A meta-analysis reported in the May 3 issue of JAMA revealed that most nonhormonal therapies have limited to no effect in reducing the incidence of hot flashes in menopausal women. Looking at only the findings from randomized, controlled trials involving oral agents, researchers led by Heidi D. Nelson, MD, MPH of the Oregon Health and Science University found that antidepressants that block just serotonin or both serotonin and norepinephrine are the most likely agents besides estrogen to reduce the occurence of hot flashes. The average is effect is small, however, with pooled results showing that antidepressants prevent just more than one attack over placebo. Most isoflavone extracts, the so-called natural estrogens, show no effect on hot flashes.