meta-analysis of randomized trials. J Gen Intern Med. 2014 Jan;29(1):204-13. doi: 10.1007/s11606-013-2535-9. Epub 2013 Jul 26.

  PMID: 23888328 BACKGROUND

• Soares CN, Arsenio H, Joffe H, Bankier B, Cassano P, Petrillo LF, Cohen LS. Escitalopram versus ethinyl estradiol and norethindrone acetate for symptomatic peri- and postmenopausal women: impact on depression, vasomotor symptoms, sleep, and quality of life. Menopause. 2006 Sep-Oct;13(5):780-6. doi: 10.1097/01.gme.0000240633.46300.fa.

  PMID: 16894334 BACKGROUND

• Suvanto-Luukkonen E, Koivunen R, Sundstrom H, Bloigu R, Karjalainen E, Haiva-Mallinen L, Tapanainen JS. Citalopram and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized, 9-month, placebo-controlled, double-blind study. Menopause. 2005 Jan-Feb;12(1):18-26. doi: 10.1097/00042192-200512010-00006.

  PMID: 15668596 BACKGROUND

• Barton DL, LaVasseur BI, Sloan JA, Stawis AN, Flynn KA, Dyar M, Johnson DB, Atherton PJ, Diekmann B, Loprinzi CL. Phase III, placebo-controlled trial of three doses of citalopram for the treatment of hot flashes: NCCTG trial N05C9. J Clin Oncol. 2010 Jul 10;28(20):3278-83. doi: 10.1200/JCO.2009.26.6379. Epub 2010 May 24.

  PMID: 20498389 BACKGROUND

• Soares CN, Poitras JR, Prouty J, Alexander AB, Shifren JL, Cohen LS. Efficacy of citalopram as a monotherapy or as an adjunctive treatment to estrogen therapy for perimenopausal and postmenopausal women with depression and vasomotor symptoms. J Clin Psychiatry. 2003 Apr;64(4):473-9. doi: 10.4088/jcp.v64n0419.

  PMID: 12716252 BACKGROUND

• Rathnayake N, Lenora J, Alwis G, Lekamwasam S. Cross cultural adaptation and analysis of psychometric properties of Sinhala version of Menopause Rating Scale. Health Qual Life Outcomes. 2018 Aug 6;16(1):161. doi: 10.1186/s12955-018-0977-9.

  PMID: 30081962 BACKGROUND

• Jahangiry L, Parviz R, Mirghafourvand M, Khazaee-Pool M, Ponnet K. The psychometric properties of the Persian menopause rating scale. BMC Womens Health. 2020 Aug 12;20(1):172. doi: 10.1186/s12905-020-01027-0.

  PMID: 32787824 BACKGROUND

• Ajani K, Nimavat D, Vidja M, Moradiya A, Panchasara D, Bhalodiya S, Miyatra K, Tank KD. Translation, Reliability, and Validity Test of Gujarati Version of Menopause Rating Scale in Postmenopausal Women for Menopause-Related Symptoms. Indian J Community Med. 2021 Jan-Mar;46(1):40-44. doi: 10.4103/ijcm.IJCM_163_20. Epub 2021 Mar 1.

  PMID: 34035574 BACKGROUND

• Anagnostis P, Bitzer J, Cano A, Ceausu I, Chedraui P, Durmusoglu F, Erkkola R, Goulis DG, Hirschberg AL, Kiesel L, Lopes P, Pines A, van Trotsenburg M, Lambrinoudaki I, Rees M. Menopause symptom management in women with dyslipidemias: An EMAS clinical guide. Maturitas. 2020 May;135:82-88. doi: 10.1016/j.maturitas.2020.03.007. Epub 2020 Mar 16.

  PMID: 32209279 BACKGROUND

• Guthrie KA, Larson JC, Ensrud KE, Anderson GL, Carpenter JS, Freeman EW, Joffe H, LaCroix AZ, Manson JE, Morin CM, Newton KM, Otte J, Reed SD, McCurry SM. Effects of Pharmacologic and Nonpharmacologic Interventions on Insomnia Symptoms and Self-reported Sleep Quality in Women With Hot Flashes: A Pooled Analysis of Individual Participant Data From Four MsFLASH Trials. Sleep. 2018 Jan 1;41(1):zsx190. doi: 10.1093/sleep/zsx190.

