A meta-analysis examines non-hormonal options for hot flashes – which is important since many women are reluctant to go on estrogen:

The researchers found that on average, antidepressants and the blood pressure drug Catapres each appeared to reduce hot flashes by about one per day, and the seizure drug Neurontin by about two per day. Estrogen, by comparison, gets rid of two to three flashes a day.

Among the antidepressants, Paxil seemed to have the strongest evidence of benefit. There were only two studies for Effexor, and only one indicated that it might help. Paxil’s side effects included headache, nausea, insomnia or drowsiness, and Effexor’s were dry mouth, decreased appetite, nausea, constipation and sleeplessness. For both drugs, the side effects were more likely to occur with higher doses.

For the other antidepressants, Prozac and Celexa, and for the plant extracts, there was no statistically significant evidence that they worked for hot flashes.