Veozah is not an antidepressant. It belongs to an entirely different drug class called neurokinin 3 (NK3) receptor antagonists, and it was approved by the FDA in 2023 specifically to treat moderate to severe hot flashes caused by menopause. The confusion likely comes from the fact that certain antidepressants have been prescribed off-label for hot flashes for years, making Veozah seem like it might be another one. It isn’t. It works through a completely different mechanism and has no effect on mood-related brain chemistry.
Why People Confuse Veozah With Antidepressants
Before Veozah existed, women who couldn’t or didn’t want to take hormone therapy had limited options for hot flashes. The most common alternatives were antidepressants, specifically SSRIs and SNRIs. Paroxetine, citalopram, escitalopram, and venlafaxine all showed some ability to reduce the frequency and severity of hot flashes, and low-dose paroxetine was actually the only FDA-approved nonhormonal treatment for hot flashes before Veozah came along.
So for a long time, “nonhormonal hot flash treatment” essentially meant “antidepressant.” Veozah broke that pattern. It’s nonhormonal and it’s not a hormone, but it’s also not a psychotropic drug of any kind. It doesn’t affect serotonin, norepinephrine, or any of the neurotransmitters that antidepressants target.
How Veozah Actually Works
Hot flashes happen because of changes in how the brain regulates body temperature. When estrogen drops during menopause, a group of specialized brain cells ramps up their signaling in the area that acts as the body’s thermostat. These neurons overproduce a chemical messenger called neurokinin B, which essentially makes the brain’s thermostat malfunction, triggering sudden waves of heat, flushing, and sweating.
Veozah blocks the receptor that neurokinin B binds to. By doing this, it calms the overactive signaling in the brain’s temperature control center without affecting estrogen levels or mood pathways. It’s a targeted approach: it goes after the specific mechanism behind hot flashes rather than borrowing a side effect from a drug designed for something else, which is essentially what antidepressant use for hot flashes amounts to.
How It Compares to Antidepressants for Hot Flashes
Antidepressants are substantially less effective than hormone therapy for treating hot flashes. They help some women, but the relief is often partial. Veozah was designed from the ground up for this problem. In phase 3 clinical trials, women taking the 45 mg dose experienced significantly fewer hot flashes than those on placebo, with meaningful reductions showing up within the first four weeks and holding steady through 12 weeks of treatment. Both the frequency and severity of episodes improved.
Antidepressants also come with their own set of side effects, including sexual dysfunction, weight changes, drowsiness, and withdrawal symptoms if stopped abruptly. Because Veozah doesn’t interact with mood-related neurotransmitters, it avoids these particular issues entirely.
What Taking Veozah Looks Like
The standard dose is one 45 mg tablet taken once a day, with or without food. You should take it at roughly the same time each day. If you miss a dose and there are still more than 12 hours before your next one, take the missed dose as soon as you remember. If it’s less than 12 hours until your next dose, skip the missed one and pick up your regular schedule the next day.
Liver Monitoring Requirement
One important distinction between Veozah and antidepressants is that Veozah requires liver function testing. The FDA added a warning about rare cases of serious liver injury. Your provider will check liver enzymes before prescribing Veozah, then monthly for the first three months, and again at months six and nine of treatment. This monitoring schedule is specific to Veozah and isn’t something typically required with antidepressants used for hot flashes.
This doesn’t mean liver problems are common. They’re rare, but serious enough that the FDA wanted a structured monitoring plan in place. If you notice symptoms like unusual fatigue, nausea, dark urine, or yellowing of the skin or eyes while taking Veozah, those warrant prompt attention.
Who Veozah Is For
Veozah is approved for women experiencing moderate to severe hot flashes from menopause. It fills a gap for women who can’t take hormone therapy due to a history of breast cancer, blood clots, cardiovascular disease, or other estrogen-sensitive conditions, and for women who simply prefer to avoid hormones. It also offers an alternative for women who tried antidepressants for hot flashes and found them ineffective or couldn’t tolerate the side effects.
Women with existing liver disease or significant liver impairment are generally not candidates for Veozah. The prescribing information also notes that certain medications that affect how the liver processes drugs can interact with Veozah, so a full medication review is part of the prescribing process.