  PMID: 29165623 BACKGROUND

• Belso N, Kiss K, Rihmer Z, Tuzko N, Toth SJ, Paulin F. Major depressive disorder and response to citalopram treatment in women attending menopause clinic. Int J Psychiatry Clin Pract. 2003;7(4):269-72. doi: 10.1080/13651500310003183.

  PMID: 24930413 BACKGROUND

• Freeman MP, Hill R, Brumbach BH. Escitalopram for perimenopausal depression: an open-label pilot study. J Womens Health (Larchmt). 2006 Sep;15(7):857-61. doi: 10.1089/jwh.2006.15.857.

  PMID: 16999641 BACKGROUND

• Soares CN, Thase ME, Clayton A, Guico-Pabia CJ, Focht K, Jiang Q, Kornstein SG, Ninan P, Kane CP, Cohen LS. Desvenlafaxine and escitalopram for the treatment of postmenopausal women with major depressive disorder. Menopause. 2010 Jul;17(4):700-11. doi: 10.1097/gme.0b013e3181d88962.

  PMID: 20539246 BACKGROUND

• Barton DL, Loprinzi CL, Novotny P, Shanafelt T, Sloan J, Wahner-Roedler D, Rummans TA, Christensen B, Dakhill SR, Martin LS. Pilot evaluation of citalopram for the relief of hot flashes. J Support Oncol. 2003 May-Jun;1(1):47-51.

  PMID: 15352642 BACKGROUND

• Defronzo Dobkin R, Menza M, Allen LA, Marin H, Bienfait KL, Tiu J, Howarth J. Escitalopram reduces hot flashes in nondepressed menopausal women: A pilot study. Ann Clin Psychiatry. 2009 Apr-Jun;21(2):70-6.

  PMID: 19439155 BACKGROUND

• Freedman RR, Kruger ML, Tancer ME. Escitalopram treatment of menopausal hot flashes. Menopause. 2011 Aug;18(8):893-6. doi: 10.1097/gme.0b013e31820ccae9.

  PMID: 21540755 BACKGROUND

• LaCroix AZ, Freeman EW, Larson J, Carpenter JS, Joffe H, Reed SD, Newton KM, Seguin RA, Sternfeld B, Cohen L, Ensrud KE. Effects of escitalopram on menopause-specific quality of life and pain in healthy menopausal women with hot flashes: a randomized controlled trial. Maturitas. 2012 Dec;73(4):361-8. doi: 10.1016/j.maturitas.2012.09.006. Epub 2012 Sep 30.

  PMID: 23031421 BACKGROUND

• Carpenter JS, Guthrie KA, Larson JC, Freeman EW, Joffe H, Reed SD, Ensrud KE, LaCroix AZ. Effect of escitalopram on hot flash interference: a randomized, controlled trial. Fertil Steril. 2012 Jun;97(6):1399-404.e1. doi: 10.1016/j.fertnstert.2012.03.001. Epub 2012 Apr 3.

  PMID: 22480818 BACKGROUND

• Joffe H, Guthrie KA, Larson J, Cohen LS, Carpenter JS, Lacroix AZ, Freeman EW. Relapse of vasomotor symptoms after discontinuation of the selective serotonin reuptake inhibitor escitalopram: results from the menopause strategies: finding lasting answers for symptoms and health research network. Menopause. 2013 Mar;20(3):261-8. doi: 10.1097/GME.0b013e31826d3108.

  PMID: 23435022 BACKGROUND

• Diem SJ, LaCroix AZ, Reed SD, Larson JC, Newton KM, Ensrud KE, Woods NF, Guthrie KA. Effects of pharmacologic and nonpharmacologic interventions on menopause-related quality of life: a pooled analysis of individual participant data from four MsFLASH trials. Menopause. 2020 Oct;27(10):1126-1136. doi: 10.1097/GME.0000000000001597.

  PMID: 32701665 BACKGROUND

• Freeman EW, Guthrie KA, Caan B, Sternfeld B, Cohen LS, Joffe H, Carpenter JS, Anderson GL, Larson JC, Ensrud KE, Reed SD, Newton KM, Sherman S, Sammel MD, LaCroix AZ. Efficacy of escitalopram for hot flashes in healthy menopausal women: a randomized controlled trial. JAMA. 2011 Jan 19;305(3):267-74. doi: 10.1001/jama.2010.2016.

  PMID: 21245182 BACKGROUND

• Davari-Tanha F, Soleymani-Farsani M, Asadi M, Shariat M, Shirazi M, Hadizadeh H. Comparison of citalopram and venlafaxine's role in treating sleep disturbances in menopausal women, a randomized, double-blind, placebo-controlled trial. Arch Gynecol Obstet. 2016 May;293(5):1007-13. doi: 10.1007/s00404-015-3900-1. Epub 2015 Oct 5.

