The present invention provides topical compositions comprising O-desmethylvenlafaxine (ODV), a selective serotonin and norepinephrine re-uptake inhibitor, or a pharmaceutically acceptable salt thereof. In certain embodiments, the inventive topical formulations contain one or more percutaneous/permucosal absorption enhancers. Also provided are methods of preparing and using these compositions for the treatment of diseases or conditions where a localized therapeutic effect is sought, such as vasomotor symptoms and pain.