  PMID: 26437957 BACKGROUND

• Shirazi M, Jalalian MN, Abed M, Ghaemi M. The Effectiveness of Melissa Officinalis L. versus Citalopram on Quality of Life of Menopausal Women with Sleep Disorder: A Randomized Double-Blind Clinical Trial. Rev Bras Ginecol Obstet. 2021 Feb;43(2):126-130. doi: 10.1055/s-0040-1721857. Epub 2021 Jan 19.

  PMID: 33465795 BACKGROUND

• Molaie M, Darvishi B, Jafari Azar Z, Shirazi M, Amin G, Afshar S. Effects of a combination of Nigella sativa and Vitex agnus-castus with citalopram on healthy menopausal women with hot flashes: results from a subpopulation analysis. Gynecol Endocrinol. 2019 Jan;35(1):58-61. doi: 10.1080/09513590.2018.1499086. Epub 2018 Aug 21.

  PMID: 30129806 BACKGROUND

• Valdes-Sustaita B, Lopez-Rubalcava C, Gonzalez-Trujano ME, Garcia-Viguera C, Estrada-Camarena E. Aqueous Extract of Pomegranate Alone or in Combination with Citalopram Produces Antidepressant-Like Effects in an Animal Model of Menopause: Participation of Estrogen Receptors. Int J Mol Sci. 2017 Dec 19;18(12):2643. doi: 10.3390/ijms18122643.

  PMID: 29257042 BACKGROUND

• Zhou J, Wang X, Feng L, Xiao L, Yang R, Zhu X, Shi H, Hu Y, Chen R, Boyce P, Wang G. Venlafaxine vs. fluoxetine in postmenopausal women with major depressive disorder: an 8-week, randomized, single-blind, active-controlled study. BMC Psychiatry. 2021 May 19;21(1):260. doi: 10.1186/s12888-021-03253-8.

  PMID: 34011310 BACKGROUND

• Rios-Espinosa A, Cruz-Luna M, Garmendia-Gallardo C, Hernandez-Castanon MY, Hernandez-Hernandez VY, Sanchez-Tinoco PM, Bajonero-Dominguez A, Vergara Lope-Nunez JA, Alvarez-Perez MA, Gonzalez-Quiroz JL, Loranca-Moreno P, Ocampo-Godinez JM. Citalopram improves vasomotor syndrome and urogenital syndrome of menopause in Mexican women: a randomized clinical trial. Arch Gynecol Obstet. 2022 Dec;306(6):2035-2045. doi: 10.1007/s00404-022-06732-9. Epub 2022 Aug 23.

  PMID: 35997971 DERIVED

MeSH Terms

Conditions

Hot Flashes

Interventions

Fluoxetine; Citalopram

Condition Hierarchy (Ancestors)

Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Propylamines; Amines; Organic Chemicals; Nitriles; Benzofurans; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds

Study Officials

• Juan M Ocampo-Godinez, M.D., Ph.D.

  Tissue Bioengineering Laboratory, National Autonomous University of Mexico [UNAM]

  STUDY DIRECTOR

• Patricia Loranca-Moreno, M.D., M.Sc.

  Peri-postmenopause and bone metabolism clinic. Regional Hospital October 1st ISSSTE

  STUDY DIRECTOR

• Alan Rios-Espinosa, M.D.

  Peri-postmenopause and bone metabolism clinic. Regional Hospital October 1st ISSSTE

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This study was a prospective randomized clinical trial made in Mexican women diagnosed with postmenopause from the climacteric clinic of the regional hospital "1ro de Octubre-Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE)". Eligible participants were randomly selected in each consult to receive citalopram 20 mg/d or fluoxetine 20 mg/d for six months. The evaluation of the MRS score was done at the first consult and three and six months after medication. The institutional ethical committee of the hospital approved the study on May 20th, 2021, with registration number CONBIOETICA-09-CEI-012-20170421 and the internal registration number 122.2021. All participants provided written informed consent.

Study Record Dates

• First Submitted: April 14, 2022
• First Posted: April 26, 2022
• Study Start: January 20, 2021
• Primary Completion: November 20, 2021
• Study Completion: December 20, 2021
• Last Updated: July 26, 2022

Record last verified: 2022-07

Data Sharing

• IPD Sharing: Will not share

Locations

ME (1)